CARDIAC REMODELLING IN RENAL TRANSPLANTED PATIENTS: A QUESTION OF GENDER?

Objectives: We investigate clinical and echocardiographic characteristics of renal transplanted patients, examining the role of elevated blood pressure (BP) in determining cardiac organ damage. Methods: 44 patients, 15.4 years after renal transplantation, underwent to echocardiograpy and ambulatory blood pressure monitoring (ABPM). Significant determinants of cardiac remodelling were explored with regression analysis adjusted for several confounders. Results: 86% of the participants were hypertensives, 45% diabetics, 68% had lipid abnormalities. Among hypertensive patients, 51% were taken three pills, 79% assumed &bgr;-blockers. At echocardiographic evaluation 64% of the patients had concentric hypertrophy, 27% concentric remodelling, 9% a normal morphology, none eccentric hypertrophy; 27% had a normal diastolic function, 68% a diastolic dysfunction, 5% a pseudo-normal pattern. Mean longitudinal strain was −21 ± 4% and 20% of the study participants had an impaired longitudinal function. According to ABPM data 27.3% had diurnal hypertension, 90.9 % nocturnal hypertension; most of the patients were risers (53%) or non-dippers (30%), only 17% had a normal dipping pattern. In multivariate regression analysis, none of the ABPM indexes was a significant predictor of left ventricular mass, diastolic function or global longitudinal strain; the main determinant was gender (p = 0.018 for left ventricle mass, p = 0.033 for GLS, p = 0.007 for diastolic function). Serum calcium level significantly differed according to gender and was higher in females. Conclusion: Renal transplanted patients showed unfavourable cardiac remodelling and nocturnal hypertension. ABPM indexes didn’t correlate with cardiac organ damage. Male gender, is a significant determinant of cardiac remodelling suggesting more intensive treatment.