ABSTRACT
Objective:To evaluate left ventricular structural and functional abnormalities and vascular calcification in kidney transplant (KT) recipients, explore their influencing factors and examine the effects of mineral and bone disorders.Methods:From January 2017 to December 2019, retrospective analysis was performed for 292 KT recipients. Biochemical markers of bone metabolism, bone mineral density (BMD), left ventricular hypertrophy (LVH), left ventricular ejection fraction (LVEF), left ventricular diastolic function, coronary artery calcification (CAC) score and thoracic aortic calcification (TAC) score were assessed. Linear regression and binary Logistic regression analyses were employed for evaluating the influencing factors of cardiovascular parameters and the influence of abnormal mineral and bone metabolism.Results:Postoperative abnormalities in mineral and bone disorders were manifested mostly as hypercalcemia (8.9%, 26/292), hypophosphatemia (27.1%, 79/292), low 25-hydroxyvitamin D (25(OH)vitD) (67.0%, 196/292), hyperparathyroidismhigh parathyroid hormone (PTH) (50.6%, 148/292), elevated bone turnover markers and bone loss rate of 25%-30%. The prevalence of LVH, LVEF<50%, left ventricular diastolic dysfunction, high CAC score and high TAC score were 39.9%(116/292), 0%, 13.1%(38/292), 17.3%(50/292) and 39.9%(116/292) respectively. The results of multivariate analysis indicated that LVH was correlated positively with hypertension and serum calcium (Ca) (95% CI: 1.242-28.080, P=0.026; 95% CI: 1.714-277.584, P=0.018); LVEF was correlated positively with lumbar vertebrae BMD (95% CI: 0.000 1-0.005 5, P=0.041); Left ventricular diastolic dysfunction was correlated positively with age, diabetes and parathyroid hyperplasia/nodules (95% CI: 1.050-1.176, P<0.001; 95% CI: 2.118-43.813, P=0.003 and 95% CI: 1.419-9.103, P=0.007); High CAC score was correlated positively with recipient age and dialysis time (95% CI: 1.036-1.160, P=0.001; 95% CI: 1.009-1.041, P=0.002); High TAC score was correlated positively with age (95% CI: 1.095-1.215, P<0.001). Correlation analysis indicated that TAC was correlated positively with serum Ca ( r=0.233, P=0.003), bone-specific alkaline phosphatase (BALP)( r=0.325, P<0.001) and type Ⅰ collagen cross-linked N-terminal peptide (NTX)( r=0.204, P=0.011) and negatively with femoral neck BMD ( r=0.194, P=0.017). Conclusions:There is a high prevalence of left ventricular structural and functional abnormalities and vascular calcification. It is closely correlated with mineral and bone disorders.
ABSTRACT
Overweight and obesity influences left ventricular structure and function. WHO Western Pacific Region in 2000 recommended lower cutoff for overweight (Body Mass Index-BMI ≥23.0) and obesity (Body Mass Index-BMI ≥25.0) in asians. However, studies considering the new recommendations of Body Mass Index (BMI) are lacking. The present study investigated the impact of different grades of BMI on left ventricular structure and systolic and diastolic function in middle aged Indian men. The study involved 74 men aged 31 to 60 (mean age 45.24±10.9) years who were grouped according to BMI as normal weight (18.5–22.9 kg/m2, n=19), overweight (23–24.9 kg/m2, n=17) and obese (≥25 kg/m2, n=38). Left ventricular structure and function were evaluated by 2-D doppler echocardiography. Compared to normal and overweight, obese had significantly higher left ventricular mass (P<0.05) and left atrial diameter (P<0.01). Left ventricular diastolic function (atrial filling velocity-A) showed a significant decline in obese and even in overweight compared to normal (P<0.05). Left ventricular systolic function showed no significant changes with increase in BMI. Left ventricular diastolic function decreases in all grades of BMI more than 23 kg/m2, whereas structural changes are present only in obese (BMI ≥25 kg/m2). Hence the revised BMI cut-off for Asians as recommended by WHO need to be considered for assessing cardiovascular risk and mortality among Indian men and more stringent control of body weight especially abdominal obesity is justified in the maintenance of cardiovascular health and functional capacity.