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      QT Dispersion in Renal Transplant Recipients


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          An increased QT dispersion (QTd) is associated with a variety of cardiac diseases and predicts sudden death. Although chronic renal failure patients and patients on hemodialysis are shown to have an increased QTd, evidence of increased QTd in renal transplant patients is scarce. In this study, renal transplant patients were evaluated to find out if they had an increased QTd. Thirty-four renal transplant recipients aged 35 ± 8 years and 34 healthy control subjects aged 34 ± 8 years were included in the study. The mean time after transplantation was 51.8 ± 40.4 (range 5–154) months. The QT interval was measured by 12-lead electrocardiogram, and the QTd was defined as the difference between the maximum and minimum QT interval. Bazett’s formula was used to correct for the heart rate (QTc). Both QTd and QTc dispersion (QTcd) in renal transplant patients were compared with those of control subjects. All patients underwent transthoracic echocardiographic assessment and 24-hour ambulatory blood pressure monitoring. Renal transplant recipients had similar QTd (37 ± 15 vs. 39 ± 17 ms) and QTcd (50 ± 18 vs. 55 ± 20 ms) compared to control subjects. QTd and QTcd were similar in patients with and without left ventricular hypertrophy (QTd 37 ± 14 vs. 36 ± 17 ms and QTcd 50 ± 14 vs. 49 ± 21 ms, respectively). No association was found between QTd and left ventricular mass index or blood pressure measurements. The QTd was not found to be increased in renal transplant recipients as compared with that of healthy controls in this study. Normalization of the QTd after renal transplantation may be through the correction of several factors responsible for increased QTd in uremic patients.

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          Long-term changes in left ventricular hypertrophy after renal transplantation.

          Concentric and eccentric left ventricular hypertrophy are common progressive disorders in dialysis patients and are associated with cardiac failure and death. Although partial regression of these abnormalities is known to occur during the first post-transplant year, their long-term evolution is unknown. A total of 143 of 433 dialysis patients participating in a long-term prospective cohort study received renal transplants. Laboratory parameters were assessed monthly. Echocardiography was performed annually. Left ventricular mass index (LVMI) and cavity volume index were calculated according to standard formulae. Multiple linear regression was used to model change in LVMI as a function of baseline clinical and laboratory variables. LVMI fell from 161 g/m2 at 1 year to 146 g/m2 (P=0.009) g/m2 after 2 years. No further regression was seen in years 3 and 4. Left ventricular volume index showed similar trends, with a decline from year 1 to year 2 (P=0.05) followed by stabilization in years 3 and 4. Older age, long duration of hypertension, need for more than one antihypertensive, high pulse pressure in normal-size hearts, and low pulse pressure in dilated hearts were significantly associated with failure of regression of LVMI between the first and second years (MLR, P<0.000001, r2=0.57). Regression of left ventricular hypertrophy continues beyond the first year after renal transplantation, reaching a nadir at 2 years and persisting into the third and fourth posttransplant years. Failure to regress was associated with older age, hypertension, high pulse pressure in normal-size hearts and low pulse pressure in dilated hearts.
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            Effect of Hemodialysis on the Dispersion of the QTc Interval

            The QTc dispersion reflects the underlying regional heterogeneity of the recovery of the ventricular excitability, thereby it is considered as a novel marker of risk of ventricular arrhythmias. Because a higher incidence of ventricular arrhythmias is described during and after hemodialysis, the aim of this study has been to evaluate the QTc dispersion before and after uncomplicated hemodialysis session. Twenty chronic uremics without heart failure, ischemic heart disease or dialysis hypotension were selected. The QTc dispersion was determined as the difference between the longer and the shorter QTc interval measured on a 12-lead electrocardiogram. Following the hemodialysis session, the QTc dispersion increased from 30 ± 9 to 54 ± 17 ms (p < 0.001) associated with the expected reduction of potassium and magnesium and with the increase of extracellular calcium concentration. However, no correlation has been observed between the QTc dispersion increase and the degree of the intradialytic changes of plasma electrolytes, blood pressure or body weight. In summary, the hemodialysis treatment per se does induce an increase of the QTc dispersion, likely due to the rapid changes of electrolyte plasma concentrations. This can potentially contribute to the arrhythmogenic effect of the hemodialysis procedure, reflecting an enhanced regional heterogeneity of ventricular repolarization. The clinical importance of the increase of QTc dispersion as risk factor of ventricular arrhythmias, particularly in hemodialyzed patients suffering from ischemic or hypertrophic heart diseases, should be the matter of further investigations.
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              Improvement of Uremic Autonomic Dysfunction after Renal Transplantation: A Heart Rate Variability Study

              Autonomic dysfunction in hemodialysis patients is one of the components of uremic neuropathy. In this prospective study, we investigated the effect of renal transplantation on uremic autonomic dysfunction with long-term time-domain and frequency-domain heart rate variability. Fourteen hemodialysis patients (10 male, 4 female; mean age 33 ± 11 (range 16–50) years) were examined before and at the early after transplantation period (mean 4.6 ± 1.5 (range 3–7.5) months). The mean time spent on hemodialysis was 16.7 ± 15.6 (range 6–65) months. In time-domain analysis, significant increases in all parameters except pNN50 (SD, SDANN, SDNN, rMSSD) were observed after renal transplantation (p < 0.01). In frequency-domain analysis, low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.40 Hz) spectral power were found to be significantly increased after renal transplantation (4.54 ± 1.04 vs. 12.58 ± 8.69 for LF (p = 0.005), 2.80 ± 1.0 vs. 6.50 ± 3.55 for HF (p = 0.005)), but the LF/HF ratio was not different from a pretransplant period (1.71 ± 0.349 vs. 1.85 ± 0.49, p = 0.26). It was concluded that autonomic dysfunction in hemodialysis patients is reversible and renal transplantation reverses the sympathetic and parasympathetic autonomic dysfunction simultaneously and at a relatively early stage.

                Author and article information

                S. Karger AG
                June 2002
                03 June 2002
                : 91
                : 2
                : 250-254
                aDivision of Nephrology and bDepartment of Internal Medicine, Marmara University Hospital, Istanbul, Turkey
                58400 Nephron 2002;91:250–254
                © 2002 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 3, References: 33, Pages: 5
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/58400
                Self URI (text/html): https://www.karger.com/Article/FullText/58400
                Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
                Original Paper

                Cardiovascular Medicine,Nephrology
                QT dispersion,Arrhythmia,Hypertension,Left ventricular hypertrophy,Renal transplantation


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