Two-dimensional speckle-tracking echocardiography for evaluating left atrial remodeling in renal transplant recipients.

Background: Kidney transplantation (KT) improves left ventricular (LV) systolic function, but few studies have examined its impact on left atrial (LA) function. This study aimed to assess LA structural and functional changes in patients with end-stage renal disease (ESRD) after KT through use of two-dimensional speckle-tracking echocardiography (2D-STE). Methods: A prospective cohort of 163 patients with ESRD (85 in the KT group; 78 in the dialysis group) who underwent echocardiography at baseline and 12-month follow-up was included, with LA strain and stiffness being measured via 2D-STE. Inter- and intragroup changes were compared, with multivariate linear regression and adjustment for confounders. Results: KT significantly improved LA function at 12 months: LA reservoir strain (LASr) increased from 39.0%±11.12% to 42.9%±13.74% (P=0.043), and LA conduit strain (LAScd) increased from 22.4%±7.52% to 25.3%±7.99% (P=0.016). LA volume index (LAVI), LA stiffness (LASt), and LA contractile strain (LASct) showed no significant changes. No improvements were observed in the dialysis group. At follow-up, the KT group had significantly better LA function than did the dialysis group, as indicated by LASr (42.9%±13.74% vs. 36.1%±13.92%; P=0.004), LAScd (25.3%±7.99% vs. 20.1%±10.16%; P<0.001), and LASt (0.25±0.14 vs. 0.40±0.29; P<0.001), with significance persisting after adjustment. Structural parameters (LAVI and LASct) did not differ between the groups. Conclusions: Our study provides insights into the cardiovascular protective mechanisms of KT and indicates that it can improve LA reservoir and conduit function, maintain lower stiffness in patients with ESRD, and thus potentially delay atrial remodeling and stiffness progression.