*Purpose: Relative to dialysis, cardiovascular (CV) mortality improves with transplantation. Nevertheless, CV disease (CVD) is the leading cause of death for kidney transplant recipients (KTR), with atherosclerotic heart disease and heart failure comprising the majority of diagnoses. Cardiac remodeling in response to transplantation contributes to improved outcomes, but reasons that some patients do not improve as much as others are not established. It is unknown whether or not an inability to improve may predict later adverse outcomes. We hypothesize that sensitive measures of cardiac remodeling captured by novel “speckle tracking” echocardiography may be able to identify KTR at greater risk for later CVD events.

*Methods: We recruited 41 KTR undergoing six-month post-transplant kidney allograft protocol biopsy at our center who were enrolled in the Cardiovascular Risk After Kidney Transplantation (CARAKTER) study. We performed echocardiograms on the day of biopsy. We measured conventional parameters (left ventricular (LV) and atrial dimensions, ejection fraction, etc.) as well as cardiac strain (global longitudinal strain, E wave / diastolic strain rate) using speckle echocardiography on both baseline (pre-transplant) and six-month post-transplant echocardiograms. Images were analyzed using vendor-independent post-processing software TomTec-Arena 2D-CPA.

*Results: Mean (SD) age was 47 (14) and 44% were male. 30% had diabetes and 44% had glomerular disease as the reason for requiring transplant. Five patients had received pre-emptive transplants. We found evidence of improvement in conventional echo parameters at 6 months post-transplant, including changes in heart size, chamber size, and diastolic function (assessed by E prime) (Table 1). Speckle echo parameters also showed improvement (Table 2).

*Conclusions: Speckle echo can detect subtle changes in heart function in relatively healthy patients post-transplant. Longer follow-up and larger sample sizes will be needed to understand how these measurements predict later CVD outcomes and how graft function and other clinical variables influence these measurements.

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