Department of Internal Medicine, Nephrology Section, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent, Belgium.
Hypertension. 2011 Nov;58(5):833-8. doi: 10.1161/HYPERTENSIONAHA.111.176594. Epub 2011 Sep 6.
Although renal transplantation improves survival, cardiovascular morbidity and mortality remain significantly elevated compared with nonrenal populations. The negative impact of traditional, uremia-related, and transplantation-related risk factors in this process remains, however, largely unexplored. Surrogate markers such as aortic stiffness and central wave reflections may lead to more accurate cardiovascular risk stratification, but outcome data in renal transplant recipients are scarce. We aimed to establish the prognostic significance of these markers for fatal and nonfatal cardiovascular events in renal transplant recipients. Carotid-femoral pulse wave velocity, central augmentation pressure, and central augmentation index were measured in a cohort of 512 renal transplant recipients using the SphygmoCor system. After a mean follow-up of 5 years, 20 fatal and 75 nonfatal cardiovascular events were recorded. Using receiver operating characteristic curves, the area under the curve for predicting cardiovascular events was 0.718 (95% CI 0.659-0.776) for pulse wave velocity, 0.670 (95% CI 0.604-0.736) for central augmentation pressure, and 0.595 (95% CI 0.529-0.660) for central augmentation index. When we accounted for age, gender, and C-reactive protein in Cox-regression analysis, pulse wave velocity (hazard ratio: 1.349 per 1 SD increase; 95% CI 1.104-1.649; P=0.003) and central augmentation pressure (hazard ratio: 1.487 per 1 SD increase; 95% CI 1.219-1.814; P<0.001) remained independent predictors of outcome. Aortic stiffness and increased wave reflections are independent predictors of cardiovascular events in renal transplant recipients. As single parameter of wave reflection, central augmentation pressure was better than central augmentation index. Combined measurement of pulse wave velocity and central augmentation pressure may contribute to an accurate cardiovascular risk estimation in this heterogeneous population.
虽然肾移植可以提高存活率，但与非肾脏人群相比，心血管发病率和死亡率仍然显著升高。然而，在这个过程中，传统的、与尿毒症相关的和与移植相关的风险因素的负面影响在很大程度上仍未得到探索。替代标志物，如主动脉僵硬和中心波反射，可能导致更准确的心血管风险分层，但在肾移植受者中的结果数据却很少。我们旨在确定这些标志物对肾移植受者致命和非致命心血管事件的预后意义。使用 SphygmoCor 系统测量了 512 例肾移植受者的颈动脉-股动脉脉搏波速度、中心增强压和中心增强指数。平均随访 5 年后，记录了 20 例致命和 75 例非致命心血管事件。使用受试者工作特征曲线，脉搏波速度预测心血管事件的曲线下面积为 0.718（95%CI 0.659-0.776），中心增强压为 0.670（95%CI 0.604-0.736），中心增强指数为 0.595（95%CI 0.529-0.660）。当我们在 Cox 回归分析中考虑年龄、性别和 C 反应蛋白时，脉搏波速度（风险比：每增加 1 SD 增加 1.349；95%CI 1.104-1.649；P=0.003）和中心增强压（风险比：每增加 1 SD 增加 1.487；95%CI 1.219-1.814；P<0.001）仍然是独立的预后预测因素。主动脉僵硬和波反射增加是肾移植受者心血管事件的独立预测因素。作为波反射的单一参数，中心增强压优于中心增强指数。脉搏波速度和中心增强压的联合测量可能有助于对这个异质人群进行准确的心血管风险评估。
