Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
Int J Med Sci. 2013;10(5):617-23. doi: 10.7150/ijms.5773. Epub 2013 Mar 21.
This study evaluated the prognostic value of the aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in peritoneal dialysis (PD) patients.
PD patients who received both abdominal CT and echocardiography were divided into a low-ACI group (n=46) and a high-ACI group (n=46).
During follow-up (median, 35.2 months; range, 3.6-111.3), 30 patients (32.6%) died and 10 patients (10.9%) developed nonfatal cardiovascular (CV) events. The 5-year event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group (35.7% vs. 64.1%, P = 0.01). The ACI was positively correlated with left atrial diameter and ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio; a marker of left ventricular diastolic function). Using multivariate analyses, the high-ACI group (vs. low-ACI group, HR 5.25, 95% CI 1.77-15.58, P = 0.003) and increased E/E' ratio (HR 1.16, 95% CI 1.03-1.31, P = 0.013) were independent predictors for mortality and CV events. The ACI provided a higher predictive value for adverse outcomes (AUC = 0.755, P = 0.002) than the E/E' ratio (AUC = 0.543, P = 0.61).
The ACI was significantly associated with left ventricular diastolic dysfunction and predicted all-cause mortality and nonfatal CV events in PD patients.
本研究通过腹部 CT 平扫评估主动脉钙化指数（ACI），评估腹主动脉钙化程度，旨在探讨其对腹膜透析（PD）患者左心室（LV）舒张功能障碍、死亡率和非致死性心血管（CV）事件的预后价值。
纳入同时接受腹部 CT 和超声心动图检查的 PD 患者，根据 ACI 将其分为低 ACI 组（n=46）和高 ACI 组（n=46）。
中位随访时间为 35.2 个月（范围 3.6-111.3 个月），30 例患者（32.6%）死亡，10 例患者（10.9%）发生非致死性 CV 事件。与低 ACI 组相比，高 ACI 组的死亡率和非致死性 CV 事件的 5 年无事件生存率明显更低（35.7% vs. 64.1%，P=0.01）。ACI 与左心房直径和二尖瓣环早期舒张峰值速度与早期舒张峰值速度比（E/E'比值；LV 舒张功能的标志物）呈正相关。多因素分析显示，与低 ACI 组相比，高 ACI 组（HR 5.25，95%CI 1.77-15.58，P=0.003）和 E/E'比值升高（HR 1.16，95%CI 1.03-1.31，P=0.013）是死亡率和 CV 事件的独立预测因素。与 E/E'比值（AUC=0.543，P=0.61）相比，ACI 对不良结局的预测价值更高（AUC=0.755，P=0.002）。
ACI 与 LV 舒张功能障碍显著相关，可预测 PD 患者的全因死亡率和非致死性 CV 事件。
