Calcification of the thoracic aorta determined by three-dimensional computed tomography predicts cardiovascular complications in patients undergoing hemodialysis.

PURPOSE

In patients on dialysis, the most common cause of death is cardiovascular disease. This is caused, at least in part, by excessive vascular calcification. Studies that have examined coronary calcification have been published, but these measurements require expensive equipment. Here, we used computed tomography to determine aortic calcification and evaluated these data as prognostic markers for cardiovascular disease.

METHODS

Computed tomography with contrast medium was performed on 49 patients undergoing hemodialysis (29 males and 20 females; average age, 68.9 ± 11.0 years). A calcification score (CS) was defined as the ratio of the volume of vascular calcification to the volume of the thoracic aorta. All patients were monitored for cardiovascular end points, which included cerebral infarction or hemorrhage, myocardial infarction, electrocardiographic, or echocardiographic abnormalities that suggested myocardial ischemia, cardiac surgery, leg amputation, and hospitalization or death due to heart failure.

RESULTS

Patients were followed for 3 years, with 12 patients reaching the end point. Both high CS (p = 0.007) and male gender (p = 0.009) were significantly associated with cardiovascular events. In contrast, events were not related to age, dialysis duration, diabetes mellitus, smoking status, low-density lipoprotein cholesterol level, pulse-wave velocity, maximum intima-media thickness of the carotid artery wall, systolic blood pressure, or left ventricular hypertrophy. Multiple logistic regression analysis revealed that a high baseline CS was a significant predictor for cardiovascular events (p < 0.05).

CONCLUSIONS

Calcification of the thoracic aorta determined by three-dimensional computed tomography predicts cardiovascular complications in patients on hemodialysis.