Sawai Akihiro, Yasuda Yoshinari, Suzuki Susumu, Ishii Hideki, Goto Motomitsu, Kato Sawako, Hayashi Mutsuharu, Maruyama Shoichi, Murohara Toyoaki, Oiso Yutaka, Matsuo Seiichi
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Clin Exp Nephrol. 2016 Jun;20(3):416-24. doi: 10.1007/s10157-015-1169-0. Epub 2015 Sep 24.
The clinical usefulness of physiological and radiological examinations for cardiovascular disease (CVD) risk stratification has not been fully demonstrated in chronic kidney disease (CKD) patients. In the present study, predictive values of CVD were investigated among asymptomatic CKD patients by comprehensive and non-invasive CVD screening programs.
We prospectively evaluated 139 asymptomatic CKD patients. All patients were examined by comprehensive and non-invasive CVD risk screening programs that included carotid ultrasonography, coronary artery calcification score (CACS), pulse wave velocity, and flow-mediated vasodilation, and their associations with major adverse cardiovascular events (MACEs) were analyzed.
During the median follow-up of 32.3 months, 13 MACEs were observed. Among all CVD screening examinations, severity of the carotid plaque score (PS) and CACS was significantly higher in the MACE group than in the MACE-free group (11.3 ± 5.8 versus 6.1 ± 5.3, P = 0.001 and 657 versus 74, P = 0.020, respectively). Kaplan-Meier curves for the incidences of MACEs classified according to the combination of carotid PS and CACS showed that severe carotid PS and severe CACS groups had the highest event rate in comparison with the groups without any of these (29.9, 11.9, and 3.6 %, respectively, P < 0.001).
In this long-term follow-up analysis, the combination of carotid atherosclerosis and CACS was a useful and non-invasive screening tool for predicting cardiovascular events among asymptomatic CKD patients.
生理和放射学检查对心血管疾病（CVD）风险分层的临床实用性在慢性肾脏病（CKD）患者中尚未得到充分证实。在本研究中，通过全面且无创的CVD筛查项目，对无症状CKD患者的CVD预测价值进行了调查。
我们前瞻性地评估了139例无症状CKD患者。所有患者均接受了全面且无创的CVD风险筛查项目检查，包括颈动脉超声检查、冠状动脉钙化评分（CACS）、脉搏波速度和血流介导的血管舒张，并分析了它们与主要不良心血管事件（MACE）的相关性。
在32.3个月的中位随访期内，观察到13例MACE。在所有CVD筛查检查中，MACE组的颈动脉斑块评分（PS）和CACS严重程度显著高于无MACE组（分别为11.3±5.8对6.1±5.3，P = 0.001；657对74，P = 0.020）。根据颈动脉PS和CACS组合分类的MACE发生率的Kaplan-Meier曲线显示，与无任何一项的组相比，严重颈动脉PS组和严重CACS组的事件发生率最高（分别为29.9%、11.9%和3.6%，P <(0.001)）。
在这项长期随访分析中，颈动脉粥样硬化和CACS的组合是预测无症状CKD患者心血管事件的一种有用且无创的筛查工具。
