慢性肾脏病5期患者的冠状动脉钙化与不良心脏功能及死亡率增加有关。
Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality .
作者信息
Anaya Paul, Blomquist Gustav A, Davenport Daniel L, Monier-Faugere Marie-Claude, Sorrell Vincent L, Malluche Hartmut H
出版信息
Clin Nephrol. 2016 Dec;86 (2016)(12):291-302. doi: 10.5414/CN108940.
BACKGROUND
Coronary artery calcification (CAC) is common in patients with chronic kidney disease on hemodialysis (CKD-5D) and is an important predictor of mortality. However, cardiac functional links between CAC and mortality have not been well established. This study tested the hypothesis that CAC increases mortality by adversely affecting cardiac function.
METHODS
Patients were recruited from 37 regional dialysis centers. 2-D and Doppler echocardiographic analyses were performed, and CAC was measured using 64-slice computed tomography. Relationships between CAC and echocardiographic measures of left ventricular (LV) function were analyzed. Survival was assessed with median follow-up of 37 months.
RESULTS
There were 157 patients: 59% male, 46% Caucasian, 48% diabetic. Median age was 55 years, and median duration of CKD-5D was 45 months. Agatston CAC scores 100 were found in 69% of patients, with 51% having a score 400. CAC was associated with measures of LV systolic and diastolic function (global longitudinal strain (GLS; rho = 0.270, p = 0.004)), peak LV systolic velocity (rho = -0.259, p = 0.004), and estimate of LV filling pressure (E:E'; rho = 0.286, p = 0.001). Multivariate regression confirmed these relationships after adjustment for age, gender, LV ejection fraction, and coronary artery disease. Valvular calcification varied linearly with CAC (p < 0.05). Both LV diastolic and systolic functional measures were significant predictors of mortality, the strongest of which was LV diastolic dysfunction.
CONCLUSIONS: These findings show a link between CAC, cardiac function, and mortality in CKD-5D. LV diastolic function (E:E'), peak LV systolic velocity, and GLS are independent predictors of mortality. Valvular calcification may be an important marker of CAC in CKD-5D. These effects on cardiac function likely explain the high mortality with CKD-5D and describe a potentially-valuable role for echocardiography in the routine management of these patients. .
背景
冠状动脉钙化（CAC）在接受血液透析的慢性肾脏病患者（CKD-5D）中很常见，是死亡率的重要预测指标。然而，CAC与死亡率之间的心脏功能联系尚未完全确立。本研究检验了CAC通过对心脏功能产生不利影响而增加死亡率的假说。
方法
从37个地区透析中心招募患者。进行二维和多普勒超声心动图分析，并使用64层计算机断层扫描测量CAC。分析了CAC与左心室（LV）功能的超声心动图测量指标之间的关系。通过中位随访37个月评估生存率。
结果
共有157例患者：男性占59%，白种人占46%，糖尿病患者占48%。中位年龄为55岁，CKD-5D的中位病程为45个月。69%的患者Agatston CAC评分≥100，51%的患者评分≥400。CAC与LV收缩和舒张功能指标相关（整体纵向应变（GLS；rho = 0.270，p = 0.004））、LV收缩期峰值速度（rho = -0.259，p = 0.004）以及LV充盈压估计值（E:E'；rho = 0.286，p = 0.001）。在对年龄、性别、LV射血分数和冠状动脉疾病进行调整后，多变量回归证实了这些关系。瓣膜钙化与CAC呈线性变化（p < 0.05）。LV舒张和收缩功能指标均是死亡率的重要预测指标，其中最强的是LV舒张功能障碍。
结论
这些发现表明CKD-5D患者中CAC、心脏功能和死亡率之间存在联系。LV舒张功能（E:E'）、LV收缩期峰值速度和GLS是死亡率的独立预测指标。瓣膜钙化可能是CKD-5D患者中CAC的重要标志物。这些对心脏功能的影响可能解释了CKD-5D患者的高死亡率，并描述了超声心动图在这些患者常规管理中的潜在重要作用。
Zotero 插件