Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Nephrol Dial Transplant. 2018 Dec 1;33(12):2253-2259. doi: 10.1093/ndt/gfy158.
Aortic calcification is associated with an increased risk for cardiovascular events in renal transplant recipients. This study focused on the association of abdominal aortic calcification (AAC) and cardiovascular events assessed using a dual-energy X-ray absorptiometry (DXA) scoring methodology for AAC.
From 2008 to 2014, renal transplant recipients referred for a DXA procedure within 6 months after transplantation were included in a retrospective, single-centre study. The primary endpoint was the occurrence of cardiovascular events, defined as myocardial infarction, cerebrovascular accident or transient ischaemic attack, after transplantation. AAC was quantified using an 8-point scoring system and patients were divided into three groups; a control group (AAC = 0), a low AAC group (AAC = 1-3) and a high AAC group (AAC = 4-8).
We evaluated 701 patients, 267 (38.1%) had detectable calcifications (low AAC 190 patients, high AAC 77 patients) and 434 (61.9%) had no calcifications. Cardiovascular events were seen in 37 (8.5%) patients in the control group, in 18 (9.5%) in the low AAC group and in 20 (26.0%) in the high AAC group. Univariate Cox proportional hazards analysis of the high AAC score showed a hazard ratio (HR) of 4.23 [95% confidence interval (CI) 2.44-7.33; P < 0.01] for cardiovascular events, while results were not significant for the low AAC score. Multivariate analysis showed an independent significant association between a high AAC score and cardiovascular events [HR 2.78 (95% CI 1.05-7.64); P = 0.04]. Assessment of the continuous net reclassification index (NRI), comparing the combined clinical variables with a model of both AAC scoring and clinical variables, showed an NRI of 0.76 (95% CI 0.65-0.86; P < 0.01).
An independent association between a high AAC score, assessed by DXA, and cardiovascular events was identified and provides an opportunity for early cardiovascular risk stratification in renal transplant recipients.
在肾移植受者中，主动脉钙化与心血管事件风险增加相关。本研究关注的是使用双能 X 射线吸收法（DXA）评分方法评估的腹主动脉钙化（AAC）与心血管事件之间的关系。
2008 年至 2014 年，在移植后 6 个月内接受 DXA 检查的肾移植受者被纳入回顾性单中心研究。主要终点是移植后发生心血管事件，定义为心肌梗死、脑血管意外或短暂性脑缺血发作。使用 8 分评分系统定量评估 AAC，患者分为三组；对照组（AAC=0）、低 AAC 组（AAC=1-3）和高 AAC 组（AAC=4-8）。
我们评估了 701 例患者，其中 267 例（38.1%）有可检测的钙化（低 AAC 190 例，高 AAC 77 例），434 例（61.9%）无钙化。对照组中有 37 例（8.5%）患者发生心血管事件，低 AAC 组中有 18 例（9.5%），高 AAC 组中有 20 例（26.0%）。对高 AAC 评分的单因素 Cox 比例风险分析显示，心血管事件的风险比（HR）为 4.23（95%可信区间（CI）2.44-7.33；P<0.01），而低 AAC 评分的结果不显著。多因素分析显示，高 AAC 评分与心血管事件之间存在独立显著关联[HR 2.78（95%CI 1.05-7.64）；P=0.04]。比较联合临床变量与 AAC 评分和临床变量的综合模型，评估连续净重新分类指数（NRI），结果显示 NRI 为 0.76（95%CI 0.65-0.86；P<0.01）。
通过 DXA 评估的高 AAC 评分与心血管事件之间存在独立关联，为肾移植受者的早期心血管风险分层提供了机会。
