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终末期肾病血液透析患者发生新的心脏瓣膜钙化可预测未来心血管事件：一项纵向队列研究。

De novo Cardiac Valve Calcification after Hemodialysis in End-Stage Renal Disease Patients Predicts Future Cardiovascular Events: A Longitudinal Cohort Study.

机构信息

Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Cardiorenal Med. 2019;9(4):229-239. doi: 10.1159/000494701. Epub 2019 Apr 17.

DOI:10.1159/000494701

PMID:30995648

Abstract

BACKGROUND

Cardiac valve calcification (CVC) in maintenance hemodialysis patients is associated with adverse cardiovascular outcomes. However, whether de novo CVC in incident hemodialysis patients predicts future cardiovascular events is unknown.

METHODS

This study included 174 patients newly receiving hemodialysis without CVC as reflected by echocardiography between January 2005 and December 2014. De novo CVC was determined with echocardiography once every 6 months until December 2016.

RESULTS

The median follow-up was 66 months (range, 19-141). De novo CVC developed in 80 out of 174 (45.98%) subjects: 58 developed aortic valve calcification (AVC) alone, 42 developed mitral valve calcification (MVC) alone, and 20 developed both AVC and MVC. The median time from baseline to de novo CVC was 46 months (range, 3-120) for AVC and 50 months (range, 13-127) for MVC. Patients who developed CVC had a higher major adverse cardiovascular events (MACE) rate than those who did not (AVC: 30/58 [51.72%] vs. 23/116 [19.83%]; MVC: 25/42 [59.52%] vs. 28/132 [21.21%]). Multivariate time-dependent Cox regression showed an association between MACE with both de novo AVC and MVC (AVC: hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.55-6.63; MVC: HR 5.95, 95% CI 2.90-12.20).

CONCLUSIONS

De novo CVC is an independent risk factor for MACE in hemodialysis patients, and regular CVC screening among hemodialysis patients without preexisting CVC may be helpful to identify patients at increased risk of adverse cardiovascular outcomes.

摘要

背景

维持性血液透析患者的心脏瓣膜钙化（CVC）与不良心血管结局相关。然而，新诊断血液透析患者的 CVC 是否预测未来心血管事件尚不清楚。

方法

本研究纳入了 2005 年 1 月至 2014 年 12 月期间首次接受血液透析且超声心动图无 CVC 的 174 例患者。新诊断的 CVC 通过每 6 个月一次的超声心动图检查来确定，随访至 2016 年 12 月。

结果

中位随访时间为 66 个月（范围 19-141 个月）。174 例患者中有 80 例（45.98%）发生新诊断的 CVC：58 例患者发生单纯主动脉瓣钙化（AVC），42 例患者发生单纯二尖瓣钙化（MVC），20 例患者发生 AVC 和 MVC 同时钙化。基线至新诊断 CVC 的中位时间为 AVC 46 个月（范围 3-120 个月），MVC 50 个月（范围 13-127 个月）。发生 CVC 的患者的主要不良心血管事件（MACE）发生率高于未发生 CVC 的患者（AVC：30/58 [51.72%] vs. 23/116 [19.83%]；MVC：25/42 [59.52%] vs. 28/132 [21.21%]）。多变量时间依赖性 Cox 回归显示，新诊断的 AVC 和 MVC 均与 MACE 相关（AVC：风险比 [HR] 3.2，95%置信区间 [CI] 1.55-6.63；MVC：HR 5.95，95% CI 2.90-12.20）。