Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark,
Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark,
Kidney Blood Press Res. 2019;44(4):704-714. doi: 10.1159/000501226. Epub 2019 Jul 30.
Central blood pressure (BP) assessed noninvasively considerably underestimates true invasively measured aortic BP in chronic kidney disease (CKD) patients. The difference between the estimated and the true aortic BP increases with decreasing estimated glomerular filtration rates (eGFR). The present study investigated whether aortic calcification affects noninvasive estimates of central BP.
Twenty-four patients with CKD stage 4-5 undergoing coronary angiography and an aortic computed tomography scan were included (63% males, age [mean ± SD ] 53 ± 11 years, and eGFR 9 ± 5 mL/min/1.73 m2). Invasive aortic BP was measured through the angiography catheter, while non-invasive central BP was obtained using radial artery tonometry with a SphygmoCor® device. The Agatston calcium score (CS) in the aorta was quantified on CT scans using the CS on CT scans.
The invasive aortic systolic BP (SBP) was 152 ± 23 mm Hg, while the estimated central SBP was 133 ± 20 mm Hg. Ten patients had a CS of 0 in the aorta, while 14 patients had a CS >0 in the aorta. The estimated central SBP was lower than the invasive aortic SBP in patients with aortic calcification compared to patients without (mean difference 8 mm Hg, 95% CI 0.3-16; p = 0.04). The brachial SBP was lower than the aortic SBP in patients with aortic calcification compared to patients without (mean difference 10 mm Hg, 95% CI 2-19; p = 0.02).
In patients with advanced CKD the presence of aortic calcification is associated with a higher difference between invasively measured central aortic BP and non-invasive estimates of central BP as compared to patients without calcifications.
在慢性肾脏病(CKD)患者中,通过无创方法评估的中心血压(BP)显著低估了真正的经动脉测量的主动脉 BP。在估算肾小球滤过率(eGFR)降低的情况下,估计的与真实的主动脉 BP 之间的差异会增加。本研究调查了主动脉钙化是否会影响中心 BP 的无创估计值。
纳入 24 例接受冠状动脉造影和主动脉计算机断层扫描(CT)的 CKD 4-5 期患者(63%为男性,年龄[均值±标准差]为 53±11 岁,eGFR 为 9±5 mL/min/1.73 m2)。通过造影导管测量经动脉的主动脉 BP,使用 SphygmoCor®设备通过桡动脉测压法测量无创中心 BP。在 CT 扫描上通过 CT 扫描的钙分数(CS)定量主动脉中的 Agatston 钙分数(CS)。
经动脉的主动脉收缩压(SBP)为 152±23mmHg,而估计的中心 SBP 为 133±20mmHg。10 例患者的主动脉中 CS 为 0,而 14 例患者的主动脉中 CS>0。与无主动脉钙化的患者相比,有主动脉钙化的患者的估计中心 SBP 低于经动脉的主动脉 SBP(平均差值 8mmHg,95%CI 0.3-16;p=0.04)。与无主动脉钙化的患者相比,有主动脉钙化的患者的肱动脉 SBP 低于主动脉 SBP(平均差值 10mmHg,95%CI 2-19;p=0.02)。
在晚期 CKD 患者中,与无钙化的患者相比,主动脉钙化的存在与经动脉测量的中心主动脉 BP 与无创中心 BP 估计值之间的差异更大相关。