Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec city, Québec, Canada; Cardiology department, Expert Valve Center, Henri Mondor hospital, Créteil, France; INSERM unit U955, Team 8, Paris-Est Créteil University, Val-de-Marne, Créteil, France.
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec city, Québec, Canada.
Can J Cardiol. 2019 Sep;35(9):1195-1207. doi: 10.1016/j.cjca.2019.05.028. Epub 2019 May 28.
Valvular heart calcification is common in patients with chronic kidney disease (CKD), especially in those receiving hemodialysis therapy, and it is associated with poor prognosis. Furthermore, progression of valvular heart disease (VHD) and structural valve deterioration of bioprosthetic valves are faster in these patients. Mechanisms involved in the pathophysiology of VHD are similar between patients with and without impaired kidney function, but CKD is associated with a bone metabolism dysregulation, which might lead to a procalcifying phenotype within vessels and heart valves. CKD is also associated with left ventricular remodelling and dysfunction, which might contribute to increase the risk of heart failure and death in patients with VHD. Even if promising pharmacotherapeutic avenues are in development, no medical treatment can prevent or reduce the valvular calcific process. Patients with advanced CKD should undergo transthoracic echocardiography for detection of VHD, and if present, follow-up should be more frequent than what is recommended in the guidelines. Transcatheter valve replacement might be preferred over surgical replacement in patients with CKD and severe aortic valve stenosis.
心脏瓣膜钙化在慢性肾脏病（CKD）患者中很常见，尤其是接受血液透析治疗的患者，与预后不良有关。此外，这些患者的瓣膜性心脏病（VHD）进展和生物假体瓣膜的结构恶化更快。VHD 的病理生理学机制在肾功能受损和无肾功能受损的患者中相似，但 CKD 与骨代谢失调有关，这可能导致血管和心脏瓣膜内的促钙化表型。CKD 还与左心室重构和功能障碍有关，这可能会增加 VHD 患者心力衰竭和死亡的风险。即使有有前途的药物治疗途径正在开发中，也没有药物治疗可以预防或减少瓣膜钙化过程。晚期 CKD 患者应接受经胸超声心动图检查以检测 VHD，如果存在，随访应比指南推荐的更频繁。对于 CKD 和严重主动脉瓣狭窄患者，经导管瓣膜置换可能优于手术置换。
