Rekucki Konrad, Sławuta Agnieszka, Zyśko Dorota, Madziarska Katarzyna
Department of Cardiology, T. Marciniak Lower Silesian Specialist Hospital, Wrocław, Poland.
Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2022 Jul;31(7):757-767. doi: 10.17219/acem/146970.
Patients with kidney disease suffer from high cardiovascular risk due to classic and disease-specific risk factors. Arterial stiffness is a novel cardiovascular risk factor whose role is yet to be established. High-resolution echo-tracking is a developing method for the assessment of local arterial stiffness.
To assess carotid stiffness in patients on long-term hemodialysis (HD) using high-resolution echo-tracking and to analyze the impact of arterial stiffness on mortality in the mid-term follow-up.
Fifty-eight HD patients (28 female (F), 30 male (M)) underwent clinical examination, laboratory tests and carotid stiffness assessment. Local arterial stiffness parameters such as beta stiffness index (β), Young's modulus (Ep), arterial compliance (AC), and one-point pulse wave velocity (PWVβ) were measured both before and after HD, allowing to calculate their change (Δ). The survival of patients was analyzed up to 48 months. The multivariate analysis of survival with the use of Cox proportional hazard stepwise regression was performed to determine the factors significantly correlated with the survival.
After 48 months, 33 patients were alive (16 F, 17 M) and 25 patients (12 F, 13 M) died. The deceased group was significantly older (66.5 ±12.3 years compared to 56.6 ±17.8 years), had more pronounced coronary artery disease (percutaneous coronary intervention (PCI) 36% compared to 9%, p < 0.05, respectively). Deceased patients had significantly higher ΔAC than survivors. The results showed that age, history of PCI, left ventricular ejection fraction (LVEF), ΔAC, fasting glucose, serum total protein, sodium level after HD, and potassium level before HD were significantly associated with mortality.
Echo-tracking-based arterial stiffness assessment in patients with chronic kidney disease (CKD) yields the clinical information regarding mid-term mortality risk. A paradoxical increase in AC is among independent risk factors for mid-term mortality in patients undergoing maintenance HD. The proper estimation of the correlations among vascular, hemodynamic and sympathetic-dependent changes in a given patient with kidney failure is complex.
由于经典和疾病特异性危险因素，肾病患者存在较高的心血管风险。动脉僵硬度是一种新型心血管危险因素，其作用尚未明确。高分辨率回声跟踪是一种用于评估局部动脉僵硬度的发展中的方法。
使用高分辨率回声跟踪评估长期血液透析（HD）患者的颈动脉僵硬度，并分析中期随访中动脉僵硬度对死亡率的影响。
58例HD患者（28例女性（F），30例男性（M））接受了临床检查、实验室检查和颈动脉僵硬度评估。在HD前后测量局部动脉僵硬度参数，如β僵硬度指数（β）、杨氏模量（Ep）、动脉顺应性（AC）和单点脉搏波速度（PWVβ），从而计算其变化（Δ）。对患者进行长达48个月的生存分析。使用Cox比例风险逐步回归进行生存的多变量分析，以确定与生存显著相关的因素。
48个月后，33例患者存活（16例F，17例M），25例患者（12例F，13例M）死亡。死亡组年龄显著更大（分别为66.5±12.3岁和56.6±17.8岁），冠状动脉疾病更明显（经皮冠状动脉介入治疗（PCI）分别为36%和9%，p<0.05）。死亡患者的ΔAC显著高于存活者。结果表明，年龄、PCI病史、左心室射血分数（LVEF）、ΔAC、空腹血糖、血清总蛋白、HD后钠水平和HD前钾水平与死亡率显著相关。
基于回声跟踪的慢性肾脏病（CKD）患者动脉僵硬度评估可提供有关中期死亡风险的临床信息。AC的反常增加是维持性HD患者中期死亡的独立危险因素之一。正确估计特定肾衰竭患者血管、血流动力学和交感神经依赖性变化之间的相关性很复杂。
