Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
Cardiorenal Med. 2023;13(1):38-45. doi: 10.1159/000529136. Epub 2023 Feb 1.
Heart valvular calcification (HVC) is an important predictor of cardiovascular events (CEs) and all-cause mortality in dialysis patients. Patients in the early stage of dialysis or those with central venous catheters (CVC) are also at high risk of cardiovascular and all-cause mortality. It could be a confounding factor for the prognosis of HVC on CE.
From March 2017 to April 2022, the prognosis of HVC on CE and all-cause mortality was studied retrospectively in 158 hemodialysis (HD) patients who used arteriovenous fistulas or arteriovenous grafts as vascular access and entered HD for more than 12 months.
Out of 158 patients, 70 (44.3%) were diagnosed with HVC via echocardiography. A total of 180 CEs occurred during follow-up. Among them, acute heart failure accounted for 62.66%, and its prevalence was significantly higher in the HVC group than that in the non-HVC group (p < 0.0001). The cumulative incidence of CE-free survival in the HVC group was significantly lower than that in the non-HVC group (p = 0.030). Only 11 patients died, and there was no significant difference in all-cause mortality between the two groups (p = 0.560). Multivariate COX regression analyses showed that HD vintage, mitral valve calcification, and aortic valve regurgitation (AR)/aortic valve stenosis (AS) but not aortic valve calcification were risk factors for CE (p < 0.05).
After excluding the factors of the early stage of HD and CVC, HVC remained a predictor of adverse CE in HD patients.
心脏瓣膜钙化（HVC）是透析患者心血管事件（CE）和全因死亡率的重要预测因素。透析早期或使用中心静脉导管（CVC）的患者也存在较高的心血管和全因死亡率风险。这可能是 HVC 对 CE 预后的混杂因素。
回顾性分析 2017 年 3 月至 2022 年 4 月期间，158 例使用动静脉瘘或动静脉移植物作为血管通路且透析时间超过 12 个月的血液透析（HD）患者的 HVC 对 CE 和全因死亡率的预后。
在 158 例患者中，70 例（44.3%）经超声心动图诊断为 HVC。随访期间共发生 180 例 CE。其中，急性心力衰竭占 62.66%，HVC 组的患病率明显高于非 HVC 组（p < 0.0001）。HVC 组的 CE 无事件生存率明显低于非 HVC 组（p = 0.030）。仅有 11 例患者死亡，两组间全因死亡率无显著差异（p = 0.560）。多变量 COX 回归分析显示，HD 病程、二尖瓣钙化以及主动脉瓣反流（AR）/主动脉瓣狭窄（AS）而非主动脉瓣钙化是 CE 的危险因素（p < 0.05）。
排除 HD 早期和 CVC 因素后，HVC 仍然是 HD 患者不良 CE 的预测因素。
