Department of Medicine, National University Health System, Singapore.
Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore.
Singapore Med J. 2024 Nov 1;65(11):624-630. doi: 10.4103/singaporemedj.SMJ-2021-427. Epub 2023 Mar 24.
Management of aortic stenosis (AS) in patients with chronic kidney disease (CKD) may often be overlooked, and this could confer poorer outcomes.
Consecutive patients ( n = 727) with index echocardiographic diagnosis of moderate to severe AS (aortic valve area <1.5 cm 2 ) were examined. They were divided into those with CKD (estimated glomerular filtration rate < 60 mL/min) and those without. Baseline clinical and echocardiographic parameters were compared, and a multivariate Cox regression model was constructed. Clinical outcomes were compared using Kaplan-Meier curves.
There were 270 (37.1%) patients with concomitant CKD. The CKD group was older (78.0 ± 10.3 vs. 72.1 ± 12.9 years, P < 0.001), with a higher prevalence of hypertension, diabetes mellitus, hyperlipidaemia and ischaemic heart disease. AS severity did not differ significantly, but left ventricular (LV) mass index (119.4 ± 43.7 vs. 112.3 ± 40.6 g/m 2 , P = 0.027) and Doppler mitral inflow E to annular tissue Doppler e' ratio (E: e' 21.5 ± 14.6 vs. 17.8 ± 12.2, P = 0.001) were higher in the CKD group. There was higher mortality (log-rank 51.5, P < 0.001) and more frequent admissions for cardiac failure (log-rank 25.9, P < 0.001) in the CKD group, with a lower incidence of aortic valve replacement (log-rank 7.12, P = 0.008). On multivariate analyses, after adjusting for aortic valve area, age, left ventricular ejection fraction and clinical comorbidities, CKD remained independently associated with mortality (hazard ratio 1.96, 95% confidence interval 1.50-2.57, P < 0.001).
Concomitant CKD in patients with moderate to severe AS was associated with increased mortality, more frequent admissions for cardiac failure and a lower incidence of aortic valve replacement.
患有慢性肾脏病（CKD）的主动脉瓣狭窄（AS）患者的管理常常被忽视，这可能导致预后更差。
连续检查了 727 例经超声心动图确诊为中重度 AS（主动脉瓣口面积＜1.5cm 2 ）的患者。他们被分为 CKD 患者（估计肾小球滤过率＜60ml/min）和非 CKD 患者。比较了两组的基线临床和超声心动图参数，并建立了多变量 Cox 回归模型。使用 Kaplan-Meier 曲线比较临床结果。
共有 270 例（37.1%）患者同时患有 CKD。CKD 组年龄较大（78.0±10.3 岁 vs. 72.1±12.9 岁，P＜0.001），高血压、糖尿病、高脂血症和缺血性心脏病的患病率更高。AS 严重程度无显著差异，但左心室质量指数（119.4±43.7g/m 2 vs. 112.3±40.6g/m 2 ，P=0.027）和多普勒二尖瓣血流 E 峰与组织多普勒 e'环比值（E:e'21.5±14.6vs. 17.8±12.2，P=0.001）较高。CKD 组死亡率较高（对数秩检验 51.5，P＜0.001），心力衰竭入院率更高（对数秩检验 25.9，P＜0.001），主动脉瓣置换术发生率较低（对数秩检验 7.12，P=0.008）。多变量分析调整主动脉瓣面积、年龄、左心室射血分数和临床合并症后，CKD 与死亡率独立相关（危险比 1.96，95%置信区间 1.50-2.57，P＜0.001）。
中重度 AS 患者合并 CKD 与死亡率增加、心力衰竭入院率增加和主动脉瓣置换术发生率降低有关。
