Dos Santos Daniel B C, Gowdak Luis Henrique W, David-Neto Elias, Nataniel Felizardo A, De Lima José J G, Bortolotto Luiz A
Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo 05403-000, Brazil.
Hospital das Clínicas, University of São Paulo Medical School, São Paulo 05508-090, Brazil.
J Clin Med. 2023 Sep 10;12(18):5882. doi: 10.3390/jcm12185882.
There is a need of simple, inexpensive, and reliable noninvasive testing to predict coronary artery disease (CAD) in patients with chronic kidney disease (CKD), where the prevalence of cardiovascular (CV) events and death is elevated. We analyzed the association between peripheral artery disease (PAD) and CAD in 201 patients with stage 5 CKD on dialysis using a prospective observational cohort. Diagnosis of PAD by both palpation and USD were significantly correlated. In patients with PAD diagnosed by palpation, CAD was observed in 80%, while in those diagnosed by USD, CAD was present in 79.1%. The absence of a pulse by palpation predicted CAD with a sensitivity of 55% and a specificity of 76%; USD showed a sensitivity of 62% and specificity of 60% to predict CAD. The risk of combined serious CV events and death was significantly higher in subjects with PAD diagnosed by palpation, but not by USD. PAD assessed by palpation also correlated with the occurrence of multivessel CAD and with the probability of coronary intervention. Both methods are moderately useful for predicting CAD, but PAD diagnosis by palpation was a better predictor of combined CV events and death and was also associated with CAD severity and likelihood of intervention.
对于慢性肾脏病（CKD）患者而言，心血管（CV）事件和死亡的发生率有所升高，因此需要一种简单、廉价且可靠的非侵入性检测方法来预测冠状动脉疾病（CAD）。我们采用前瞻性观察队列研究，分析了201例接受透析的5期CKD患者外周动脉疾病（PAD）与CAD之间的关联。通过触诊和超声诊断PAD具有显著相关性。在通过触诊诊断为PAD的患者中，80%观察到CAD，而在通过超声诊断为PAD的患者中，CAD的发生率为79.1%。触诊未触及脉搏预测CAD的敏感性为55%，特异性为76%；超声预测CAD的敏感性为62%，特异性为60%。通过触诊而非超声诊断为PAD的受试者发生严重CV事件和死亡的风险显著更高。通过触诊评估的PAD也与多支冠状动脉疾病的发生以及冠状动脉介入治疗的可能性相关。两种方法对预测CAD都有一定作用，但通过触诊诊断PAD对CV事件和死亡的联合预测效果更好，并且还与CAD严重程度及介入治疗可能性相关。
