Chao Chia-Ter, Liao Min-Tser, Wu Chung-Kuan
Neprology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Ther Adv Chronic Dis. 2024 Jan 9;15:20406223231222817. doi: 10.1177/20406223231222817. eCollection 2024.
The factors affecting cardiovascular risk associated with vascular calcification in patients with chronic kidney disease are less well addressed. Distinct risk factors may contribute synergistically to this elevated cardiovascular risk in this population.
We aimed to determine whether echocardiographic left ventricular hypertrophy (LVH) affects the risk of major adverse cardiac events (MACE) associated with vascular calcification in end-stage kidney disease (ESKD) patients.
In this retrospective cohort study, ESKD patients underwent chest radiography and echocardiography to assess aortic arch calcification (AoAC) and LVH, respectively, and were classified into three groups accordingly: non-to-mild AoAC without LVH, non-to-mild AoAC with LVH, and moderate-to-severe AoAC. The risks of MACE, cardiovascular mortality, and overall mortality were assessed using Cox proportional hazard analysis.
Of the 283 enrolled ESKD patients, 44 (15.5%) had non-to-mild AoAC without LVH, 117 (41.3%) had non-to-mild AoAC with LVH, and 122 (43.1%) had moderate-to-severe AoAC. After 34.1 months, 107 (37.8%) participants developed MACE, including 6 (13.6%), 40 (34.2%), and 61 (50%) from each respective group. Those with moderate-to-severe AoAC (Hazard ratio, 3.72; 95% confidence interval, 1.58-8.73) had a significantly higher risk of MACE than did those with non-to-mild AoAC without LVH or with non-to-mild AoAC and LVH (Hazard ratio, 2.73; 95% confidence interval, 1.16-6.46). A similar trend was observed for cardiovascular and overall mortality.
Echocardiographic LVH could modify the risk of adverse cardiovascular events associated with vascular calcification in ESKD patients. Interventions aiming to ameliorate both morbidities might be translated into a lower MACE risk in this population.
慢性肾脏病患者中，影响与血管钙化相关的心血管风险的因素尚未得到充分研究。不同的风险因素可能协同作用，导致该人群心血管风险升高。
我们旨在确定超声心动图左心室肥厚（LVH）是否会影响终末期肾病（ESKD）患者中与血管钙化相关的主要不良心脏事件（MACE）风险。
在这项回顾性队列研究中，ESKD患者分别接受胸部X线摄影和超声心动图检查，以评估主动脉弓钙化（AoAC）和LVH，并据此分为三组：无LVH的非至轻度AoAC、有LVH的非至轻度AoAC、中度至重度AoAC。使用Cox比例风险分析评估MACE、心血管死亡率和总死亡率的风险。
在283例纳入研究的ESKD患者中，44例（15.5%）为无LVH的非至轻度AoAC，117例（41.3%）为有LVH的非至轻度AoAC，122例（43.1%）为中度至重度AoAC。34.1个月后，107例（37.8%）参与者发生了MACE，分别来自各组的有6例（13.6%）、40例（34.2%）和61例（50%）。中度至重度AoAC患者（风险比，3.72；95%置信区间，1.58 - 8.73）发生MACE的风险显著高于无LVH的非至轻度AoAC患者或有LVH的非至轻度AoAC患者（风险比，2.73；95%置信区间，1.16 - 6.46）。心血管死亡率和总死亡率也观察到类似趋势。
超声心动图LVH可能会改变ESKD患者中与血管钙化相关的不良心血管事件风险。旨在改善这两种疾病的干预措施可能会降低该人群的MACE风险。
