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Accelerated progression of calcific aortic stenosis in dialysis patients
Vlado Perkovic1, David Hunt, Sian V Griffin
1Department of Nephrology, Royal Melbourne Hospital, Parkville, Vic., Australia. vlado@perkovic.net
Insights
Patients with renal failure experience faster progression of aortic stenosis. This finding suggests that dialysis patients require more frequent monitoring and potentially earlier intervention for aortic valve disease compared to the general population.
Area of Science:
- Cardiology
- Nephrology
- Valvular Heart Disease
Background:
- Aortic valve abnormalities are common in patients with renal failure, contributing to increased cardiovascular mortality.
- Limited data exist on the progression rate of aortic stenosis in this high-risk group.
Purpose of the Study:
- To compare the rate of aortic stenosis progression in dialysis patients versus sex-matched controls.
- To identify factors associated with accelerated aortic stenosis progression in end-stage renal disease.
Main Methods:
- Retrospective case-control study design.
- Comparison of 28 dialysis patients with 56 sex-matched controls diagnosed with aortic stenosis.
- Analysis of serial echocardiographic data (mean/peak transvalvular gradient, valve area) over at least 6 months.
Main Results:
- Aortic stenosis progressed significantly faster in dialysis patients (change in valve area: -0.19 vs. -0.07 cm²/year; change in peak gradient: 6.5 vs. 3.9 mm Hg/year).
- End-stage renal failure and baseline valve area were independent predictors of accelerated aortic stenosis progression.
- A trend towards more rapid progression of mean transvalvular gradient was observed in dialysis patients (4.9 vs. 2.5 mm Hg/year).
Conclusions:
- Renal failure accelerates the progression of aortic stenosis.
- Dialysis patients with aortic stenosis warrant shorter surveillance intervals and potentially earlier surgical consideration than the general population.
Background:
Abnormalities of the aortic valve occur with increased frequency in patients with renal failure and may contribute to the observed excess cardiovascular mortality. Little data exist on the rate at which aortic stenosis progresses in this patient group.
Methods:
A retrospective case-control study was designed to compare the rate of progression of aortic stenosis in dialysis patients with that in sex-matched controls. Dialysis patients with aortic stenosis were identified by a search of the echocardiography database. Twenty-eight dialysis patients were compared to 56 sex-matched controls, all of whom had aortic stenosis on at least two echocardiograms 6 months apart. Changes in mean and peak transvalvular gradient as well as valve area were calculated from echocardiographic data and compared.
Results:
Aortic stenosis progressed more rapidly in the dialysis patients than in the controls when measured by change in valve area (-0.19 vs. -0.07 cm2/year; p < 0.001) and change in peak transvalvular gradient (6.5 vs. 3.9 mm Hg/ year; p = 0.04). There was also a trend towards more rapid progression of mean transvalvular gradient (4.9 vs. 2.5 mm Hg/year; p = 0.052). On multivariate linear regression analysis, only end-stage renal failure (p = 0.02) and baseline valve area (p = 0.04) predicted accelerated progression of aortic stenosis.
Conclusions:
Aortic stenosis progressed more rapidly in the presence of renal failure. The time frames for review and operation in dialysis patients should be shorter than for the general population.