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Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Aortic calcification predicts cardiovascular events and all-cause mortality in renal transplantation
Stephanie S DeLoach1, Marshall M Joffe, Xingchen Mai
1Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Insights
Aortic calcification is common in kidney transplant patients and predicts future cardiovascular events. This finding aids in assessing cardiovascular risk for these individuals.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Cardiovascular disease is a major cause of death in renal transplant recipients.
- Aortic calcification is linked to mortality in dialysis patients, but its role in transplant recipients is unclear.
- This study investigated aortic calcification in asymptomatic incident renal transplant recipients.
Purpose of the Study:
- To prospectively assess the association between aortic calcification and cardiovascular events.
- To determine the relationship between aortic calcification and all-cause mortality in renal transplant recipients.
- To identify aortic calcification as a risk factor for cardiovascular events in this population.
Main Methods:
- 112 renal transplant recipients underwent electron beam computed tomography (EBCT) for aortic calcification scoring using the Agatston method.
- Follow-up averaged 5.1 years, during which cardiovascular events and all-cause mortality were recorded.
- The study analyzed the predictive value of aortic calcification for cardiovascular events and survival.
Main Results:
- 34% of recipients had aortic calcification; 12 cardiovascular events and 10 deaths occurred during follow-up.
- Aortic calcification was significantly associated with a higher incidence of cardiovascular events (23.7% vs. 4.1%, P=0.001).
- Aortic calcification score independently predicted survival (HR 1.15, P=0.01), along with diabetes; dialysis vintage predicted combined events and mortality.
Conclusions:
- Aortic calcification is prevalent in renal transplant recipients and predicts future cardiovascular events.
- Non-invasive identification of aortic calcification is feasible and valuable for cardiovascular risk assessment.
- Aortic calcification should be considered in the cardiovascular risk stratification of asymptomatic renal transplant recipients.
Background:
Cardiovascular disease is a leading cause of death among renal transplant recipients. Aortic calcification is associated with increased mortality in dialysis subjects. The significance of aortic calcification among renal transplant recipients is unknown. Our objective was to prospectively examine the association of aortic calcification with cardiovascular events and all-cause mortality among asymptomatic incident renal transplant recipients.
Methods:
One hundred and twelve renal transplant recipients underwent electron beam computed tomography. Aortic calcification was scored by the Agatston method. The mean follow-up time was 5.1 years. Cardiovascular events (heart failure, coronary artery disease, peripheral arterial disease and stroke) and all-cause mortality were recorded.
Results:
The cohort consisted of 62% Caucasians, 38% African Americans and 62% male gender. The mean age was 49.0 +/- 12.5 years. Thirty-four percent had aortic calcification. During follow-up, 12 cardiovascular events and 10 deaths were recorded. Subjects with aortic calcification had more cardiovascular events compared to those without aortic calcification (23.7 versus 4.1%, P = 0.001). Recipients with aortic calcification had higher mortality compared to those without aortic calcification but it did not reach statistical significance (15.8 versus 5.4%, P = 0.07). The univariate hazard ratio of aortic calcification score in a proportional hazard Cox model to assess event-free survival was 1.15 (1.04-1.27, P = 0.01). Diabetes and aortic calcification score were independently associated with survival. In addition to the predictors above, dialysis vintage was an independent predictor for combined future cardiovascular event and mortality.
Conclusions:
In conclusion, aortic calcification is prevalent among renal transplant recipients and is predictive of future cardiovascular events. Aortic calcification is easily identified by non-invasive testing, and should be considered when assessing cardiovascular risk in asymptomatic renal transplant recipients.
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