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Updated: May 22, 2026
Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Vascular calcification estimated by aortic calcification area index is a significant predictive parameter of
Masaki Ohya1, Haruhisa Otani, Keigo Kimura
1Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan. m-ohya@384.jp
Insights
High aortic calcification area index (ACAI) in hemodialysis patients strongly correlates with increased mortality, especially cardiovascular death. ACAI serves as a valuable prognostic tool for these individuals.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Radiology
Background:
- Vascular calcification is a key feature of arteriosclerosis, progressing rapidly in hemodialysis (HD) patients.
- The aortic calcification area index (ACAI) quantifies vascular calcification.
Purpose of the Study:
- To evaluate vascular calcification factors in HD patients using ACAI.
- To investigate the correlation between ACAI and long-term prognosis.
- To assess the relationship between various factors and long-term prognosis in HD patients.
Main Methods:
- 137 maintenance HD patients were included.
- Abdominal CT scans measured ACAI; patients were grouped as high (H) or low (L) based on the mean value (21.4%).
- Long-term all-cause and cardiovascular death rates were compared, and risk factors analyzed using Cox hazard analysis.
Main Results:
- During a mean follow-up of 95.3 months, 76 patients died (46 cardiovascular deaths).
- Group H (70 patients) had significantly higher all-cause (67.1%) and cardiovascular (51.4%) death rates compared to Group L (67 patients; 37.3% and 14.9%, respectively).
- Multivariate analysis identified ACAI (%) as a significant prognostic indicator for cardiovascular death (HR 1.03, P=0.03).
Conclusions:
- Elevated ACAI is strongly associated with increased mortality rates in HD patients.
- ACAI is a significant predictor of long-term cardiovascular mortality in this population.
- ACAI is a useful prognostic indicator for long-term outcomes in hemodialysis patients.
Background:
Vascular calcification is a feature of arteriosclerosis. In hemodialysis (HD) patients, vascular calcification progresses rapidly. This study used the aortic calcification area index (ACAI), an index of vascular calcification, to evaluate vascular calcification factors in HD patients, to investigate correlations between ACAI and long-term prognosis and to assess correlations between various factors and long-term prognosis.
Methods:
Subjects comprised 137 patients on maintenance HD. ACAI was measured as an index of vascular calcification as measured by abdominal plain computed tomography. The patients were divided into a high ACAI (H) group and a low ACAI (L) group according to whether the ACAI was below or above the mean value (21.4%) of ACAI, and long-term all-cause death and cardiovascular death rates were compared between groups. Risk factors for all-cause death and cardiovascular death were examined by Cox hazard analysis.
Results:
During follow-up (mean follow-up period 95.3 ± 50.3 months), 76 patients died, including 46 cardiovascular deaths. Deaths included 51 of 70 patients (67.1%) in Group H and 25 of 67 patients (37.3%) in Group L. Cardiovascular death rates were 51.4 and 14.9%, respectively. On Kaplan-Meier analysis, the number of all-cause deaths was significantly higher in Group H (P < 0.001, log-rank test). Similarly, the number of cardiovascular deaths was significantly higher in Group H. Multivariate Cox proportional hazards analysis showed that ACAI (%) was a significant prognostic indicator for cardiovascular death (hazard ratio 1.03; 95% confidence interval 1.00-1.06, P = 0.03).
Conclusion:
High ACAI was clearly correlated with mortality rate in HD patients, particularly cardiovascular mortality rate. ACAI was a useful long-term prognostic indicator in HD patients.
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