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Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
Insights
Coronary artery calcification (CAC) in chronic kidney disease patients on hemodialysis is linked to impaired cardiac function and increased mortality. Echocardiography can identify these risks, aiding patient management.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Coronary artery calcification (CAC) is prevalent in patients with chronic kidney disease on hemodialysis (CKD-5D).
- CAC is a significant predictor of mortality in this population.
- The precise cardiac functional mechanisms linking CAC to mortality in CKD-5D remain unclear.
Purpose of the Study:
- To investigate the relationship between CAC and cardiac function in patients with CKD-5D.
- To determine if CAC adversely affects left ventricular (LV) systolic and diastolic function.
- To assess the impact of these cardiac functional changes on mortality.
Main Methods:
- Echocardiographic analysis (2-D and Doppler) and 64-slice computed tomography for CAC measurement were performed in 157 CKD-5D patients.
- Statistical analyses examined associations between CAC scores and LV function parameters (e.g., global longitudinal strain, peak LV systolic velocity, E:E').
- Survival analysis with a median follow-up of 37 months assessed mortality predictors.
Main Results:
- A high prevalence of significant CAC was observed (69% with scores ≥100, 51% with scores ≥400).
- CAC was significantly associated with impaired LV systolic and diastolic function, including global longitudinal strain (GLS) and E:E' (LV filling pressure).
- LV diastolic dysfunction and reduced peak LV systolic velocity were strong, independent predictors of mortality.
Conclusions:
- This study establishes a clear link between CAC, impaired cardiac function, and increased mortality in CKD-5D patients.
- LV diastolic function, peak LV systolic velocity, and GLS are identified as independent mortality predictors.
- Echocardiography may play a crucial role in managing CKD-5D patients by assessing CAC-related cardiac risks.
Background:
Coronary artery calcification (CAC) is common in patients with chronic kidney disease on hemodialysis (CKD-5D) and is an important predictor of mortality. However, cardiac functional links between CAC and mortality have not been well established. This study tested the hypothesis that CAC increases mortality by adversely affecting cardiac function.
Methods:
Patients were recruited from 37 regional dialysis centers. 2-D and Doppler echocardiographic analyses were performed, and CAC was measured using 64-slice computed tomography. Relationships between CAC and echocardiographic measures of left ventricular (LV) function were analyzed. Survival was assessed with median follow-up of 37 months.
Results:
There were 157 patients: 59% male, 46% Caucasian, 48% diabetic. Median age was 55 years, and median duration of CKD-5D was 45 months. Agatston CAC scores 100 were found in 69% of patients, with 51% having a score 400. CAC was associated with measures of LV systolic and diastolic function (global longitudinal strain (GLS; rho = 0.270, p = 0.004)), peak LV systolic velocity (rho = -0.259, p = 0.004), and estimate of LV filling pressure (E:E'; rho = 0.286, p = 0.001). Multivariate regression confirmed these relationships after adjustment for age, gender, LV ejection fraction, and coronary artery disease. Valvular calcification varied linearly with CAC (p < 0.05). Both LV diastolic and systolic functional measures were significant predictors of mortality, the strongest of which was LV diastolic dysfunction.
Conclusions:
These findings show a link between CAC, cardiac function, and mortality in CKD-5D. LV diastolic function (E:E'), peak LV systolic velocity, and GLS are independent predictors of mortality. Valvular calcification may be an important marker of CAC in CKD-5D. These effects on cardiac function likely explain the high mortality with CKD-5D and describe a potentially-valuable role for echocardiography in the routine management of these patients. .
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