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Combined Effects of Pulmonary Hypertension and Heart Valve Calcification on Cardiovascular Outcomes in Maintenance
Xinyi Fu1, Chenyu Lei2, Anning Xu1
1Department of Nephrology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
The combination of pulmonary hypertension (PH) and heart valve calcification (HVC) significantly increases cardiovascular risk in maintenance hemodialysis (MHD) patients. Echocardiography can identify these risks for better patient stratification.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Cardiovascular disease is the leading cause of mortality in maintenance hemodialysis (MHD) patients.
- Pulmonary hypertension (PH) and heart valve calcification (HVC) are known independent risk factors for adverse outcomes in MHD.
- The combined impact of PH and HVC on cardiovascular prognosis in MHD patients is not well understood.
Purpose of the Study:
- To investigate the synergistic effect of PH and HVC on cardiovascular outcomes in MHD patients.
- To evaluate the combined risk of PH and HVC for all-cause mortality, cardiovascular mortality, and new-onset cardiovascular events.
- To assess the utility of echocardiography for risk stratification in MHD patients.
Main Methods:
- Prospective study of 302 MHD patients with a two-year follow-up.
- Stratification into three groups: no risk factors, either PH or HVC, and both PH and HVC.
- Survival analysis using Kaplan-Meier curves and Cox regression models.
Main Results:
- Patients with both PH and HVC had significantly higher cardiovascular mortality (30.2%) and new-onset CV events (67.4%) compared to those with neither (5.1% and 20.3%, respectively).
- The combination of PH and HVC was a significant predictor of increased risk for all-cause mortality (HR: 3.76), cardiovascular mortality (HR: 9.23), and CV events (HR: 4.21) after adjusting for confounders.
- Having both PH and HVC conferred a substantially higher risk than having either condition alone.
Conclusions:
- The coexistence of PH and HVC significantly elevates cardiovascular risk in MHD patients.
- Echocardiography is crucial for identifying PH and HVC, aiding in risk stratification for this high-risk population.
Introduction:
Cardiovascular disease remains the leading cause of mortality in maintenance hemodialysis (MHD) patients. While both pulmonary hypertension (PH) and heart valve calcification (HVC) are established independent risk factors for adverse outcomes in this population, the synergistic effect of these two echocardiographic parameters on cardiovascular prognosis has not been well investigated.
Methods:
In this prospective study, we analyzed clinical and echocardiographic data from 302 MHD patients over a two-year follow-up period. Patients were stratified into three groups based on the presence of risk factors: group 1 (no risk factors), group 2 (either PH or HVC), and group 3 (both PH and HVC). Survival analysis was performed using Kaplan-Meier curves, and Cox regression models were employed to evaluate the impact on all-cause mortality, cardiovascular mortality, and new-onset cardiovascular events (CV events).
Results:
During follow-up, 63 patients (20.9%) died from all causes, with 36 deaths (57.1%) attributed to CV events. Cardiovascular mortality was significantly higher in groups 2 (13.2%) and 3 (30.2%) compared to group 1 (5.1%; p < 0.001). New-onset CV events occurred in 33.1% of patients, with rates of 20.3%, 35.5%, and 67.4% in groups 1, 2 and 3, respectively (p < 0.001). The presence of both PH and HVC was associated with a higher risk of all-cause mortality, cardiovascular mortality, and new-onset CV events compared to either PH or HVC alone. After adjusting for confounders, the combination of PH and HVC remained a significant predictor, demonstrating a higher risk than having a single risk factor (hazard ratio [HR] for all-cause mortality: 3.76 [95% CI: 1.83-7.73] vs. 1.90 [95% CI: 1.03-3.52]; HR for cardiovascular mortality: 9.23 [95% CI: 3.42-24.95] vs. 3.11 [95% CI: 1.23-7.84]; HR for new-onset CV events: 4.21 [95% CI: 2.39-7.21] vs. 1.68 [95% CI: 1.01-2.76]).
Conclusion:
The coexistence of PH and HVC significantly increases cardiovascular risk compared to either condition alone in MHD patients. Echocardiography is a valuable tool for screening and risk stratification in this high-risk population by identifying both PH and HVC.
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