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Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality

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...

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Autores principales: Anaya, Paul, Blomquist, Gustav A., Davenport, Daniel L., Monier-Faugere, Marie-Claude, Sorrell, Vincent L., Malluche, Hartmut H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dustri-Verlag Dr. Karl Feistle 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467156/
https://www.ncbi.nlm.nih.gov/pubmed/27805564
http://dx.doi.org/10.5414/CN108940
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author Anaya, Paul
Blomquist, Gustav A.
Davenport, Daniel L.
Monier-Faugere, Marie-Claude
Sorrell, Vincent L.
Malluche, Hartmut H.
author_facet Anaya, Paul
Blomquist, Gustav A.
Davenport, Daniel L.
Monier-Faugere, Marie-Claude
Sorrell, Vincent L.
Malluche, Hartmut H.
author_sort Anaya, Paul
collection PubMed
description 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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spelling pubmed-54671562017-06-13 Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality Anaya, Paul Blomquist, Gustav A. Davenport, Daniel L. Monier-Faugere, Marie-Claude Sorrell, Vincent L. Malluche, Hartmut H. Clin Nephrol Research Article 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. Dustri-Verlag Dr. Karl Feistle 2016-12 2016-11-02 /pmc/articles/PMC5467156/ /pubmed/27805564 http://dx.doi.org/10.5414/CN108940 Text en © Dustri-Verlag Dr. K. Feistle http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Anaya, Paul
Blomquist, Gustav A.
Davenport, Daniel L.
Monier-Faugere, Marie-Claude
Sorrell, Vincent L.
Malluche, Hartmut H.
Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
title Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
title_full Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
title_fullStr Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
title_full_unstemmed Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
title_short Coronary artery calcification in CKD-5D patients is tied to adverse cardiac function and increased mortality
title_sort coronary artery calcification in ckd-5d patients is tied to adverse cardiac function and increased mortality
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467156/
https://www.ncbi.nlm.nih.gov/pubmed/27805564
http://dx.doi.org/10.5414/CN108940
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