J Korean Med Sci.  2012 Aug;27(8):870-875. 10.3346/jkms.2012.27.8.870.

Abdominal Aortic Calcification is Associated with Diastolic Dysfunction, Mortality, and Nonfatal Cardiovascular Events in Maintenance Hemodialysis Patients

• Yoon HE
• Chung S
• Whang HC
• Shin YR
• Hwang HS
• Chung HW
• Park CW
• Yang CW
• Kim YS
• Shin SJ

• KMID: 1714197
• DOI: http://doi.org/10.3346/jkms.2012.27.8.870

Abstract

This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio), a marker of LV diastolic function. The E/E' ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.

Keyword

Hemodialysis; Vascular Calcification; Ventricular Dysfunction, Left; Cardiovascular Diseases

MeSH Terms

Adult
Age Factors
Aged
Aged, 80 and over
Aorta, Abdominal
Blood Flow Velocity
Blood Pressure
Calcinosis/*etiology
Cardiovascular Diseases/*complications
Disease-Free Survival
Echocardiography
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/*complications/mortality
Male
Middle Aged
Predictive Value of Tests
Prognosis
Regression Analysis
Renal Dialysis
Risk Factors
Tomography, X-Ray Computed
Ventricular Dysfunction, Left/complications/*physiopathology

Figure

• 

  Fig. 1 Correlation between the aortic calcification index (ACI) and left ventricular diastolic dysfunction. The ACI showed negative correlations with left ventricular end-diastolic volume (LVEDV, A) and left ventricular stroke volume (LVSV, B). The ACI showed positive correlations with mitral valve peak late diastolic flow velocity (MV-A, C) and a ratio of peak early transmitral flow velocity (E) to peak early diastolic mitral annular velocity (E') (E/E' ratio, D).

• 

  Fig. 2 Comparison of event-free survival rates for all-cause mortality and nonfatal cardiovascular (CV) events between the low-aortic calcification index (ACI) group and the high-ACI group. Note that the event-free survival rates for the high-ACI group were significantly lower than the low-ACI group at 5 yr (P = 0.001).

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