Association of Pulse Wave Velocity with Vascular and Valvular Calcification in Hemodialysis Patients

1
Association of Pulse Wave Velocity with Vascular
and Valvular Calcification in Hemodialysis
Patients
P. Raggi MD1 A. Bellasi, MD1,2 E. Ferramosca,
MD3 T. Islam, PhD5 P. Muntner Paul,
PhD5 G.A. Block, MD4 1Division of Cardiology
and Department of Medicine and Radiology, Emory
University School of Medicine, Atlanta, GA
2Department of Nephrology, Ospedale San Paolo and
University of Milan, Milan, Italy 3Department of
Nephrology, Ospedale Malpighi and University of
Bologna, Bologna, Italy 4Denver Nephrology, PC,
Denver, CO 5Department of Epidemiology, Tulane
University, New Orleans, LA
Kidney International 2007 71(8) 802-7. Epub
2007 Feb 21
2
Disclosure information
Research supported by Genzyme Therapeutics
3
All-Cause and CV Mortality and Glomrular
Filtration Rate (GFR)
All cause of mortality
CV Events
Hospitalization
Adjusted risk
N1.120.295
GFR 45-59 ml/min/1.73m2
GFR 30-44 ml/min/1.73m2
GFR 15-29 ml/min/1.73m2
GFR lt15 ml/min/1.73m2
Go et al. N. Engl J Med, 3511296-305,2004
4
Vascular Calcifications Portend Poor Prognosis in
CKD-5 Patients
Block al. Kidney International 200771438-41
5
Impact of Aortic Stiffness on Survival in
End-Stage Renal Disease
PWV pulse wave velocity
Blacher et al. Circulation 1999 992434-2439
6
Aim of the study
To further investigate the relationship between
presence and extent of cardiovascular
calcification assessed radiologically and
vascular stiffness
Raggi et al. Kidney International 2007
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Study Design
D.O.V.E. (Dialysis Outcome, Vascular Evaluation)
Multicenter, cross-sectional, one-arm, non
invasive study of cardiovascular disease in
chronic dialysis patients
131 patients patients on maintenance dialysis
(more than 3 months) from 2 centers (New Orleans,
LA Denver, CO) underwent

• PWV assessment for vascular stiffness
• Echocardiography to assess presence of valvular
  calcification
• Chest CT to measure coronary and thoracic aorta
  calcification
• Lateral-lumbar X-Ray to assess the presence of
  abdominal
• aorta calcification

Raggi et al. Kidney International 2007
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Methods arterial stiffness
Aortic Pulse Wave Velocity (aPWV) was assessed
by applanation tonometry with the Sphygmocor Vx
Software (AtCor Medical, Sydney, Au)
Raggi et al. Kidney International 2007
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Methods valvular calcification
Bi-dimensional echocardiographic studies were
performed utilizing Sequoia 512 (Siemens,
Erlangen, Germany) or Vivid 7 (General Electric,
Milwaukee, WI) equipment. Aortic and mitral valve
calcification were simply assessed as present or
absent without applying any quantification method
Raggi et al. Kidney International 2007
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Methods Coronary Arteries and Thoracic Aorta
Calcification
Coronary Artery Calcium Score (CAC) and Aorta
Calcium Score (AoC) were assessed by Electron
Beam Computed Tomography (EBCT) (GE-Imatron, San
Francisco, CA) The total calcium score for the
coronary arteries and the thoracic aorta was
calculated according to the Agatston method
Raggi et al. Kidney International 2007
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Methods Abdominal Aorta Calcification
Abdominal Aorta calcification were measured by
Plain X-Ray film via the Kauppilas
method (Kauppila et al Atherosclerosis
1997132235-240)
Raggi et al. Kidney International 2007
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Demographic and Clinical Data for the Study
Cohort by PWV Category (high vs low)
13
Concomitant Medication Use
Raggi et al. Kidney International 2007
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Median Coronary Artery and Thoracic Aorta Calcium
Scores by PWV Category
p0.002
2
0
0
0
1
8
5
2
.
0
1
8
0
0
1
6
0
0
1
4
0
0
1
2
0
0
Median Calcium Score
P
W
V

lt
1
2

m
/
s
1
0
0
0
P
W
V


gt
1
2

m
/
s
p0.307
8
0
0
6
0
0
4
7
0
.
1
3
2
3
.
3
4
0
0
1
6
1
.
5
2
0
0
0
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y

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y

C
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e
Raggi et al. Kidney International 2007
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Mean PWV at Various Levels of Vascular
Calcification and With Different Techniques
Raggi et al. Kidney International 2007
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Multivariate-Adjusted Prevalence Rate Ratio of
PWVgt12 m/sec Associated with Increased Vascular
Calcification
Adjusted for age, race, diabetes mellitus, pulse
pressure, systolic blood pressure and use of
calcium acetate
Raggi et al. Kidney International 2007
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Strengths and limitations

• Strengths
• First study to investigate the association
  between arterial stiffness (PWV) and
  cardiovascular calcification (vascular and
  valvular) in hemodialysis patients
• The largest and the most homogeneous group of
  hemodialysis patients studied with a variety of
  diagnostic tools
• Limitations
• Cross sectional study
• Relatively small sample size might have prevented
  some of the detected association from being
  statistically significant at the Plt0.05 level

Raggi et al. Kidney International 2007
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Conclusions

• PWV is closely associated with radiological
  measures of abdominal aorta calcification even
  when assessed by plain X-Ray films, and less
  strongly associated with thoracic aorta and
  coronary artery calcification
• These data provide evidence of a good
  correspondence between functional and structural
  assessment of vascular disease in CKD-5

Raggi et al. Kidney International 2007