Prognostic value of valve calcification and high cardiothoracic ratio for major adverse cardiovascular events and mortality in hemodialysis patients

Q: What are the key findings of this study?

The coexistence of valve calcification and cardiothoracic ratio ≥ 0.5 was associated with a significantly increased risk of major adverse cardiovascular events (aHR 2.787) compared to patients with neither condition.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage kidney disease on maintenance hemodialysis (n=312). Intervention: Valve calcification and cardiothoracic ratio ≥ 0.5 vs. No valve calcification and cardiothoracic ratio < 0.5. Primary outcome: Major adverse cardiovascular events (MACEs) (aHR 2.787, 95% CI 1.140-6.817, p=0.025).

Q: What does this research mean for the field?

Coexisting valve calcification and a cardiothoracic ratio ≥0.5 identifies hemodialysis patients at high risk for major adverse cardiovascular events and mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wan‐Lun Hsu; Chen-Lien Hong; Yukiko Ono; Vy-Khanh Nguyen; Chung‐Kuan Wu

doi:10.1080/0886022x.2026.2659425

July 21, 2026Renal FailureOpen Access

Prognostic value of valve calcification and high cardiothoracic ratio for major adverse cardiovascular events and mortality in hemodialysis patients

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Key result

Valve calcification plus cardiothoracic ratio ≥0.5 is linked to ~179% higher MACE risk.

aHR 2.787
95% CI 1.140-6.817
P=0.025
n=312

Figures

Graphical abstract published by Renal Failure — Graphical abstract · Published by Renal Failure · CC BY-NC

Why the study?

Does the coexistence of valve calcification and cardiothoracic ratio ≥ 0.5 predict major adverse cardiovascular events and mortality in hemodialysis patients?

Key Points

To determine the prognostic value of concurrent valve calcification and an elevated cardiothoracic ratio (≥0.5) for major adverse cardiovascular events and mortality in maintenance hemodialysis patients.
Followed maintenance hemodialysis (MHD) patients for more than 3 years (over 40 months) to track major adverse cardiovascular events (MACEs), cardiovascular mortality, and overall mortality.
Stratified patients into four groups based on echocardiographic valve calcification (VC) status and chest radiographic cardiothoracic ratio (CTR <0.5 vs. CTR ≥0.5).
Compared survival distributions using Kaplan-Meier log-rank tests and calculated unadjusted and multivariable-adjusted hazard ratios using Cox proportional hazards regression models.
MACEs occurred in 125 (39.9%) patients over follow-up, with cumulative incidence ranging from 6 (15.8%) in the no VC with CTR <0.5 group to 67 (50.8%) in the VC with CTR ≥0.5 group (log-rank p = 0.025).
Having both VC and CTR ≥0.5 remained an independent predictor of MACEs after full multivariable adjustment (unadjusted HR 4.053, 95% CI 1.757–9.349; fully adjusted aHR 2.787, 95% CI 1.140–6.817).
Patients with both VC and CTR ≥0.5 had the highest cumulative incidence of CV mortality (35 [26.5%]; unadjusted HR 6.016, 95% CI 1.447–25.02; log-rank p = 0.004) and all-cause mortality (45 [34.1%]; unadjusted HR 3.869, 95% CI 1.319–10.76; log-rank p = 0.004), though associations became insignificant after full multivariable adjustment.

Study Design

Type

Cohort (n=312)

Multicenter

No

Structured PICO

Does the coexistence of valve calcification and cardiothoracic ratio ≥ 0.5 predict major adverse cardiovascular events and mortality in hemodialysis patients?

P

Population

312 patients with end-stage kidney disease on maintenance hemodialysis, mean age ~70 years, 47% female, followed for over 3 years.

E

Exposure

Presence of valve calcification (VC) and cardiothoracic ratio (CTR) ≥ 0.5

C

Comparator

Absence of valve calcification and/or CTR < 0.5 (categorized into four groups: no VC with CTR <0.5, no VC with CTR ≥0.5, VC with CTR <0.5, VC with CTR ≥0.5)

O

Outcome

Major adverse cardiovascular events (MACEs), defined as a composite of hospitalization for myocardial infarction, coronary revascularization, stroke, heart failure, or death from CV causescomposite

Main Result

Hazard Ratio: 2.787 (95% CI 1.14–6.817)

Absolute Event Rate: 50.8% vs 15.8%

p-value: p=0.025

The coexistence of valve calcification and cardiothoracic ratio ≥ 0.5 identifies hemodialysis patients at significantly elevated risk for major adverse cardiovascular events.

Limitations

Single-center, retrospective design
Restricted enrollment period of three months
Simplistic echocardiographic definition of valvular calcification
Lack of longitudinal data
Wide confidence intervals for CV mortality
Cross-sectional design cannot establish causal relationships or rule out reverse causality

Implication

May support risk stratification in hemodialysis patients; leaves open whether targeted interventions improve outcomes.

Abstract

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Discussion

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Cite This Study

Hsu et al. (2026) conducted a cohort in End-stage kidney disease on maintenance hemodialysis (n=312). Valve calcification and cardiothoracic ratio ≥ 0.5 vs. No valve calcification and cardiothoracic ratio < 0.5 was evaluated on Major adverse cardiovascular events (MACEs) (aHR 2.787, 95% CI 1.140-6.817, p=0.025). The coexistence of valve calcification and cardiothoracic ratio ≥ 0.5 was associated with a significantly increased risk of major adverse cardiovascular events (aHR 2.787) compared to patients with neither condition.

synapsesocial.com/papers/6a61b056faa9903c5116ae94 https://doi.org/10.1080/0886022x.2026.2659425

Topics

Valvular heart disease

Women and heart disease

Cardiovascular prevention

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Prognostic value of valve calcification and high cardiothoracic ratio for major adverse cardiovascular events and mortality in hemodialysis patients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Prognostic value of valve calcification and high cardiothoracic ratio for major adverse cardiovascular events and mortality in hemodialysis patients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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