Key result
Co-existing moderate-to-severe aortic arch calcification and concentric left ventricular hypertrophy significantly increased the risk of cardiovascular mortality (HR 5.01) compared to non-to-mild calcification and eccentric hypertrophy in patients with end-stage kidney disease.
Why the study?
It remained unclear whether LVH geometry co-modulates cardiovascular outcomes with vascular calcification in patients with ESKD.
Does the combination of moderate-to-severe aortic arch calcification and concentric LVH increase cardiovascular mortality in patients with ESKD on hemodialysis?
Cohort (n=223)
No
Does the combination of moderate-to-severe aortic arch calcification and concentric LVH increase cardiovascular mortality in patients with ESKD on hemodialysis?
Hazard Ratio: 5.01 (95% CI 2.38–10.52)
Absolute Event Rate: 41.1% vs 13.5%
p-value: p=0.002
Co-existing severe vascular calcification and concentric LVH significantly aggravates cardiovascular and all-cause mortality risk in patients with ESKD on hemodialysis.
AIM: Patients with end-stage kidney disease (ESKD) have an unparalleled risk of left ventricular hypertrophy (LVH) and vascular calcification (VC), both of which introduce excessive cardiovascular risk. However, it remains unclear whether LVH geometry co-modulates cardiovascular outcomes with VC in this population. METHODS: A retrospective cohort study was conducted. Patients with ESKD requiring chronic hemodialysis were identified from Shin Kong Wu Ho-Su Memorial Hospital between October and December 2018, with echocardiographic LVH geometry and aortic arch calcification (AoAC) determined. They were divided into four groups according to AoAC severity and eccentric or concentric LVH. We used Kaplan-Meier analysis and Cox proportional hazard regression to analyze their cardiovascular and all-cause mortality after multivariate adjustment. RESULTS: Overall, 223 patients with ESKD with LVH were analyzed, among whom 29.1%, 23.3%, 25.1%, and 22.4% had non-to-mild AoAC with eccentric and concentric LVH and moderate-to-severe AoAC with eccentric and concentric LVH, respectively. After 3.5 years of follow-up, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher risk of cardiovascular mortality than those with non-to-mild AoAC and eccentric LVH (hazard ratio 3.35, p=0.002). However, those with moderate-to-severe AoAC but eccentric LVH did not have higher cardiovascular mortality. Similarly, patients with ESKD with moderate-to-severe AoAC and concentric LVH had a significantly higher all-cause mortality than those with non-to-mild AoAC and eccentric LVH, whereas the other two groups did not have higher risk. CONCLUSION: LVH geometry could help stratify the risk of patients with ESKD when they had severe VC, and co-existing severe VC and concentric LVH aggravated cardiovascular risk.
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Chao et al. (2022) conducted a cohort in End-Stage Kidney Disease with Left Ventricular Hypertrophy (n=223). Moderate-to-severe aortic arch calcification and concentric left ventricular hypertrophy vs. Non-to-mild aortic arch calcification and eccentric left ventricular hypertrophy was evaluated on Cardiovascular mortality (HR 5.01, 95% CI 2.38-10.52, p=0.002). Co-existing moderate-to-severe aortic arch calcification and concentric left ventricular hypertrophy significantly increased the risk of cardiovascular mortality (HR 5.01) compared to non-to-mild calcification and eccentric hypertrophy in patients with end-stage kidney disease.
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