Low skeletal muscle density is independently associated with cardiac valve calcification in dialysis patients

Figures

• 

  FIGURE 1. Flowchart of patient selection in the cross-sectional study. From 2,772 dialysis patients, 2,140 were eligible for inclusion.

• 

  FIGURE 2. Distribution of calcified valves by SMD quartiles separated by sex. Figure 2 shows the percentage of patients with different numbers of calcified valves across SMD quartiles, separated by sex. Quartiles Q1 to Q4 represent increasing levels of SMD. Different colors of the bars represent the number of calcified valves. The data illustrate that lower SMD quartiles have a higher prevalence of calcified valves, with prevalence decreasing as SMD increases. SMD, skeletal muscle density.

• 

  FIGURE 3. Odds Ratios (95% CIs) of CVC According to SMD Model 1: adjusted for SMI, age, and sex. Model 2: adjusted for all the covariates included in model 1 and additionally adjusted for BMI, smoking history, dialysis duration, hypertension, and diabetes. Model 3: included all the covariates from model 2 and additionally adjusted for WBC (log WBC), TG [log(TG + 1)], LDL-C, iPTH (log iPTH), serum phosphate, corrected serum calcium, and Vitamin D use. CVC indicates cardiac valve calcification; SMD, skeletal muscle density; SMI, skeletal muscle index; BMI, body mass index; WBC, white blood cell count; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; iPTH, intact parathyroid hormone; CI, confidence interval. The SMD variation is expressed per 1 standard deviation decrease. P for trend: Model 1: P < 0.001; Model 2: P = 0.009; Model 3: P = 0.017.

• 

  FIGURE 4. Illustrative Diagram of the Relationship Between SMD and the Presence of Valve Calcification (A) A 69-year-old male underwent a chest CT showing L1 SMD = 17.6 HU, (B) followed by transthoracic echocardiography in parasternal short-axis view demonstrating aortic valve calcification (white arrow), and (C) concurrent calcification of the mitral valve leaflets (white arrow) and mitral valve annulus (yellow arrow). (D) Another 69-year-old male with chest CT showing L1 SMD = 49.7 HU, (E) transthoracic echocardiography in the same view showing no aortic valve calcification, and (F) no calcification in the mitral valve leaflets or annulus. SMD indicates skeletal muscle density; L1, the first lumbar vertebra.

• 

  FIGURE 5. Diagnostic Performance of SMD for CVC Risk in the Entire Population and across Sexes SMD indicates skeletal muscle density; CVC, cardiac valve calcification; AUC, area under the curve. All diagnostic P-values are less than 0.001.