Association of aortic arch and aortic valve calcifications with cardiovascular risk in patients on maintenance hemodialysis

Min-Tser Liao; Chia-Ter Chao; Chung-Kuan Wu

doi:10.3389/fcvm.2022.1053265

Association of aortic arch and aortic valve calcifications with cardiovascular risk in patients on maintenance hemodialysis

Front Cardiovasc Med. 2022 Dec 6:9:1053265. doi: 10.3389/fcvm.2022.1053265. eCollection 2022.

Authors

Min-Tser Liao^{1

2}, Chia-Ter Chao^{3

4

5}, Chung-Kuan Wu^{6

7}

Affiliations

¹ Department of Pediatrics, Taoyuan Armed Forces General Hospital Hsinchu Branch, Hsinchu, Taiwan.
² Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan.
³ Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
⁴ Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan.
⁵ Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei City, Taiwan.
⁶ Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.
⁷ School of Medicine, Fu Jen Catholic University, New Taipei city, Taiwan.

Abstract

Introduction: This study aimed to investigate the association of aortic arch calcification (AoAC) and aortic valve calcification (AVC) with major adverse cardiovascular events (MACE) and cardiovascular and all-cause mortality in patients on maintenance hemodialysis (MHD).

Methods: This study enrolled 297 adult patients with end-stage kidney disease who were on MHD. They were divided into those with an AoAC score <2 without AVC (n = 70, 23.6%), those with an AoAC score <2 with AVC (n = 96, 32.3%), and those with an AoAC score ≥2 regardless of AVC status (n = 131, 44.1%). We analyzed the risks of MACE, cardiovascular and overall mortality among the three groups using Cox proportional hazard analyses. Survival probabilities were estimated using the log-rank test via the Kaplan-Meier method.

Results: Kaplan-Meier analysis revealed that the MACE-free rate and the survival rates of cardiovascular and overall mortality were significantly higher in adult chronic hemodialysis patients with AoAC score <2 without AVC, followed by those with AoAC score <2 with AVC, and then those with AoAC score ≥2 (log-rank test; all p < 0.01). The grade of AoAC is a significant risk factor for MACE, cardiovascular mortality, and overall mortality after adjusting for age and gender Relative to AoAC score <2 without AVC, adult chronic hemodialysis patients with AoAC score ≥2 remained an independently significantly risk factor of MACE (adjusted hazard ratio, 2.17; 95% confidence interval 1.11-4.20; p = 0.023) after adjusting for age, sex, and all significant variables in baseline characteristics.

Conclusion: AoAC grade was positively correlated with a higher risk of MACE and cardiovascular and overall mortality. Furthermore, the presence of AVC modified the adverse cardiovascular risk associated with AoAC in patients on MHD.

Keywords: aortic arch calcification; aortic arch calcification score; aortic valve calcification; maintenance hemodialysis; major adverse cardiovascular events.