Aortic arch calcification increases major adverse cardiac event risk, modifiable by echocardiographic left ventricular hypertrophy, in end-stage kidney disease patients

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

doi:10.1177/20406223231222817

Aortic arch calcification increases major adverse cardiac event risk, modifiable by echocardiographic left ventricular hypertrophy, in end-stage kidney disease patients

Ther Adv Chronic Dis. 2024 Jan 9:15:20406223231222817. doi: 10.1177/20406223231222817. eCollection 2024.

Authors

Chia-Ter Chao^{1

2

3}, Min-Tser Liao⁴, Chung-Kuan Wu^{5

6}

Affiliations

¹ Neprology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
³ Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Department of Pediatrics, Taoyuan Armed Forces General Hospital Taoyuan, Taiwan.
⁵ Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, NO.95, Wen-Chang Road, Shih-Lin District, Taipei 111, Taiwan.
⁶ School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan.

Abstract

Background: The factors affecting cardiovascular risk associated with vascular calcification in patients with chronic kidney disease are less well addressed. Distinct risk factors may contribute synergistically to this elevated cardiovascular risk in this population.

Objectives: We aimed to determine whether echocardiographic left ventricular hypertrophy (LVH) affects the risk of major adverse cardiac events (MACE) associated with vascular calcification in end-stage kidney disease (ESKD) patients.

Methods: In this retrospective cohort study, ESKD patients underwent chest radiography and echocardiography to assess aortic arch calcification (AoAC) and LVH, respectively, and were classified into three groups accordingly: non-to-mild AoAC without LVH, non-to-mild AoAC with LVH, and moderate-to-severe AoAC. The risks of MACE, cardiovascular mortality, and overall mortality were assessed using Cox proportional hazard analysis.

Results: Of the 283 enrolled ESKD patients, 44 (15.5%) had non-to-mild AoAC without LVH, 117 (41.3%) had non-to-mild AoAC with LVH, and 122 (43.1%) had moderate-to-severe AoAC. After 34.1 months, 107 (37.8%) participants developed MACE, including 6 (13.6%), 40 (34.2%), and 61 (50%) from each respective group. Those with moderate-to-severe AoAC (Hazard ratio, 3.72; 95% confidence interval, 1.58-8.73) had a significantly higher risk of MACE than did those with non-to-mild AoAC without LVH or with non-to-mild AoAC and LVH (Hazard ratio, 2.73; 95% confidence interval, 1.16-6.46). A similar trend was observed for cardiovascular and overall mortality.

Conclusion: Echocardiographic LVH could modify the risk of adverse cardiovascular events associated with vascular calcification in ESKD patients. Interventions aiming to ameliorate both morbidities might be translated into a lower MACE risk in this population.

Keywords: aortic calcification; chronic kidney disease; echocardiography; end-stage kidney disease; left ventricular hypertrophy; vascular calcification.