(Circulation. 1999;99:2434-2439.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Aortic Stiffness on Survival in End-Stage Renal Disease
From the Service de Médecine, Hôpital Broussais, Paris (J.B., M.E.S.), and the Hôpital F.H. Manhès, Fleury-Mérogis (A.P.G., B.P., S.J.M., G.M.L.), France.
Correspondence to Dr Gérard London, CH Manhès, 8, Grande Rue, Fleury-Mérogis, 91712 Ste/Geneviève des Bois, France.
Background—Damage to large arteries is a major factor in the high cardiovascular morbidity and mortality of patients with end-stage renal disease (ESRD). Increased arterial stiffness and intima-media thickness, together with increased pulse pressure, are the principal arterial alterations. Whether increased aortic pulse-wave velocity (PWV), a classic marker of increased arterial stiffness, may predict all-cause and/or cardiovascular mortality has never been investigated.
Methods and Results—A cohort of 241 patients with ESRD undergoing hemodialysis was studied between April 1987 and April 1998. The mean duration of follow-up was 72±41 months (mean±SD). Mean age at entry was 51.5±16.3 years. Seventy-three deaths occurred, including 48 cardiovascular and 25 noncardiovascular fatal events. At entry, together with standard clinical and biochemical analyses, patients underwent echocardiography and aortic PWV measured by Doppler ultrasonography. On the basis of Cox analyses, 2 factors emerged as predictors of all-cause and cardiovascular mortality: age and aortic PWV. Hemoglobin and low diastolic pressure interfered to a smaller extent. After adjustment for all the confounding factors, an OR for PWV >12.0 versus <9.4 m/s was 5.4 (95% CI, 2.4 to 11.9) for all-cause mortality and 5.9 (95% CI, 2.3 to 15.5) for cardiovascular mortality. For each PWV increase of 1 m/s in our study population, all-cause mortality–adjusted OR was 1.39 (95% CI, 1.19 to 1.62).
Conclusions—These results provide the first direct evidence that in patients with ESRD, increased aortic stiffness determined by measurement of aortic PWV is a strong independent predictor of all-cause and mainly cardiovascular mortality.
Key Words: aorta • survival • kidney
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 A. R. Khoshdel, S. L. Carney, B. R. Nair, and A. Gillies Better Management of Cardiovascular Diseases by Pulse Wave Velocity: Combining Clinical Practice with Clinical Research using Evidence-Based Medicine Clin. Med. Res., March 1, 2007; 5(1): 45 - 52. [Abstract] [Full Text] [PDF]
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K. Noma, C. Goto, K. Nishioka, D. Jitsuiki, T. Umemura, K. Ueda, M. Kimura, K. Nakagawa, T. Oshima, K. Chayama, et al. Roles of Rho-Associated Kinase and Oxidative Stress in the Pathogenesis of Aortic Stiffness J. Am. Coll. Cardiol., February 13, 2007; 49(6): 698 - 705. [Abstract] [Full Text] [PDF]
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 A. D. Achimastos, S. P. Efstathiou, T. Christoforatos, T. N. Panagiotou, G. S. Stergiou, and T. D. Mountokalakis Arterial Stiffness: Determinants and Relationship to the Metabolic Syndrome Angiology, February 1, 2007; 58(1): 11 - 20. [Abstract] [PDF]
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 J. Cameron Ageing and central aortic pulse wave analysis. Commentary on 'Is Augmentation Index a Good Measure of Vascular Stiffness in the Elderly?' by Fantin et al. Age Ageing, January 1, 2007; 36(1): 3 - 5. [Full Text] [PDF]
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G. Fernandez-Fresnedo, E. Rodrigo, A. L. M. de Francisco, S. S. de Castro, O. Castaneda, and M. Arias Role of Pulse Pressure on Cardiovascular Risk in Chronic Kidney Disease Patients J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S246 - S249. [Abstract] [Full Text] [PDF]
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 S. Laurent, J. Cockcroft, L. Van Bortel, P. Boutouyrie, C. Giannattasio, D. Hayoz, B. Pannier, C. Vlachopoulos, I. Wilkinson, H. Struijker-Boudier, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications Eur. Heart J., November 1, 2006; 27(21): 2588 - 2605. [Abstract] [Full Text] [PDF]
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N.C. Edwards, R.P. Steeds, C.J. Ferro, and J.N. Townend The treatment of coronary artery disease in patients with chronic kidney disease QJM, November 1, 2006; 99(11): 723 - 736. [Abstract] [Full Text] [PDF]
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C Vlachopoulos, K Aznaouridis, and C Stefanadis Clinical appraisal of arterial stiffness: the Argonauts in front of the Golden Fleece Heart, November 1, 2006; 92(11): 1544 - 1550. [Abstract] [Full Text] [PDF]
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 N Bjarnegard, C Bengtsson, J Brodszki, G Sturfelt, O Nived, and T Lanne Increased aortic pulse wave velocity in middle aged women with systemic lupus erythematosus Lupus, October 1, 2006; 15(10): 644 - 650. [Abstract] [PDF]
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A. Covic, N. Mardare, P. Gusbeth-Tatomir, O. Prisada, R. Sascau, and D. J. A. Goldsmith Arterial wave reflections and mortality in haemodialysis patients--only relevant in elderly, cardiovascularly compromised? Nephrol. Dial. Transplant., October 1, 2006; 21(10): 2859 - 2866. [Abstract] [Full Text] [PDF]
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