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Circulation. 1999;99:2434-2439

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(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

Jacques Blacher, MD; Alain P. Guerin, MD; Bruno Pannier, MD; Sylvain J. Marchais, MD; Michel E. Safar, MD; Gérard M. London, MD

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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Hypertension, July 1, 2007; 50(1): 172 - 180.
[Abstract] [Full Text] [PDF]


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Am. J. Respir. Crit. Care Med.Home page
R. Sabit, C. E. Bolton, P. H. Edwards, R. J. Pettit, W. D. Evans, C. M. McEniery, I. B. Wilkinson, J. R. Cockcroft, and D. J. Shale
Arterial Stiffness and Osteoporosis in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., June 15, 2007; 175(12): 1259 - 1265.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
P. Raggi, A. Bellasi, E. Ferramosca, G. A. Block, and P. Muntner
Pulse Wave Velocity Is Inversely Related to Vertebral Bone Density in Hemodialysis Patients
Hypertension, June 1, 2007; 49(6): 1278 - 1284.
[Abstract] [Full Text] [PDF]


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ChestHome page
L. F. Drager, L. A. Bortolotto, A. C. Figueiredo, B. C. Silva, E. M. Krieger, and G. Lorenzi-Filho
Obstructive Sleep Apnea, Hypertension, and Their Interaction on Arterial Stiffness and Heart Remodeling
Chest, May 1, 2007; 131(5): 1379 - 1386.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
I. J. Kullo and A. R. Malik
Arterial Ultrasonography and Tonometry as Adjuncts to Cardiovascular Risk Stratification
J. Am. Coll. Cardiol., April 3, 2007; 49(13): 1413 - 1426.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
C. Meyer, B. P. McGrath, and H. J. Teede
Effects of Medical Therapy on Insulin Resistance and the Cardiovascular System in Polycystic Ovary Syndrome
Diabetes Care, March 1, 2007; 30(3): 471 - 478.
[Abstract] [Full Text] [PDF]


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Clin Med ResHome page
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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J Am Coll CardiolHome page
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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ANGIOLOGYHome page
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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Age AgeingHome page
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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J. Am. Soc. Nephrol.Home page
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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Eur Heart JHome page
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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QJMHome page
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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HeartHome page
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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LupusHome page
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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Nephrol Dial TransplantHome page
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]