We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population.
SummaryCentral aortic pressure waveform (AoPW) is the summation of a forward-traveling wave generated by the left ventricle and a backward-traveling wave caused by the reflection of the forward wave. The aim of this study was to evaluate the effect of ventricular-vascular coupling on the morphology of AoPW in chronic heart failure patients with different degrees of left ventricular systolic dysfunction (LVSD) using pulse wave analysis (PWA). PWA of AoPW and left ventricular (LV) function were evaluated by applanation tonometry in 26 control subjects, in 12 patients with left ventricular ejection fraction (LVEF) ≤ 30%, and in 14 patients with LVEF > 30%. Augmentation pressure, augmentation index, wasted energy, and ejection duration were lower in patients with LVEF ≤ 30% than in those with LVEF > 30% and in control subjects. Furthermore, augmentation index showed an inverse correlation with Doppler mitral E-wave amplitude (r = -0.40; P = 0.04) and E/A ratio (r = -0.42; P = 0.03) and a direct correlation with deceleration time of mitral E-waves (r = 0.39; P = 0.04). In patients with severe LVSD (LVEF ≤ 30%), aortic wave reflections negatively interfere with LV function and induce a shortening of ejection duration. In contrast, AoPW is similar in patients with moderate LVSD (LVEF > 30%) and in control subjects. (Int Heart J 2014; 55: 526-532) Key words: Arterial stiffness, Heart failure, Ejection fraction, Pulse pressure H igh brachial pulse pressure (PP), commonly considered a marker of arterial stiffness, has been shown to predict adverse outcomes in patients with left ventricular (LV) systolic dysfunction.1,2) However, in patients with advanced systolic heart failure, the association between PP and outcome is reversed and a low PP is an independent predictor of all cause and cardiovascular death.3,4) It is conceivable that different pathophysiological mechanisms may underlie the opposite prognostic significance of PP in patients with LV systolic dysfunction (LVSD) and different severity of cardiac function impairment.Several sets of data support the greater importance of the central rather than peripheral blood pressure profile in patients with various cardiovascular diseases. A central blood pressure profile offers a more direct measure of LV load and arterial stiffness and provides useful clinical information independently from peripheral PP. [5][6][7][8] The central aortic pressure wave is composed of a forward-traveling wave generated by LV ejection and a late-arriving reflected wave from the periphery. Normally, wave reflections arrive during diastole, when LV has completed the ejection and contribute to coronary perfusion. As arterial stiffness increases, the velocity of forward and reflected waves increases so that the reflected wave arrives earlier to the heart and boosts pressure in late systole with an extra pulsatile workload on the left ventricle.9,10) The availability of noninvasive methods to accurately measure central blood pressure and flow has increased interest in gaining a further understan...
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