Reduced arterial distensibility is a predictor of cardiovascular disease in patients after renal transplantation

Barenbrock, Michael; Kosch, Markus; Jöster, Elke; Kisters, Klaus; Rahn, K. H.; Hausberg, Martin

doi:10.1097/00004872-200201000-00012

Cited by 121 publications

(82 citation statements)

References 25 publications

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“…In agreement with previous studies on ESRD patients, [3][4][5] patients with essential hypertension and diabetes, 6 -11 our present findings indicate that aortic PWV is a strong and independent predictor of CV mortality. In contrast, the PWV of peripheral conduit arteries, for both upper and lower limbs, has no prognostic value for CV mortality in ESRD patients.…”

Section: Discussionsupporting

confidence: 93%

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Stiffness of Capacitive and Conduit Arteries

et al. 2005

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Abstract-The aorta is the principal capacitive element of the arterial tree and its increased stiffness, determined by measurement of aortic pulse wave velocity (PWV), is a strong independent predictor of cardiovascular mortality in the general population and end-stage renal disease (ESRD) patients. Whether stiffness of ESRD patients' peripheral arteries has the same prognostic value has never been investigated. A cohort of 305 ESRD patients was followed for 70Ϯ49 months (meanϮSD). Ninety-six deaths of cardiovascular origin occurred. At entry into the study, together with standard clinical and biochemical analyses, patients' aortic, brachial artery, and femorotibial PWV were determined. Based on Kaplan-Meier survival curve analyses and Cox proportional hazards analyses, adjusted for age, pulse pressure, and clinical data, aortic PWV was a significant and independent predictor of outcome. Neither brachial artery nor femotibial artery stiffness was able to predict cardiovascular outcome. Receiver operating characteristic curve analysis of aortic PWV indicated the cutoff value of 10.75 m/s, with 84% sensitivity, 73% specificity, 87% negative predictive value, and 72% positive predictive value. These results provide evidence that, in ESRD, increased stiffness of capacitive arteries, like the aorta, is an independent strong predictor of cardiovascular mortality, whereas stiffness of peripheral conduit arteries had no prognostic value. (Hypertension. 2005;45:592-596.)

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Section: Discussionsupporting

confidence: 93%

“…[3][4][5][6][7][8][9][10][11] In contrast to aortic PWV peripheral arteries, PWV had no prognostic value in ESRD patients. Whether a similar absence of a relationship between and CV mortality is present in the general population remains to be established.…”

Section: Pannier Et Al Stiffness Of Capacitive and Conduit Arteriesmentioning

confidence: 99%

Stiffness of Capacitive and Conduit Arteries

et al. 2005

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“…3 In addition, because for a given ventricular ejection aortic stiffness is the major determinant of PP, increased aortic pulse wave velocity (PWV), a classic marker of arterial rigidity, has also been identified as an independent predictor of CV risk in numerous populations. [4][5][6][7][8][9][10][11][12][13][14][15][16] Only three studies took place in the elderly; 7,13,16 none was specifically designed to test the multi-adjusted added value of aortic PWV in term of all-cause mortality prediction. Finally, very few studies addressed the potential validity of thesepathophysiological considerations in the frail oldest old with a high burden of CV disease.…”

Section: Introductionmentioning

confidence: 99%

Aortic stiffness, inflammation, denutrition and prognosis in the oldest people

et al. 2011

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Observational studies have shown that some of the classic CV risk factors, namely hypertension or hypercholesterolemia, become nebulous, or even act in the reverse direction, in the oldest people. We investigated whether in the elderly, increased aortic stiffness was associated with higher mortality risk, before and after adjustments on common geriatric confounders. In a cohort of 331 (86 men) subjects aged 470 years (mean age ( ± s.d.): 85 ± 7 years), aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Classical CV risk factors were determined simultaneously, in association with inflammation and denutrition parameters. One hundred and ten subjects died during a 2-year follow-up period. In crude analysis, a positive non-significant trend was observed between PWV and mortality risk. Multivariate Cox regression analysis showed that five parameters entered the prediction model: two were positively related to mortality risk, PWV (P ¼ 0.008) and orosomucoide (P ¼ 0.045), and three were related negatively, total cholesterol (P ¼ 0.006), albumin (P ¼ 0.026) and body weight (P ¼ 0.035). Interaction analysis revealed that the effect of PWV on mortality was increased in the presence of renal dysfunction and increased inflammation. In conclusion, although marginally significant in crude analysis, PWV is a powerful determinant of prognosis in the oldest people taking into account inflammation and denutrition.

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“…Nevertheless, classic risk factors cannot fully explain the CV risk in this population. It is reported that the Framingham CV risk score significantly underestimates the risk of ischemic heart disease in transplant patients [66] and therefore, non-classic risk factors including C-reactive protein, homocystein and renal function as well as arterial stiffness may contribute in CV risk in this population [67,68].…”

Section: Risk In Kidney Transplanted Patientsmentioning

confidence: 98%