Research Paper|Volume 7, Issue 4|pp 269—279

Coronary artery calcifications predict long term cardiovascular events in non diabetic Caucasian hemodialysis patients

Annalisa Noce¹, Maria Paola Canale¹, Ambrogio Capria¹, Valentina Rovella¹, Manfredi Tesauro¹, Giorgio Splendiani², Margherita Annicchiarico-Petruzzelli³, Micol Manzuoli¹, Giovanni Simonetti⁴, Nicola Di Daniele¹

¹Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome ”Tor Vergata”, Rome Italy
²Lazio Regional Agency for Transplantations and Related Pathologies, Rome Italy
³Biochemistry Laboratory, IDI-IRCCS, c/o Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata” Italy
⁴Department of Diagnostic Imaging, Molecular imaging, Interventional Radiology and Radiotherapy, University of Rome ”Tor Vergata”, Rome Italy

Received: August 13, 2014Accepted: April 16, 2015Published: April 24, 2015

https://doi.org/10.18632/aging.100740

Copyright: © 2015 Noce et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Vascular calcifications are frequent in chronic renal disease and are associated to significant cardiovascular morbidity and mortality. The long term predictive value of coronary artery calcifications detected by multi-layer spiral computed tomography for major cardiovascular events was evaluated in non-diabetic Caucasian patients on maintenance hemodialysis free of clinical cardiovascular disease. Two-hundred and five patients on maintenance hemodialysis were enrolled into this observational, prospective cohort study. Patients underwent a single cardiac multi-layer spiral computed tomography. Calcium load was quantified and patients grouped according to the Agatston score: group 1 (Agatston score: 0), group 2 (Agatston score 1-400), group 3 (Agatston score 401-1000) and group 4 (Agatston score >1000). Follow-up was longer than seven years. Primary endpoint was death from a major cardiovascular event. Actuarial survival was calculated separately in the four groups with Kaplan-Meier method. Patients who died from causes other than cardiovascular disease and transplanted patients were censored. The “log rank” test was employed to compare survival curves. One-hundred two patients (49.7%) died for a major cardiovascular event during the follow-up period. Seven-year actuarial survival was more than 90% for groups 1 and 2, but failed to about 50% for group 3 and to <10% for group 4. Hence, Agatston score >400 predicts a significantly higher cardiovascular mortality compared with Agatston score <400 (p<0.0001); furthermore, serum Parathyroid hormone levels > 300 pg/l were associated to a lower survival (p < 0.05). Extended coronary artery calcifications detected by cardiac multi-layer spiral computed tomography, strongly predicted long term cardiovascular mortality in non-diabetic Caucasian patients on maintenance hemodialysis. Moreover, it was not related to conventional indices of atherosclerosis, but to other non-traditional risk factors, as serum Parathyroid hormone levels. A full cost-benefit analysis is however necessary to justify a widespread use of cardiac multi-layer spiral computed tomography in clinical practice.