Prognostic value of ultrasonographic measurement of carotid intima media thickness in dialysis patients
Prognostic value of ultrasonographic measurement of carotid intima media thickness in dialysis patients
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DOI：
10.1681/asn.v12112458
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发表时间：
2001-11-01
影响因子：
13.6
通讯作者：
Zoccali, C
中科院分区：
文献类型：
--
作者：
Benedetto, FA;Mallamaci, F;Zoccali, C
高分辨率颈动脉超声检查被认为是血管系统研究的基本技术。然而，颈动脉超声检查对终末期肾病患者心血管事件的预测是否有用仍不清楚。颈动脉超声检查对全因死亡率和心血管死亡率的预测能力在138名接受慢性透析治疗的患者队列中进行了测试（91例接受血液透析治疗，47例接受持续非卧床腹膜透析治疗;随访29.8 ± 15.0个月），并检查该参数与左心室质量（LVM）和几何形状变化之间的关系。在单变量分析中，内膜中层厚度（IMT）与左心室质量以及左心室壁的绝对和相对厚度直接相关，但与左心室舒张末期容积无关。基于LV几何图形的数据分析显示，向心性肥厚患者IM最高。颈总动脉内径（DCCA）也与向心性肥厚有关，但这种关系的强度是临界意义（P = 0.06）。在随访期间，63例患者死亡：其中32例（1%）死于心血管原因。心血管死亡患者的IMT（1.10 ± 0.21 nm）显著高于存活患者（0.99 ± 0.24 nm）（P = 0.006）。在考克斯回归模型中，该参数被证明是心血管死亡的独立预测因子，在包括左心室质量的模型中，它保留了独立效应。治疗方式未能独立预测这一结果。心血管死亡的风险从第一个IMT三分位数开始逐渐升高。DCCA未能预测心血管结局。透析患者的IMT与左室向心性肥厚相关，是心血管死亡的独立预测因子。IMT可用于透析人群的风险分层。
High-resolution carotid ultrasonography is considered a fundamental technique for the investigation of the vascular system. However, it is still very unclear whether ultrasonographic studies of carotid arteries are useful for the prediction of cardiovascular events in patients with end-stage renal disease. The prediction power of carotid ultrasonography for all-cause and cardiovascular mortality was tested in a cohort of 138 patients receiving chronic dialysis treatment (91 receiving hemodialysis treatment and 47 receiving continuous ambulatory peritoneal dialysis treatment; follow-up, 29.8 +/- 15.0 mo), and the relationship between this parameter and alterations in left ventricular mass (LVM) and geometry was examined. On univariate analysis, intima media thickness (IMT) was directly related to LVM as well as to the absolute and relative thicknesses of LV walls but independent of LV end-diastolic volume. Data analysis based on LV geometry patterns revealed that patients with concentric hypertrophy were those with the highest IM. The internal diameter of the common carotid artery (DCCA) was also related to concentric hypertrophy, but the strength of this relationship was of borderline significance (P = 0.06). During the follow-up period, 63 patients died: 32 (1%) of them of cardiovascular causes. IMT was significantly higher (P = 0.006) in patients who died of cardiovascular causes (1.10 +/- 0.21 nim) than in patients who survived (0.99 +/- 0.24 nm), In a Cox regression model, this parameter turned out to be all independent predictor of cardiovascular death, and it retained an independent effect in a model that included LVM. Treatment modality failed to independently predict this outcome. The risk of cardiovascular death was progressively higher from the first IMT tertile onward. DCCA failed to predict cardiovascular outcomes. IMT in dialysis patients is associated with LV concentric hypertrophy and is an independent predictor of cardiovascular death. IMT may be usefully applied for risk stratification in the dialysis population.