Associations between renal duplex parameters and adverse cardiovascular events in the elderly: a prospective cohort study.
Associations between renal duplex parameters and adverse cardiovascular events in the elderly: a prospective cohort study.
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DOI：
10.1053/j.ajkd.2009.10.044
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发表时间：
2010-02
期刊：
影响因子：
--
通讯作者：
Hansen KJ
中科院分区：
文献类型：
--
作者：
Pearce JD;Craven TE;Edwards MS;Corriere MA;Crutchley TA;Fleming SH;Hansen KJ
动脉粥样硬化性肾血管疾病与心血管疾病（CVD）事件的风险增加有关。本研究探讨了美国老年队列中肾动脉和肾实质多普勒衍生参数与全因死亡率、致死性和非致死性CVD事件之间的关系。队列研究。心血管健康研究（CHS）参与者的一个子集。通过一项辅助研究，870名（70%招募）福赛斯县，NC， CHS参与者同意接受肾脏双工超声检查，以确定老年人肾脏血管疾病的患病率，导致726名（36%男性，平均年龄77岁）技术上足够完整的研究纳入本调查。肾动脉和肾实质的多普勒信号。多普勒频移频谱分析和超声角度用于估计肾动脉收缩期峰值和舒张末期速度（单位均为米/秒）。彩色多普勒检查皮质-髓交界处。使用3毫米多普勒样本，获得实质收缩峰值和舒张末期频移（均以千赫兹为单位）。取肾主动脉收缩峰值速度较高的左肾或右肾门动脉多普勒样本，计算阻力指数为（1 -[舒张末期频移/收缩期峰值频移]）。比例风险回归分析用于确定肾脏双超声多普勒信号与心血管疾病事件和经公认心血管危险因素校正的全因死亡率之间的关系。指数CVD结果定义为冠状动脉事件（心绞痛、心肌梗死、冠状动脉旁路移植术/经皮冠状动脉介入治疗）、脑血管事件（中风或短暂性脑缺血发作）和任何CVD事件（心绞痛、充血性心力衰竭、心肌梗死、中风、短暂性脑缺血发作、冠状动脉旁路移植术[CABG]/经皮腔内冠状动脉介入治疗[PTCI]）。在随访期间，观察到221例死亡（31%），229例CVD事件（32%），122例冠状动脉事件（17%）和92例脑血管事件（13%）。肾实质双超声多普勒信号与全因死亡率和CVD结果独立相关。特别是，实质舒张末期频移增加与任何CVD事件显著相关（HR, 0.73; 95% CI, 0.62-0.87; P < 0.001）。实质舒张末期频移的增加与死亡风险的降低（HR, 0.86; 95% CI, 0.73-1.00; P = 0.06）和脑血管事件风险的降低（HR, 0.78; 95% CI, 0.61-1.01; P = 0.06）之间存在显著相关性。实质舒张末期频移不能显著预测冠状动脉事件（HR, 0.84; 95% CI, 0.67-1.06; P = 0.1）。CHS参与者表现出“健康队列”效应，可能低估了普通人群中心血管事件的发生率。在控制其他重要危险因素后，肾实质的双超声多普勒信号显示与随后的CVD事件有显著关联。特别是，实质舒张末期频移的标准差增加与任何CVD事件的风险降低27%相关。
Atherosclerotic renovascular disease is associated with an increased risk of cardiovascular disease (CVD) events. This study examines associations between Doppler-derived parameters from the renal artery and renal parenchyma and all-cause mortality and fatal and nonfatal CVD events in a cohort of elderly Americans. Cohort study. A subset of participants from the Cardiovascular Health Study (CHS). Through an ancillary study, 870 (70% recruitment) Forsyth County, NC, CHS participants consented to undergo renal duplex sonography to define the prevalence of renovascular disease in the elderly, resulting in 726 (36% men; mean age, 77 years) technically adequate complete studies included in this investigation. Renal duplex sonography–derived Doppler signals from the main renal arteries and renal parenchyma. Spectral analysis from Doppler-shifted frequencies and angle of insonation were used to estimate renal artery peak systolic and end diastolic velocity (both in meters per second). Color Doppler was used to identify the corticomedullary junction. Using a 3-mm Doppler sample, the parenchymal peak systolic and end diastolic frequency shift (both in kilohertz) were obtained. Resistive index was calculated as (1 – [end diastolic frequency shift/peak systolic frequency shift]) using Doppler samples from the hilar arteries of the left or right kidney with the higher main renal artery peak systolic velocity. Proportional hazard regression analysis was used to determine associations between renal duplex sonography–derived Doppler signals and CVD events and all-cause mortality adjusted for accepted cardiovascular risk factors. Index CVD outcomes were defined as coronary events (angina, myocardial infarction, and coronary artery bypass grafting/percutaneous coronary intervention), cerebrovascular events (stroke or transient ischemic attack), and any CVD event (angina, congestive heart failure, myocardial infarction, stroke, transient ischemic attack, and coronary artery bypass grafting [CABG]/percutaneous transluminal coronary intervention [PTCI]). During follow-up, 221 deaths (31%), 229 CVD events (32%), 122 coronary events (17%), and 92 cerebrovascular events (13%) were observed. Renal duplex sonography–derived Doppler signals from the renal parenchyma were associated independently with all-cause mortality and CVD outcomes. In particular, increased parenchymal end diastolic frequency shift was associated significantly with any CVD event (HR, 0.73; 95% CI, 0.62-0.87; P < 0.001). Marginally significant associations were observed between increases in parenchymal end diastolic frequency shift and decreased risk of death (HR, 0.86; 95% CI, 0.73-1.00; P = 0.06) and decreased risk of cerebrovascular events (HR, 0.78; 95% CI, 0.61-1.01; P = 0.06). Parenchymal end diastolic frequency shift was not significantly predictive of coronary events (HR, 0.84; 95% CI, 0.67-1.06; P = 0.1). CHS participants showed a “healthy cohort” effect that may underestimate the rate of CVD events in the general population. Renal duplex sonographic Doppler signals from the renal parenchyma showed significant associations with subsequent CVD events after controlling for other significant risk factors. In particular, a standard deviation increase in parenchymal end diastolic frequency shift was associated with 27% risk reduction in any CVD event.
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影响因子：
4.3
作者：
HANSEN, KJ;TRIBBLE, RW;DEAN, RH
通讯作者：
DEAN, RH
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13.2
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37.8
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158.5
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