Number of calcified aortic valve leaflets: natural history and prognostic value in patients undergoing haemodialysis
Number of calcified aortic valve leaflets: natural history and prognostic value in patients undergoing haemodialysis
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钙化主动脉瓣叶数量：血液透析患者的自然史和预后价值
DOI：
10.1093/ehjci/jead020
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Maruyama S.
中科院分区：
文献类型：
--
作者：
Kurasawa S;Okazaki M;Imaizumi T;Kondo T;Hishida M;Nishibori N;Takeda Y;Kasuga H;Maruyama S.
目的主动脉硬化症中的主动脉瓣钙化是主动脉狭窄(AS)的先兆，并不总是出现在所有三个叶中；钙化是如何在每个叶中发展的尚不清楚。方法与结果采用回顾性多中心队列研究方法，利用超声心动图观察了非AS血液透析患者各瓣叶钙化发展的情况。我们使用事件发生时间分析研究了钙化小叶的数量与AS的发展和死亡率之间的关系。在纳入纵向超声心动图分析的1507名患者中(平均年龄66岁；男性66%)，709名(47%)在基线时有主动脉硬化：单叶钙化370例(52%)；双叶钙化215例(30%)；三叶钙化124例(17%)。一个钙化小叶增加的中位时间为3-4年，251例(17%)患者在中位3.2年的随访期内发生。与单叶钙化相比，二叶和三叶钙化的调整危险比(AHRS)分别为2.12(1.49~3.00)和4.43(3.01~6.52)，每一叶钙化的AHR(95%CI)增加2.24(1.96~2.55)。钙化瓣叶的AHR(95%CI)为1.18(1.08~1.27)。结论在血液透析患者中，钙化的主动脉瓣瓣叶的数目可以预测其发展甚至死亡，提示超声心动图单独评估每个瓣叶的钙化程度是有用的。
AimsAortic valve calcification in aortic sclerosis, a precursor of aortic stenosis (AS), is not always present in all three leaflets; how calcification develops in each leaflet is unknown. We aimed to investigate the natural history of calcification development in each aortic valve leaflet and the prognostic value of the number of calcified leaflets.Methods and resultsIn a retrospective multicentre cohort study of patients undergoing haemodialysis without AS, we observed calcification development in each aortic valve leaflet using echocardiography. We investigated the association between the number of calcified leaflets and AS development and mortality using time-to-event analysis. Among the 1507 patients (mean age, 66 years; 66% male) included in the longitudinal echocardiography analysis, 709 (47%) had aortic sclerosis at baseline: one-leaflet calcified, 370 (52%); two-leaflet calcified, 215 (30%); and three-leaflet calcified, 124 (17%). The median time for one calcified leaflet increase was 3–4 years, and 251 (17%) patients developed AS during a median 3.2-year follow-up. The increased number of calcified aortic valve leaflets was associated with developing AS; compared with that of one-leaflet calcified, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of two- and three-leaflet calcified were 2.12 (1.49–3.00) and 4.43 (3.01–6.52), respectively; the aHR (95% CI) per one calcified leaflet increase was 2.24 (1.96–2.55). It was also associated with all-cause mortality; the aHR (95% CI) per one calcified leaflet increase was 1.18 (1.08–1.27).ConclusionThe number of calcified aortic valve leaflets strongly predicted AS development and even mortality in patients undergoing haemodialysis, suggesting the usefulness of assessing calcification for each valve leaflet separately using echocardiography.