Impact of aortic stiffness on survival in end-stage renal disease
Impact of aortic stiffness on survival in end-stage renal disease
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DOI：
10.1161/01.cir.99.18.2434
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发表时间：
1999-05-11
期刊：
影响因子：
37.8
通讯作者：
London, GM
中科院分区：
文献类型：
--
作者：
Blacher, J;Guerin, AP;London, GM
背景：大动脉损伤是终末期肾病（ESRD）患者心血管疾病发病率和死亡率高的一个主要因素。动脉硬化和内膜-中膜厚度增加以及脉压增加是主要的动脉改变。主动脉脉波速度增加（PWV）是动脉僵硬度增加的典型标志，是否可以预测全因和/或心血管死亡率从未被研究过。方法与结果对1987年4月至1998年4月间接受血液透析治疗的241例ESRD患者进行了队列研究。平均随访时间为72+/-41个月（平均+/-SD）。入职时平均年龄为51.5±16.3岁。发生73例死亡，包括48例心血管死亡和25例非心血管死亡。入组时，结合标准的临床和生化分析，对患者进行超声心动图和多普勒超声测量主动脉PWV。在Cox分析的基础上，出现了2个因素作为全因死亡率和心血管死亡率的预测因素：年龄和主动脉PWV。血红蛋白和低舒张压干扰较小。在对所有混杂因素进行调整后，PWV的OR值为12.0
Background-Damage to large arteries is a major factor in the high cardiovascular morbidity and mortality of patients with end-stage renal disease (ESRD). Increased arterial stiffness and intima-media thickness, together with increased pulse pressure, are the principal arterial alterations. Whether increased aortic pulse-wave velocity (PWV), a classic marker of increased arterial stiffness, may predict all-cause and/or cardiovascular mortality has never been investigated.Methods and Results-A cohort of 241 patients with ESRD undergoing hemodialysis was studied between April 1987 and April 1998. The mean duration of follow-up was 72+/-41 months (mean+/-SD). Mean age at entry was 51.5+/-16.3 years. Seventy-three deaths occurred, including 48 cardiovascular and 25 noncardiovascular fatal events. At entry, together with standard clinical and biochemical analyses, patients underwent echocardiography and aortic PWV measured by Doppler ultrasonography, On the basis of Cox analyses, 2 factors emerged as predictors of all-cause and cardiovascular mortality: age and aortic PWV. Hemoglobin and low diastolic pressure interfered to a smaller extent. After adjustment for all the confounding factors, an OR for PWV >12.0 versus