Severe mitral annular calcification predicts chronic kidney disease
Severe mitral annular calcification predicts chronic kidney disease
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DOI：
10.1016/j.ijcard.2007.05.015
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发表时间：
2008-08-18
影响因子：
3.5
通讯作者：
Pressman, Gregg S.
中科院分区：
文献类型：
--
作者：
Jesri, Ammar;Braitman, Leonard E.;Pressman, Gregg S.
背景资料：二尖瓣环钙化（MAC）在老年人中很常见，与动脉粥样硬化相关，有许多相同的危险因素。在透析患者中也很常见。我们假设，在一般的心脏病患者没有肾功能衰竭，MAC，特别是当严重的，可能是一个标记为renal dysfunction.Methods：41例受试者被确定为搜索门诊超声心动图报告的短语表明严重MAC。根据总体心内钙化程度的大小将其分为亚组。“MAC移动的”亚组的钙化主要局限于后瓣环，二尖瓣前叶移动正常。在“MAC受限”亚组中，钙化延伸至前瓣环，限制二尖瓣前叶活动。后者的患者也有更严重的主动脉瓣钙化。77个对照组有轻微或无心内钙化被用于comparation.Results：总MAC组有更差的肾功能，肌酐和肾小球滤过率（GFR），比对照组（P < 0.001的两个比较）。近60%的人患有慢性肾脏疾病，定义为GFR b 60 ml/min/1.73 m（2），与对照组相比，相对风险为1.8。随着钙化增加，观察到GFR以分级方式下降（对照组与“MAC移动的”组与“MAC限制性”组）。虽然这一趋势并没有保持统计学显着控制后的年龄和性别，GFR显着低于“MAC限制”与“MAC移动的”patients（p=0.03）。MAC严重程度与肾功能不全严重程度之间的分级关系有待进一步研究。(c)2007爱思唯尔爱尔兰有限公司保留所有权利。
Background: Mitral annular calcification ( MAC) is common in the elderly and is associated with atherosclerosis, sharing many of the same risk factors. It is also frequent among dialysis patients. We hypothesized that in general cardiology patients without kidney failure, MAC, especially when severe, may be a marker for renal dysfunction.Methods: Forty-one subjects were identified by searching outpatient echocardiogram reports for phrases indicating severe MAC. These were divided into subgroups based on greater or lesser overall intracardiac calcification. The "MAC mobile" subgroup had calcification largely limited to the posterior annulus with normal anterior mitral leaflet mobility. In the "MAC restricted" subgroup, calcification extended to the anterior annulus and limited anterior mitral leaflet mobility. These latter patients also had more severe aortic valve calcification. Seventy-seven controls with minimal or no intracardiac calcification were used for comparison.Results: The total MAC group had worse renal function, measured by creatinine and glomerular filtration rate (GFR), than controls (p < 0.001 for both comparisons). Nearly 60% had chronic kidney disease as defined by a GFRb60 ml/min/1.73 m(2) with a relative risk of 1.8 versus controls. GFR was observed to decline in a graded fashion as calcification increased ( control versus "MAC mobile" versus "MAC restricted"). Though this trend did not remain statistically significant after controlling for age and gender, GFR was substantially lower in "MAC restricted" versus "MAC mobile" patients (p=0.03).Conclusions: Severe MAC on echocardiogram points to a strong likelihood of chronic kidney disease. Further study is needed to explore a possible graded relationship between severity of MAC and severity of renal dysfunction. (c) 2007 Elsevier Ireland Ltd. All rights reserved.