Abstract 5206: Aortic Valve Calcification and Stenosis is Strongly Associated With Cardiac and All-cause Mortality in End-stage Renal Disease Patients

Abstract

Background: Vascular or tissue calcification has been recognized as a frequent complication in patients with end-stage renal disease (ESRD). Aortic valve calcification (AVC) is especially frequent, and the presence of AVC is a strong predictor of restenosis after drug-eluting stent implantation in ESRD patients. However, its prevalence in ESRD patients and the association with adverse events remain unclear. The aim of this study was to clarify the prevalence and predictive power of AVC and aortic valve stenosis (AVS) for cardiac and all-cause mortality in ESRD patients. Methods: Consecutive 1,290 ESRD patients were screened by echocardiography within 1 month after initiating hemodialysis (HD). AVC was defined as bright echoes >1mm on one or more cusps of the aortic valve. AVS was also defined as pressure gradient >20mmHg. They were followed-up for 7 years. Results: AVC was seen in 627 patients (49%). Among patients with AVC, AVS was observed in 76 patients (12%). Patients were divided into 3 groups; those without AVC (n=663), with AVC alone (n=551) and with AVC and AVS (n=76). Mean follow-up period was 45±34months. Cardiac survival for 7 years was 93.0% in patients without AVC, 84.5% in patients with AVC alone and 69.5% in patients with AVC and AVS, respectively (p<0.0001). Cardiovascular survival was 87.6%, 76.4% and 64.1%, respectively (p=0.0004), and all-cause survival was 74.4%, 58.1% and 39.7% (p<0.0001), respectively. On Cox analysis, AVC and AVC with AVS were independently stratified as predictors of mortalities even after adjustment for gender, age, traditional risk factors, body mass index, hemoglobin, albumin, cholesterol and C-reactive protein levels (Table ). Conclusion: AVC was seen in about a half of ESRD patients even at initial phase of HD therapy, and was strongly associated with cardiac and all-cause mortality in this population.