Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients

Abstract

Atherosclerosis is evaluated by carotid mean intima-media thickness (mean IMT), pulse wave velocity (PWV), and the aortic calcification index (ACI). We have attempted to examine if these atherosclerotic parameters are associated with each other and which parameters are closely related to cardiac function in chronic HD patients. The mean IMT, PWV and ACI were examined in 69 maintenance HD patients using carotid ultrasonography, a blood volume plethysmographic apparatus and abdominal CT, respectively. Echocardiographic studies were also performed for measuring left ventricular (LV) geometry. Serum total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, albumin, C-reactive protein (CRP), calcium and phosphate were measured. The mean IMT correlated positively with ACI (r = 0.461, P < 0.0001) and tended to be correlated with PWV, but did not reach statistical significance. The PWV value correlated positively with ACI (r = 0.494, P <or= 0.0001). The mean IMT correlated positively with the LV mass index (r = 0.273, P = 0.0228), and fractional shortening (FS) correlated negatively with PWV value (r = -0.293, P = 0.0141) and ACI score (r = -0.289, P = 0.0158). Multivariate analyses indicated that the LV mass index was independently associated with mean IMT (P = 0.0231) as well as systolic blood pressure (P < 0.0001), pulse pressure (P < 0.0001) and hemoglobin (P = 0.016), and FS is independently associated with ACI (P = 0.0162) as well as PWV (P = 0.0144) and CRP (P = 0.0375). Atherosclerosis and reduced LV function are associated with increased vascular calcification and arterial stiffness in chronic HD patients.