SUN-225 Significant association between posterior mitral annular calcification and the mortality in maintenance hemodialysis patients

Abstract

It is widely recognized that maintenance dialysis patients have many cardiovascular complications causing morbidity and mortality. The mortality rate due to cardiovascular disease (CVD) in maintenance dialysis patients is 10-30 times higher than that in the general population, making it a leading cause of death. Thus, risk stratification for CVD mortality is clinically important for improving survival in such individuals. Vascular calcification (VC) is common in maintenance hemodialysis patients and results in increased cardiovascular disease and both overall and cardiovascular mortality. Cardiac valve calcification, also frequently seen in hemodialysis patients, has been regarded as a marker of atherosclerosis, and its existence could not only affect therapeutic outcomes after coronary intervention, but is also predict factor of CVD morbidity. Furthermore, in maintenance hemodialysis patient cardiac valvular calcification is also correlated with mortality. However, no detailed investigation has been done on which part of the heart valve calcification is associated with mortality. The purpose of this study was to investigate the prevalence of calcification according to the location of heart valve leaflets and mitral annulus, and to clarify the association between them and the mortality in maintenance hemodialysis patients. This was a retrospective cohort study of a clinical database containing the medical records of 130 patients on maintenance HD who received hemodialysis during the period between February 2016 and January 2017 in a single center. Totally, 120 patients were involved in this study. Of whom, 72 (65.0%) patients were male, the mean age was 71.1 ± 11.1 years, and the median hemodialysis duration was 129.2 ± 96.4 months. Cardiac valve calcification was seen in 50 (41.7%) patients: 29 (24.2%) had aortic valve calcification and 41 (34.2%) had mitral annulus calcification (MAC) (Anterior MAC, 8 [6.6%], and posterior MAC, 41 [34.2%]) (Figure 1). A total of 22 (18.3%) patients died, including 11 (9.2%) as a result of cardiovascular death. Patients without pMAC had a higher all-cause survival rate compared with those with pMAC (88.6% versus 68.3%, log-rank P Figure2A). Patients without pMAC had a higher cardiovascular survival rate compared with those with pMAC (94.6% versus 79.4%, log-rank P=0.01, Figure2B). Multivariate cox proportional hazards analysis revealed that posterior MAC was independently positively correlated with all-cause death and cardiovascular death (HR for all-cause death, 5.924; P<0.01, HR for all-cause death and cardiovascular death, 17.746; P=0.01). The presence of posterior MAC, which is cheap and easy to detect with echocardiography, can predict all causes of death and cardiovascular death. This findings may further help risk stratification of maintenance hemodialysis patients in any dialysis center, including small dialysis center with limited medical resources, such as developing countries.