The relationship between coronary artery calcium scores and left atrium size in hemodialysis patients.

Abstract

Hemodialysis patients have extremely increased cardiovascular mortality. The coronary artery calcification score (CACS) in uremic patients receiving hemodialysis reflects the severity of atherosclerotic vascular disease and predicts the cardiovascular events. In cardiac conditions, left atrial (LA) size has a prognostic importance. In this study, relationship between coronary artery calcification and left atrial size was investigated. This was a cross-sectional study involving 32 hemodialysis patients (16 females, 16 males; mean age, 52.4±14.1years) receiving HD for ≥6months. Coronary artery calcium scoring was performed by a 16-MDCT scanner, and CACS was calculated by Agatston score. A calcification was defined as a minimum of two adjacent pixels (>0.52mm2) with a density over 130 Hounsfield units. Patients were divided into two subgroups (group 1: CACS≤45.85, n=16 and group 2: CACS>45.85, n=16) according to median CACS value. Mean CACS value of 32 hemodialysis patients was 245.57±373.91. LA size was significantly higher in patients with CACS>45.85 (group 2) than in patients with CACS≤45.85 (group 1). In the bivariate correlation analysis, total CACS was positively correlated with left atrium size (r=0.47, p=0.006). Total CACS was positively correlated with age (r=0.43, p=0.014). LA size was positively correlated with diastolic blood pressure (r=0.42, p=0.016) and negatively correlated with ejection fraction (r=-0.42, p=0.016). The clinical parameters such as BMI, duration of dialysis, blood pressure, ejection fraction, serum levels of calcium, phosphorus, uric acid, albumin, CRP, triglyceride, cholesterol, hemoglobin and ferritin were not independently associated with total CACS. We found a positive relationship between the CACS and LA size measured by echocardiography in hemodialysis patients. Therefore; echocardiography, which is cheaper and non-invasive than tomographic examinations, might be considered for the risk stratification of coronary artery disease in hemodialysis patients.