Ankle-brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end-stage kidney disease.
Aged
Ankle Brachial Index
/ methods
Biomarkers
/ blood
C-Reactive Protein
/ metabolism
Cardiovascular Diseases
/ diagnosis
Female
Follow-Up Studies
Humans
Japan
/ epidemiology
Kidney Failure, Chronic
/ blood
Male
Natriuretic Peptide, Brain
/ blood
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Factors
Survival Rate
/ trends
Time Factors
Troponin T
/ blood
Vascular Stiffness
/ physiology
arterial stiffness
biomarker
dialysis
peripheral arterial disease
prognosis
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
03
03
2019
revised:
22
04
2019
accepted:
24
04
2019
pubmed:
26
4
2019
medline:
24
12
2019
entrez:
26
4
2019
Statut:
ppublish
Résumé
Although ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end-stage kidney disease (ESKD). We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain-natriuretic peptide, high-sensitive cardiac troponin T (hs-cTnT), and high-sensitive C-reactive protein (hs-CRP). MACE was defined as a composite event of all-cause death, acute coronary syndrome, and stroke. During a mean follow-up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs-cTnT (adjusted HR, 2.77; P < .05), and hs-CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs-CRP, 4.42 for abnormal ABI + hs-cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.
Sections du résumé
BACKGROUND
BACKGROUND
Although ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end-stage kidney disease (ESKD).
HYPOTHESIS
OBJECTIVE
We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients.
METHODS
METHODS
This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain-natriuretic peptide, high-sensitive cardiac troponin T (hs-cTnT), and high-sensitive C-reactive protein (hs-CRP). MACE was defined as a composite event of all-cause death, acute coronary syndrome, and stroke.
RESULTS
RESULTS
During a mean follow-up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs-cTnT (adjusted HR, 2.77; P < .05), and hs-CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs-CRP, 4.42 for abnormal ABI + hs-cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001).
CONCLUSION
CONCLUSIONS
Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.
Identifiants
pubmed: 31020665
doi: 10.1002/clc.23188
pmc: PMC6605000
doi:
Substances chimiques
Biomarkers
0
Troponin T
0
Natriuretic Peptide, Brain
114471-18-0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
656-662Informations de copyright
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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