The arterial stiffness changes in hemodialysis patients with chronic kidney disease: The impact on mortality.

BACKGROUND: Patients with kidney disease suffer from high cardiovascular risk due to classic and disease-specific risk factors. Arterial stiffness is a novel cardiovascular risk factor whose role is yet to be established. High-resolution echo-tracking is a developing method for the assessment of local arterial stiffness. OBJECTIVES: To assess carotid stiffness in patients on long-term hemodialysis (HD) using high-resolution echo-tracking and to analyze the impact of arterial stiffness on mortality in the mid-term follow-up. MATERIAL AND METHODS: Fifty-eight HD patients (28 female (F), 30 male (M)) underwent clinical examination, laboratory tests and carotid stiffness assessment. Local arterial stiffness parameters such as beta stiffness index (ß), Young's modulus (Ep), arterial compliance (AC), and one-point pulse wave velocity (PWVß) were measured both before and after HD, allowing to calculate their change (Δ). The survival of patients was analyzed up to 48 months. The multivariate analysis of survival with the use of Cox proportional hazard stepwise regression was performed to determine the factors significantly correlated with the survival. RESULTS: After 48 months, 33 patients were alive (16 F, 17 M) and 25 patients (12 F, 13 M) died. The deceased group was significantly older (66.5 ±12.3 years compared to 56.6 ±17.8 years), had more pronounced coronary artery disease (percutaneous coronary intervention (PCI) 36% compared to 9%, p < 0.05, respectively). Deceased patients had significantly higher ΔAC than survivors. The results showed that age, history of PCI, left ventricular ejection fraction (LVEF), ΔAC, fasting glucose, serum total protein, sodium level after HD, and potassium level before HD were significantly associated with mortality. CONCLUSIONS: Echo-tracking-based arterial stiffness assessment in patients with chronic kidney disease (CKD) yields the clinical information regarding mid-term mortality risk. A paradoxical increase in AC is among independent risk factors for mid-term mortality in patients undergoing maintenance HD. The proper estimation of the correlations among vascular, hemodynamic and sympathetic-dependent changes in a given patient with kidney failure is complex.

Atrial fibrillation in outpatients with stable coronary artery disease: results from the multicenter RECENT study.

INTRODUCTION: Atrial fibrillation (AF) frequently coexists with other cardiovascular diseases. OBJECTIVES: The aim of this study was to assess the prevalence of AF in outpatients with stable coronary artery disease (CAD) and to determine clinical and laboratory parameters associated with the higher prevalence of this arrhythmia. In addition, we compared the indications for antithrombotic treatment using the older CHADS2 and the currently used CHA2DS2-VASc scores. PATIENTS AND METHODS: We studied the clinical data of 2578 Polish patients with stable CAD participating in the multicenter RECENT study (age, 65 ±10 years; men, 55%; Canadian Cardiovascular Society class I/II/III+IV, 38%/48%/14%). RESULTS: AF was present in 19% of patients with CAD. Advanced age, longer history of CAD, and concomitant heart failure were independently associated with the higher prevalence of AF (all P <0.05). Among patients with CAD and AF, 73% of the patients required antithrombotic treatment according to the CHADS2 score (≥2), and 94%-according to the CHA2DS2-VASc score (≥2). A CHA2DS2-VASc score of 2 or higher was found in 47% of the patients with a CHADS2 score of 0 and 85% of those with a CHADS2 score of 1. Twenty-one percent of patients with CAD and AF did not have unequivocal indications for antithrombotic treatment according to the CHADS2 score (0-1), while they had strong indications for such treatment on the basis of the CHA2DS2-VASc score (≥2). CONCLUSIONS: AF affects every fifth ambulatory patient with CAD. According to the CHA2DS2-VASc score, almost all patients with CAD and AF require antithrombotic treatment, which may complicate coronary revascularization and related antiplatelet treatment.