Background and aims

Mild-to-moderate aortic stenosis (AS) and aortic sclerosis, a precursor of AS, are associated with mortality in the general population; however, their association in patients undergoing hemodialysis with higher morbidity of AS is unknown. Thus, we investigated the mortality of aortic sclerosis and mild-to-moderate AS in patients undergoing hemodialysis.

Methods

This was a retrospective multicenter cohort study of consecutive patients undergoing hemodialysis at nine dialysis facilities who underwent screening echocardiography between January 2008 and December 2019. We investigated the mortality of patients with aortic sclerosis or mild-to-moderate AS using multivariable Cox proportional hazards regression.

Results

Among 1,878 patients undergoing hemodialysis, those with normal aortic valves, aortic sclerosis, mild AS, moderate AS, severe AS, and prosthetic aortic valves were 844 (45%), 793 (42%), 161 (8.6%), 38 (2.0%), 11 (0.6%), and 31 (1.7%), respectively. After excluding patients with severe AS and prosthetic aortic valves, we performed comparative analysis on 1,836 patients (mean age, 67 years; 66% male). In a median follow-up of 3.6 years, crude death rates (per 100 person-years) were 5.2, 10.6, and 13.0 in patients with normal aortic valves, aortic sclerosis, and mild-to-moderate AS, respectively. Compared with normal aortic valves, both aortic sclerosis and mild-to-moderate AS were associated with all-cause and cardiovascular death: adjusted hazard ratios (95% confidence intervals) were 1.36 (1.13–1.65) and 1.36 (1.02–1.80) for all-cause death; and 1.52 (1.06–2.17) and 1.74 (1.04–2.92) for cardiovascular death, respectively.

Conclusions

Aortic sclerosis and mild-to-moderate AS were independent risk factors for all-cause and cardiovascular death in patients undergoing hemodialysis.

中文翻译：

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主动脉硬化和轻度至中度主动脉瓣狭窄接受血液透析患者的全因和心血管死亡率：一项队列研究

背景和目标

轻度至中度主动脉瓣狭窄 (AS) 和主动脉硬化（AS 的前兆）与一般人群的死亡率有关；然而，它们与接受血液透析的 AS 发病率较高的患者之间的关系尚不清楚。因此，我们调查了接受血液透析的患者的主动脉硬化和轻中度 AS 的死亡率。

方法

这是一项回顾性多中心队列研究，对 2008 年 1 月至 2019 年 12 月期间在 9 家透析机构接受血液透析的连续患者进行了超声心动图筛查。我们使用多变量 Cox 比例风险回归调查了主动脉硬化或轻度至中度 AS 患者的死亡率。

结果

在接受血液透析的 1,878 名患者中，主动脉瓣正常、主动脉硬化、轻度 AS、中度 AS、重度 AS 和人工主动脉瓣的患者分别为 844 (45%)、793 (42%)、161 (8.6%)、38 (2.0 %)、11 (0.6%) 和 31 (1.7%)。在排除严重 AS 和人工主动脉瓣患者后，我们对 1,836 名患者（平均年龄 67 岁；66% 为男性）进行了比较分析。在中位随访 3.6 年中，主动脉瓣正常、主动脉硬化和轻中度 AS 患者的粗死亡率（每 100 人年）分别为 5.2、10.6 和 13.0。与正常主动脉瓣相比，主动脉硬化和轻中度 AS 均与全因和心血管死亡相关：调整后的风险比（95% 置信区间）分别为 1.36 (1.13–1.65) 和 1.36 (1.02–1.80)全因死亡；和 1。

结论

主动脉硬化和轻中度 AS 是血液透析患者全因和心血管死亡的独立危险因素。