Impact of Chronic Kidney Disease on the Presence and Severity of Aortic Stenosis in Patients at High Risk for Coronary Artery Disease

• DOI: 10.1186/1476-7120-9-31
• Publication Date: 2011-12-03T03:17:48Z
• Authors: Chiaki Masuda; Kaoru Dohi; Yuko Sakurai; Yuri Bessho; Harumi Fukuda; Shinobu Fujii; Tadafumi Sugimoto; Masaki Tanabe; Katsuya Onishi; Katsuya Shiraki; Masaaki Ito; Tsutomu Nobori
• Keywords: Male; Research; Aortic Valve Stenosis; Comorbidity; Coronary Artery Disease; Coronary artery disease; Risk Assessment; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Japan; Radiology Nuclear Medicine and imaging; Echocardiography; Risk Factors; Chronic kidney disease; RC666-701; Aortic valve area; Prevalence; Diseases of the circulatory (Cardiovascular) system; Humans; Kidney Failure, Chronic; Female; Cardiology and Cardiovascular Medicine; Aged

Abstract

Objective We evaluated the impact of chronic kidney disease (CKD) on the presence and severity of aortic stenosis (AS) in patients at high risk for coronary artery disease (CAD).

Methods One hundred and twenty consecutive patients who underwent invasive coronary angiography were enrolled. Aortic valve area (AVA) was calculated by the continuity equation using transthoracic echocardiography, and was normalized by body surface area (AVA index).

Results Among all 120 patients, 78% had CAD, 55% had CKD (stage 3: 81%; stage 4: 19%), and 34% had AS (AVA < 2.0cm2). Patients with AS were older, more often female, and had a higher frequency of CKD than those without AS, but the prevalence of CAD and most other coexisting conventional risk factors was similar between patients with and without AS. Multivariate linear regression analysis indicated that only CKD and CAD were independent determinants of AVA index with standardized coefficients of -0.37 and -0.28, respectively. When patients were divided into 3 groups (group 1: absence of CKD and CAD, n = 16; group 2: presence of either CKD or CAD, n = 51; and group 3: presence of both CKD and CAD, n = 53), group 3 had the smallest AVA index (1.19 ± 0.30*# cm2/m2, *p < 0.05 vs. group 1: 1.65 ± 0.32 cm2/m2, and #p < 0.05 vs. group 2: 1.43 ± 0.29* cm2/m2) and the highest peak velocity across the aortic valve (1.53 ± 0.41*# m/sec; *p < 0.05 vs. group 1: 1.28 ± 0.29 m/sec, and #p < 0.05 vs. group 2: 1.35 ± 0.27 m/sec).

Conclusion CKD, even pre-stage 5 CKD, has a more powerful impact on the presence and severity of AS than other conventional risk factors for atherosclerosis in patients at high risk for CAD.