International Urology and Nephrology

, Volume 49, Issue 9, pp 1661–1666 | Cite as

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

  • Ismail Baloglu
  • Kultigin Turkmen
  • H. Zeki Tonbul
  • N. Yılmaz Selcuk
Nephrology - Original Paper
  • 92 Downloads

Abstract

Purpose

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.

Methods

This was a cross-sectional study involving 32 hemodialysis patients (16 females, 16 males; mean age, 52.4 ± 14.1 years) receiving HD for ≥6 months. 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 (>0.52 mm2) 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.

Results

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.

Conclusions

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.

Keywords

Hemodialysis Coronary artery calcium scores Left atrium size 

References

  1. 1.
    Collins AJ (2003) Cardiovascular mortality in end-stage renal disease. Am J Med Sci 325:163–167CrossRefPubMedGoogle Scholar
  2. 2.
    London GM, Guérin AP, Marchais SJ, Métivier F, Pannier B, Adda H (2003) Arterial medial calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transpl 18:1731–1740CrossRefGoogle Scholar
  3. 3.
    Dellegrottaglie S, Sanz J, Rajagopalan S (2006) Molecular determinants of vascular calcification: a bench to bedside view. Curr Mol Med 6:515–524CrossRefPubMedGoogle Scholar
  4. 4.
    Haydar AA, Hujairi NM, Covic AA, Pereira D, Rubens M, Goldsmith JA (2004) Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography. Nephrol Dial Transpl 19:2307–2312CrossRefGoogle Scholar
  5. 5.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832CrossRefPubMedGoogle Scholar
  6. 6.
    Turkmen K, Kayikcioglu H, Ozbek O, Solak Y, Kayrak M, Samur C, Anil M, Zeki Tonbul H (2011) The relationship between epicardial adipose tissue and malnutrition, inflammation, atherosclerosis/calcification syndrome in ESRD patients. Clin J Am Soc Nephrol 6(8):1920–1925CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Zile MR, Gottdiener JS, Hetzel SJ, McMurray JJ, Komajda M, McKelvie R, Baicu CF, Massie BM, Carson PE (2011) Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation 124:2491–2501CrossRefPubMedGoogle Scholar
  8. 8.
    Laukkanen JA, Kurl S, Eränen J, Huttunen M, Salonen JT (2005) Left atrium size and the risk of cardiovascular death in middle-aged men. Arch Intern Med 165(15):1788–1793CrossRefGoogle Scholar
  9. 9.
    Hamby RI, Zeldis SM, Hoffman I, Sarli P (1982) Left atrial size and left ventricular function in coronary artery disease: an echocardiographic-angiographic correlative study. Cathet Cardiovasc Diagn 8(2):173–183CrossRefPubMedGoogle Scholar
  10. 10.
    Pan NH, Tsao HM, Chang NC, Lee CM, Chen YJ, Chen SA (2009) Dilated left atrium and pulmonary veins in patients with calcified coronary artery: A potential contributor to the genesis of atrial fibrillation. J Cardiovasc Electrophysiol 20(2):153–158CrossRefPubMedGoogle Scholar
  11. 11.
    Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18(6):499–502PubMedGoogle Scholar
  12. 12.
    Horiguchi J, Yamamoto H, Akiyama Y, Marukawa K, Hirai N, Ito K (2004) Coronary artery calcium scoring using 16-MDCT and a retrospective ECG-gating reconstruction algorithm. AJR Am J Roentgenol 183(1):103–108CrossRefPubMedGoogle Scholar
  13. 13.
    Das M, Aronow WS, McClung JA, Belkin RN (2006) Increased prevalence of coronary artery disease, silent myocardial ischemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, mitral annular calcium, and aortic valve calcium in patients with chronic renal insufficiency. Cardiol Rev 14(1):14–17CrossRefPubMedGoogle Scholar
  14. 14.
    Vlagopoulos PT, Sarnak MJ (2005) Traditional and nontraditional cardiovascular risk factors in chronic kidney disease. Med Clin N Am 89(3):587–611CrossRefPubMedGoogle Scholar
  15. 15.
    Wang AY, Wang M, Woo J, Lam CW, Li PK, Lui SF et al (2003) Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol 14(1):159–168CrossRefPubMedGoogle Scholar
  16. 16.
    Han Jie, Wang Xiaona, Ye Ping, Ruihua Cao Xu, Yang Wenkai Xiao, Zhang Yun, Bai Yongyi, Hongmei Wu (2016) The predictive value of arterial stiffness on major adverse cardiovascular events in individuals with mildly impaired renal function. Clin Interv Aging 11:1175–1181CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Jablonski KL, Chonchol M (2013) Vascular calcification in end-stage renal disease. Hemodial Int 17(01):S17–S21CrossRefPubMedGoogle Scholar
  18. 18.
    Galkina E, Ley K (2009) Immune and inflammatory mechanisms of atherosclerosis. Annu Rev Immunol 27:165–197CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Turkmen K, Ozcicek F, Ozcicek A, Akbas EM, Erdur FM, Tonbul HZ (2014) The relationship between neutrophil-to-lymphocyte ratio and vascular calcification in end-stage renal disease patients. Hemodial Int 18(1):47–53CrossRefPubMedGoogle Scholar
  20. 20.
    Turkmen K, Tonbul HZ, Erdur FM, Guney I, Kayikcioglu H, Altintepe L, Ozbek O, Yilmaz MI, Gaipov A, Turk S, Covic A, Kanbay M (2013) Peri-aortic fat tissue and malnutrition-inflammation-atherosclerosis/calcification syndrome in end-stage renal disease patients. Int Urol Nephrol 45(3):857–867CrossRefPubMedGoogle Scholar
  21. 21.
    Turkmen K, Demirtas L, Topal E, Gaipov A, Kocyigit I, Orscelik O, Guney I, Kılıc S, Yilmaz MI (2015) Predictive value of atrial electromechanical delay on long-term cardiovascular outcomes in hemodialysis patients. Am J Nephrol 42(3):239–249CrossRefPubMedGoogle Scholar
  22. 22.
    Robinson J, Tan AU, Wilensky RL, Matthai W, Munoz M, Rosas SE (2007) Electron-beam computerized tomography correlates with coronary angiogram in chronic kidney disease patients. Am J Nephrol 27:247–252CrossRefPubMedGoogle Scholar
  23. 23.
    O’Rourke RA, Brundage BH, Froelicher VF et al (2000) American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 102:126–140CrossRefPubMedGoogle Scholar
  24. 24.
    Barraclough Katherine A, Stevens Lesley A, Er Lee, Rosenbaum Debbie, Brown Jacqueline, Tiwari Pari, Levin Adeera (2008) Coronary artery calcification scores in patients with chronic kidney disease prior to dialysis: reliability as a trial outcome measure. Nephrol Dial Transpl 23(10):3199–3205CrossRefGoogle Scholar
  25. 25.
    Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB (2002) Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 90(12):1284–1289CrossRefPubMedGoogle Scholar
  26. 26.
    Zoccali C (2002) Arterial pressure components and cardiovascular risk in end-stage renal disease. Nephrol Dial Transpl 18(2):249–252CrossRefGoogle Scholar
  27. 27.
    Ekart R, Hojs R, Pecovnik-Balon B, Bevc S, Dvorsak B (2009) Blood pressure measurements and carotid intima media thickness in hemodialysis patients. Ther Apher Dial 13(4):288–293CrossRefPubMedGoogle Scholar
  28. 28.
    Abhayaratna WP, Seward JB, Appleton CP (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47(12):2357–2363CrossRefPubMedGoogle Scholar
  29. 29.
    Zapolski Tomasz, Wysokiński Andrzej, Książek Andrzej, Jaroszyński Andrzej (2012) Left atrial volume index and aortic stiffness index in adult hemodialysed patients—link between compliance and pressure mediated by endothelium dysfunction; a cross-sectional study. BMC Cardiovasc Disord. 12:100CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Internal MedicineNecmettin Erbakan UniversityKonyaTurkey

Personalised recommendations