Aortic stiffness and valvular calcifications in patients with end-stage renal disease.

OBJECTIVES To evaluate the presence and extent of cardiac calcifications and aortic stiffness in patients with end-stage renal disease (ESRD). PATIENTS AND METHODS The study group consisted of 60 patients with ESRD with a mean age of 51.7 years, treated with peritoneal dialysis. In all patients transthoracic echocardiogram was performed to assess the following parameters: left ventricular end-systolic diameter, left ventricular end-diastolic diameter (LVEDd), interventricular septum end-diastolic diameter (IVSDd), posterior wall end-diastolic diameter (PWDd), ejection fraction (EF), fractional shortening (FS), aortic maximal and minimal diameter, aortic valve area, mitral valve area (MVA), left ventricular ejection time (LVET), maximal aortic velocity. Aortic stiffness index (AS) was calculated. Aortic and mitral valve calcifications were assessed. RESULTS Patients with ESRD had a larger left ventricle (LVEDd 5.4 cm vs. 4.76 cm) and its wall was thicker (IVSDd 1.36 cm vs. 1.02 cm; PWDd 1.31 cm vs. 0.94 cm). Patients had poorer left ventricle contractility (EF 56.1 vs. 61.6%; FS 28.5 vs. 33.2%). Atherosclerotic plaques, calcified plaques and valvular calcifications were more frequently detected in patients with ESRD. Patients with ESRD had significantly higher values of the AS index: (5.34 vs. 3.24). Among ESRD subjects with the stiffer aorta, atherosclerotic plaques including calcificones and the aortic valve damage were more frequently detected. CONCLUSIONS Patients with ESRD are characterized by increased aortic stiffness. Atherosclerotic plaques in the aorta as well as cardiac and large vessels calcifications are more common among patients with ESRD. In patients with ESRD there is a correlation between an increase in aortic stiffness and damage of aortic valvular leaflets as well as calcifications of atherosclerotic plaques in the aorta. The degree of aortic stiffness is not related to impairment of mitral valvular leaflets and extravalvular calcifications. A relationship between aortic stiffness and aortic or aortic valve calcifications suggest a different pathogenesis of aorta calcification as compared to that underlying calcifications of other localizations.