Correlation of simple imaging tests and coronary artery calcium measured by computed tomography in hemodialysis patients.
Vascular calcification is associated with an adverse prognosis in end-stage renal disease. It can be accurately quantitated with computed tomography but simple in-office techniques may provide equally useful information. Accordingly we compared the results obtained with simple non-invasive techniques with those obtained using electron beam tomography (EBT) for coronary artery calcium scoring (CACS) in 140 prevalent hemodialysis patients. All patients underwent EBT imaging, a lateral X-ray of the lumbar abdominal aorta, an echocardiogram, and measurement of pulse pressure (PP). Calcification of the abdominal aorta was semiquantitatively estimated with a score (Xr-score) of 0-24 divided into tertiles, echocardiograms were graded as 0-2 for absence or presence of calcification of the mitral and aortic valve and PP was divided in quartiles. The CACS was elevated (mean 910+/-1657, median 220). The sensitivity and specificity for CACS > or = 100 was 53 and 70%, for calcification of either valve and 67 and 91%, respectively, for Xr-score > or = 7. The area under the curve for CACS > or = 100 associated with valve calcification and Xr-score was 0.62 and 0.78, respectively. The likelihood ratio (95% confidence interval) of CACS > or = 100 was 1.79 (1.09, 2.96) for calcification of either valve and 7.50 (2.89, 19.5) for participants with an Xr-score > or = 7. In contrast, no association was present between PP and CACS. In conclusion, simple measures of cardiovascular calcification showed a very good correlation with more sophisticated measurements obtained with EBT. These methodologies may prove very useful for in-office imaging to guide further therapeutic choices in hemodialysis patients.
Bellasi
A
A
Department of Nephrology, Ospedale San Paolo and University of Milan, Milan, Italy.
Ferramosca
E
E
Muntner
P
P
Ratti
C
C
Wildman
R P
RP
Block
G A
GA
Raggi
P
P
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D002114:Calcinosis / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D002118:Calcium / Q000378:metabolism*; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D003331:Coronary Vessels / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D002118:Calcium