title: Effect of End-Stage Renal Disease on Rate of Progression of Aortic Stenosis.
abstract: This study aimed to investigate the progression of mild-to-moderate aortic stenosis (AS) in patients with end-stage renal disease (ESRD) and determine its metabolic and hemodynamic contributors and clinical outcomes. A total of 74 patients with ESRD (50 men, age 72 ± 11 years) with mild-to-moderate AS were compared with 79 age- and gender-matched controls with normal kidney function. Clinical, laboratory, and echocardiographic features and clinical outcomes including aortic valve (AV) intervention, hospitalization due to heart failure, and cardiovascular death were analyzed. Patients with ESRD were divided into 2 subgroups according to their rate of AV area changes (group 1 [n = 28], rapid progression; and group 2 [n = 46], slow progression). Progression in the degree of AS was noted in 38% of patients with ESRD and 18% of controls (p <0.01) during comparable echocardiographic follow-up durations (29 ± 15 vs 27 ± 24 months, respectively, p = 0.57). In ESRD, patients in group 1 were older (p <0.01) with higher baseline log parathyroid hormone (p <0.01) and larger stroke volume (p = 0.03) than those in group 2. During clinical follow-up (48 ± 23 months), patients in group 1 showed poorer clinical outcomes than those in group 2 and controls (log-rank p <0.01). Age, left atrial volume index ≥42 ml/m(2), and annual increases of peak pressure gradient across the AV (mm Hg/year) demonstrated additive predictive values for prognosis. AS in ESRD progresses in an accelerated manner along with higher metabolic and hemodynamic loads on AV compared with those with normal kidney function. Accelerated progression of mild-to-moderate AS in ESRD results in poor prognosis.
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Darae
authors.initials: D
authors.lastname: Kim
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: cysprs@yuhs.ac.
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: In Jeong
authors.initials: IJ
authors.lastname: Cho
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018450:Disease Progression; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*