Calcification of heart structures in patients with suspected coronary heart disease depending on renal function

Authors

DOI:

https://doi.org/10.26641/2307-0404.2022.2.260233

Keywords:

coronary artery calcification score, glomerular filtration rate, coronary artery disease

Abstract

Cardiovascular disease is the leading cause of death in the world. The use of the coronary artery calcification score (CACS) allows to determine the risk of coronary artery disease (CAD). Chronic kidney disease (CKD) is a one of the major risk factors for coronary artery disease. With a decrease in renal function, impaired calcium-phosphorus metabolism leads to excessive tissue calcification. It is likely that patients with different kidney function experience different types of calcium deposition. The use of CACS is an opportunity to assess the condition of the coronary arteries without using a contrast agent, which is very important for patients with CKD. One of the most accessible and significant research methods for clinical screening use is computed tomography with non-invasive assessment of coronary calcium (quantitative analysis of the calcium index). To evaluate it, the method of A. Agatston is used, which allows to measure calcium in units. Our aim was to investigate the pattern of calcification of heart structures depending on renal function in patients with suspected coronary heart disease. The patients in the presented study had a high incidence of diabetes mellitus (49.4%) and arterial hypertension (83.1%). In patients with suspected coronary artery disease, borderline values of systolic and diastolic blood pressure and total cholesterol were found. In the majority of the patients CACS was 1-100 Agatston units (AU). After the distribution of patients into groups depending on glomerular filtration rate (GFR), it was found that the groups of patients with lower GFR, were of older age. The proportion of patients with total CACS >100 AU was the highest in the group of patients with GFR 30-59 ml/min. There were no significant differences in the structure of general and vascular CACS between patients with GFR 90-120 ml/min and GFR 60-89 ml/min. Valvular CACS was significantly lower in patients with GFR <60 ml/min. In all cases of visual comparison of CACS depending on GFR, significantly higher CACS indices differed in patients with GFR <60 ml/min compared to patients with GFR ≥60 ml/min.

References

[Unified Clinical Protocol of Primary, Secondary (Specialized) and Tertiary (highly specialized) medical care “Stable Ischemic Heart Disease”]. Pub. L. No. N 2857. (Dec 12, 2021). Ukraine.

Juhani K, William W, Antti S, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2020;(3):407-77. doi: https://doi.org/10.1093/eurheartj/ehz425

Adriano Luiz Ammirati. Chronic Kidney Disease. Scientific Electronic Library Online [Internet]. 2020. doi: https://doi.org/10.1590/1806-9282.66.S1.3

Liew G, Chow C, Niels V, et al. Cardiac Society of Aus¬tralia and New Zealand Position Statement: Coronary Ar¬tery Calcium Scoring. Heart, Lung and Circulation. 2017;(13):1-13. doi: https://doi.org/10.1016/j.hlc.2017.05.130

Hoffmann U, Massaro JM, D’Agostino RB, et al. Cardiovascular event prediction and risk reclassification by coronary, aortic, and valvular calcification in the Framingham Heart Study. J Am Heart Assoc. 2016. doi: https://doi.org/10.1161/JAHA.115.003144.

Sarnak MJ, Amann K, Bangalore S, et al. Chronic Kidney Disease and Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019:1823-38. doi: https://doi.org/10.1016/j.jacc.2019.08.1017

Ferencik M, Pencina KM, Liu T, et al. Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events. Circulation: Cardiovascular Imaging; 2017. doi: https://doi.org/10.1161/CIRCIMAGING.117.006592

Cano-Megias M, Guisado-Vasco P, Bouarich H. et al. Coronary calcification as a predictor of cardio-vascular mortality in advanced chronic kidney disease: a prospective long-term follow-up study. BMC Nephrology. 2019;20. doi: https://doi.org/10.1186/s12882-019-1367-1

Hyun Y, Kim H, OhK, et al. eGFR and coronary artery calcification in chronic kidney disease. Eur J Clin Invest. 2019. doi: https://doi.org/10.1111/eci.13101

Tonneijck L, Muskiet M, Smits M, et al. Glome-rular Hyperfiltration in Diabetes: Mechanisms, Clinical Significance, and Treatment. Journal of the American Society of Nephrology. 2017;(4):1023-39. doi: https://doi.org/10.1681/ASN.2016060666

Carson AP, Steffes MW, Carr JJ, et al. Hemo-globin a1c and the progression of coronary artery calci-fication among adults without diabetes. Diabetes Care. 2015;38:66. doi: https://doi.org/10.2337/dc14-0360

Martin SS, Blaha MJ, Blankstein R. Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis. Circulation. 2014;129:77-86. doi: https://doi.org/10.1161/CIRCULATIONAHA.113.003625

Neves P, Joalbo A, Monção H. Coronary artery calcium score: current status. Scientific Electronic Library Online [Internet]. 2017. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-39842017000300182&lng=en&tlng=en#aff2

R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Com¬puting, Vienna, Austria [Internet]. 2020. Available from: http://www.r-project.org/index.html

Webster C, Nagler E, Morton R. Chronic Kidney Disease. The Lancet. 2017;389:1238-52. doi: https://doi.org/10.1016/S0140-6736(16)32064-5

Published

2022-06-28

How to Cite

1.
Kuryata O, Karavanska I, Semenov V, Nikutova A. Calcification of heart structures in patients with suspected coronary heart disease depending on renal function. Med. perspekt. [Internet]. 2022Jun.28 [cited 2024Apr.25];27(2):64-70. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/260233

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Section

CLINICAL MEDICINE