Associação entre volume do átrio esquerdo e escore de cálcio das artérias coronárias nos pacientes em diálise peritoneal
Data
2021-12-08
Autores
Reis, Fabrício Moreira
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A doença cardiovascular (DCV) é a principal causa de óbito em pacientes portadores de doença renal crônica (DRC) submetidos à diálise peritoneal (DP). A avaliação da calcificação coronariana pelo escore de cálcio das artérias coronárias (ECAC) tem mostrado prever a incidência de infarto agudo do miocárdio (IAM) e morte por DCV nesses pacientes. O volume do átrio esquerdo (VAE) também tem sido associado ao IAM e eventos cardiovasculares. Este estudo visa avaliar a associação entre o VAE e o ECAC nos pacientes em DP. Casuística e Métodos: Estudo transversal, prospectivo e unicêntrico. Foram incluídos pacientes adultos prevalentes em DP na Unidade de Diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP. Foram realizados: coleta de dados demográficos, clínicos e laboratoriais; avaliação do estado nutricional por antropometria e bioimpedância; cálculo da função renal residual e da adequação de diálise (Kt/V); Doppler-ecocardiograma, ultrassonografia de carótidas, velocidade de onda de pulso (VOP), índice tornozelo-braquial (ITB) e ECAC. Os pacientes foram divididos em dois grupos, de acordo com o resultado do ECAC, em positivo ou negativo. As comparações entre os grupos foram realizadas por meio do teste de Qui-quadrado, t Student ou Mann-Whitney e regressão logística uni e multivariada. Foi utilizado o programa SPSS versão 23 e o nível de significância adotado foi de p <0,05. Resultados: Foram avaliados 44 indivíduos em DP, com idade média de 56 anos, quase todos hipertensos e dislipidêmicos. A principal causa de DRC foi a HAS. A mediana do tempo em terapia dialítica foi de 11,7 meses. Na análise univariada, foi observado associação do ECAC com diversas variáveis como idade, DM, OH, VOP femoral, VAEi, relação E/A e IMVE. Após, na análise multivariada, apenas o VAEi manteve-se relacionado ao ECAC positivo, com OR de 1,71. Conclusão: O VAEi está associado ao ECAC positivo em portadores de DRC submetidos à DP.
Introduction: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD). The assessment of coronary calcification by coronary artery calcium score (CAC) has been shown to predict the incidence of acute myocardial infarction (AMI) and death by CVD in these patients. Left atrial volume (LAV) has also been associated with AMI and cardiovascular events. This study aims to assess the association between LAV and CAC in PD patients. Methods: Cross-sectional, prospective and single-center study. Adult patients with prevalence of PD in the Dialysis Unit of the Hospital das Clínicas, Botucatu Medical School – UNESP were included. The following data were performed: demographic, clinical and laboratory data collection; assessment of nutritional status by anthropometry and bioimpedance; protocol of residual renal function and adequacy of dialysis (Kt/V); Doppler echocardiogram, carotid ultrasound, pulse wave velocity (PWV), ankle-brachial index (ABI) and CAC. Patients were divided into two groups, according to the CAC result, as positive or negative. Comparisons between groups were performed using the Chi-square, Student t or Mann-Whitney test and univariate and multivariate logistic regression. The SPSS version 23 program was used and the significance level adopted was p<0.05. Results: Were evaluated 44 individuals on PD, with average age of 56 years, about 80% hypertensive and dyslipidemic. The main cause of CKD was SAH. The median time on dialysis therapy was 11.7 months. In the univariate analysis, a significant association of CAC was observed with several variables such as age, DM, OH, femoral PWV, LAVi, E/A ratio and LVMI. Afterwards, in the multivariate analysis, only LAVi remained related to a positive CAC, with an OR of 1.71. Conclusion: The LAVi is associated with positive CAC in patients with CKD undergoing PD.
Introduction: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (PD). The assessment of coronary calcification by coronary artery calcium score (CAC) has been shown to predict the incidence of acute myocardial infarction (AMI) and death by CVD in these patients. Left atrial volume (LAV) has also been associated with AMI and cardiovascular events. This study aims to assess the association between LAV and CAC in PD patients. Methods: Cross-sectional, prospective and single-center study. Adult patients with prevalence of PD in the Dialysis Unit of the Hospital das Clínicas, Botucatu Medical School – UNESP were included. The following data were performed: demographic, clinical and laboratory data collection; assessment of nutritional status by anthropometry and bioimpedance; protocol of residual renal function and adequacy of dialysis (Kt/V); Doppler echocardiogram, carotid ultrasound, pulse wave velocity (PWV), ankle-brachial index (ABI) and CAC. Patients were divided into two groups, according to the CAC result, as positive or negative. Comparisons between groups were performed using the Chi-square, Student t or Mann-Whitney test and univariate and multivariate logistic regression. The SPSS version 23 program was used and the significance level adopted was p<0.05. Results: Were evaluated 44 individuals on PD, with average age of 56 years, about 80% hypertensive and dyslipidemic. The main cause of CKD was SAH. The median time on dialysis therapy was 11.7 months. In the univariate analysis, a significant association of CAC was observed with several variables such as age, DM, OH, femoral PWV, LAVi, E/A ratio and LVMI. Afterwards, in the multivariate analysis, only LAVi remained related to a positive CAC, with an OR of 1.71. Conclusion: The LAVi is associated with positive CAC in patients with CKD undergoing PD.
Descrição
Palavras-chave
Diálise peritoneal, Escore de cálcio das artérias coronárias, Volume do átrio esquerdo, Peritoneal dialysis, Coronary artery calcium score, Left atrial volume