FACTORS ASSOCIATED WITH HEART VALVE CALCIFICATION IN PATIENTS ON CHRONIC HEMODIALYSIS

THE AIM of the investigation was to determine the spread and influence of calcification of the mitral (MV) and aortal (AV) valves of the heart on its function in a group of examined dialysis patients and to find the factors associated with calcinosis of MV and AV, and connections of valve calcification with uremic osteodystrophy. PATIENTS AND METHODS. Under investigation there were 131 patients after Doppler-Echo CG, aged 51.7±12.6 years treated by hemodialysis (HD) during 77.7±75.6 months. IHD was found in 55.6% of the patients, heart failure (HF) in 50.0%. Intact parathyroid hormone (PTH), biochemical markers of inflammation (fibrinogen and C-reactive protein) were determined in all the patients in addition to ordinary investigations. The state of MVand AV according to Doppler-Echo CG were estimated as the norm, infiltration, calcinosis (of valve annulus or cusps).The presence of stenosis, regurgitation of MV and AV were also determined. The thickness of the intima[1]media complex (IMC) of the carotid artery was measured. The 24 hours’ monitoring of arterial pressure was performed in 88 patients and ECG monitoring in 100 patients. Bone mineral density (BMD) of three parts of the skeleton (lumbar vertebra, proximal part of the femur and forearm) was measured in 63 patients by the method of dual energy X-ray absorptiometry estimated by T-criterion and Z-criterion. The BMD value more than -1 was considered normal, from -1 to -2.5 as osteopenia (mild decrease of MBD), less than – 2.5 as osteoporosis (considerably decreased MBD). RESULTS. Calcinosis of the valves was detected in 38.9% of the patients: isolated AV calcinosis – in 3.8%, MV – in 13.0%, both valves calcinosis – in 22.1% of the patients. Stenosis of that valve was more often detected in patients with AV calcinosis (χ2= 19.8; p<0.001) and they had more pronounced regurgitation (t=3.16; p=0.003). MV calcinosis also promoted stenosing (χ2= 17.27; p<0.0001) and regurgitation (t=2.11; p=0.038). A comparison of the groups of patients which differed in the presence of valvular calcinosis has shown that patients with valvular calcinosis were older (Z=4.02; p<0.001), had longer dialysis treatment (Z=2.93; p=0.0034), had IHD more often (χ2=6.02; p<0.014), HF (χ2= 3.85; p=0.05), higher levels of PTH (Z=2.09; p=0.037) and alkaline phosphatase (Z=2.93; p= 0.0034), greater IMC thickness (Z=2.45; p=0.014), less values of forearm MBD (Z=1.98; p=0.048), higher values of C-reactive protein (Z=2.50; p= 0.016). In addition, patients with valvular calcification had greater size of the left atrium (Z=3.67; p= 0.001), higher flow rate through MV (Z=4.24; p<0.001) and AV (Z=3.79; p<0.001).CONCLUSION. Calcinosis of MV and AV of the heart was diagnosed in one third of the examined patients. A combination of calcification of the valves prevailed. Calcification of the valves was more often observed in older patients, with longer HD treatment, more pronounced hyperparathyrosis, inflammatory alterations, atherosclerosis. An association of valvular calcinosis with less BMD was found for the first time. Calcification of the valves was combined with greater frequency of IHD, HF, dilatation of the left atrium and speeding up the flows through AV and MV.

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