Abstract

TAVELLA, NORBERTO et al. Factores asociados con enfermedad valvular aórtica en pacientes con falla renal. Rev.Urug.Cardiol. [online]. 2005, vol.20, n.3, pp.150-157. ISSN 1688-0420.

SUMMARY The prevalence of aortic valve stenosis in renal failure patients is higher than the observed in general population, suggesting accelerated or different pathogenic mechanisms. We studied the prevalence of aortic valve fibrosis and stenosis in 135 renal failure patients on maintenance dialysis, and the possible associated factors. Clinical and laboratory data were collected from dialysis registers; a cardiac echo-Doppler study was performed in all patients and the aortic transvalvular gradient and left ventricle mass index were calculated (LVMI). We measured total cholesterol (TC), triglycerides, HDL-cholesterol, apolipoprotein A1 and B and lipoprotein (a) in 116 patients; LDL-cholesterol, TC/HDL-cholesterol, and apo B/apo A1 ratio were calculated. The frequencies of aortic valve fibrosis (72%) and stenosis (6%) were more than double than in general population. An independent association of aortic valve disease with age (p<0,0005), diabetes mellitus (p=0,013), and time on dialysis (vintage) (p=0,013), was demonstrated by multivariate analysis. TC concentrations higher than 200 mg/dL were associated with aortic valve disease (p<0,004). There was no association with smoking, hypertension or phospho-calcium alterations. Compared to normal, fibrotic valves had higher values of maximal velocity (p<0,01), transvalvular gradient (p=0,005) and LVMI (p=0,005). The high prevalence of aortic valve disease in dialysis patients suggests that renal failure is a predisposing condition; the four independent factors that we recognized: age, diabetes mellitus, time on dialysis and hypercholesterolemia, are also traditionally associated with atherosclerosis. Higher transvalvular gradients and LVMI values suggest the presence of functional and morphologic alterations prior to aortic stenosis.

Keywords :     AORTIC VALVE STENOSIS; FIBROSIS; EPIDEMIOLOGIC FACTORS; CASE REPORT.

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