These results provide the first direct evidence that in patients with ESRD, increased aortic stiffness determined by measurement of aortic PWV is a strong independent predictor of all-cause and mainly cardiovascular mortality.

AMC is a strong prognostic marker of all-cause and CV mortality in HD patients, independently of classical atherogenic factors. The principal effect of AMC on arterial function is increased arterial stiffness.

Abstract-To test the predictive values of and independent contributions to cardiovascular and all-cause mortality of various arterial parameters exploring characteristics of the arterial wall at different sites, we studied prospectively 110 stable end-stage renal disease patients on hemodialysis. These parameters involved carotid diameter, carotid intima-media thickness, carotid compliance, carotid distensibility, carotid incremental elastic modulus, aortic diameter, aortic pulse wave velocity, and the presence of arterial calcifications measured at the sites of the carotid artery, abdominal aorta, iliofemoral axis, and legs. The presence of calcifications was analyzed semiquantitatively as a score (0 to 4) according to the number of arterial sites with calcifications. During a follow-up of 53Ϯ21 months (meanϮSD), 25 cardiovascular and 14 noncardiovascular deaths occurred. In univariate analysis, the carotid incremental elastic modulus was the most closely related to prognosis. Risk of death increased with the number of vascular sites involved by calcifications. Moreover, information (in terms of prediction) given by carotid elastic incremental modulus was additive to the presence and extent of vascular calcification-related prediction value. Adjusted hazard ratios of all-cause and cardiovascular mortality for an increase of 1 unit in calcification score were 1.9 (95% confidence interval [CI], 1.4 to 2.6) and 2.6 (95% CI, 1.5 to 4.4), respectively (PϽ0.001 for both). Adjusted hazard ratios of all-cause and cardiovascular mortality for a 1-SD increase in carotid incremental elastic modulus were 1.6 (95% CI, 1.2 to 2.2) and 1.7 (95% CI, 1.2 to 2.4), respectively (PϽ0.01 for both). 4 It has recently been reported that the presence of vascular calcifications in end-stage renal disease (ESRD) patients was associated with increased stiffness of large, capacitive, elastic-type arteries like the aorta and common carotid artery (CCA). 4 Because CCA incremental elastic modulus (Einc) and aortic pulse wave velocity (PWV) were both identified as strong predictors of prognosis in ESRD patients 5,6 and because, to the best of our knowledge, no prospective study has reported associations between arterial calcifications and prognosis in ESRD populations, we designed this study to test the predictive value of various arterial parameters exploring characteristics of the arterial wall at different sites. These parameters involved CCA diameter, CCA intima-media thickness (IMT), CCA compliance, CCA distensibility, CCA Einc, aortic diameter, aortic PWV, and the presence of arterial calcifications measured at the sites of the CCA, abdominal aorta, iliofemoral axis, and legs. Subsequently, we examined whether these different parameters had independent contributions to CV and all-cause mortality. Methods PatientsPatients were eligible for inclusion if they (1) had been on hemodialysis for Ն3 months (81Ϯ79 months, meanϮSD), (2) had no clinical CV disease during the 6 months preceding entry, and (3) agreed to participate in the follow-up...

Abstract-Large artery damage is a major contributory factor to cardiovascular morbidity and mortality of patients with hypertension. Pulse wave velocity (PWV), a classic evaluation of arterial distensibility, has never been ascertained as a cardiovascular risk marker. To determine the factors influencing aortic PWV and the potential predictor role of this measurement, we studied a cohort of 710 patients with essential hypertension. Atherosclerosis alterations (AA) were defined on the basis of clinical events. Calculation of cardiovascular risks, by use of Framingham equations, was performed in subjects without AA. PWV was higher in the presence of AA (14.9Ϯ4.0 versus 12.4Ϯ2.6 m/s, PϽ0.0001), even after adjustments on confounding factors and was the first determinant (PϽ0.0001) of the extent of atherosclerosis assessed as the sum of the atherosclerotic sites. In patients without AA, all cardiovascular risks increased constantly with PWV. Furthermore, at a given age, aortic PWV was the best predictor of cardiovascular mortality. The odds ratio of being in a high cardiovascular mortality risk group (Ͼ5% for 10 years) for patients in the upper quartile of PWV was 7.1 (95% confidence intervals 4.5 to 11.3). Nevertheless, in these studies, the number of patients needed to be treated in order to avoid 1 cardiovascular event remains high, particularly in the younger population. Clearly, the consideration of the other cardiovascular risk factors associated with hypertension would enable a more accurate evaluation of individual risk, risk stratification, and cost-effective preventive therapy. 3 From the Framingham population, evaluations have been proposed, taking into account simultaneously the contribution of blood pressure (BP), tobacco consumption, gender, lipid profile, diabetes mellitus, and ECG left ventricular hypertrophy. 4 However, an appropriate and simple evaluation of individual risk, based on a single measurement, is still lacking.Arterial stiffness increases with age 5 and hypertension 6 and is also enhanced in subjects with diabetes mellitus, 7 atherosclerosis, 8 and end-stage renal disease. 9 The most obvious consequences of arterial stiffening are increased pulsatile BP caused by higher systolic BP (SBP) and lower diastolic BP (DBP), thereby causing increased left ventricular afterload and altering coronary perfusion. 6,9 High SBP and pulse pressure, low DBP, and left ventricular hypertrophy have been identified as independent factors of cardiovascular morbidity and mortality in the general population. 1,10 -12 Arterial stiffness can be assessed noninvasively with the use of pulse wave velocity (PWV) measurement, that is, the velocity of the pulse wave to travel a given distance between 2 sites of the arterial system. Nevertheless, whether aortic stiffening is predictive of clinical outcome and/or mortality needs to be established.The goal of the present study was (1) to test the ability for aortic PWV to act as a marker of individual cardiovascular risk, integrating the atherosclerotic vascular damages ...