Relation of Carotid Intima-Media Thickness and Silent Cerebral Infarction to Cardiovascular Events and All-Cause Mortality in Chronic Hemodialysis Patients

Abstract

Objective Silent cerebral infarction (SCI) and increased carotid intima-media thickness (IMT) have been found to be associated with future stroke in the general population. We investigated whether a combination of SCI and increased IMT is a predictor of cardiovascular events and all-cause mortality in chronic hemodialysis (HD) patients. Methods We performed a retrospective cohort study of 70 HD patients who had one or more risk factors for atherosclerosis but no history of cardiovascular disease. We performed cranial magnetic resonance imaging (MRI) and measured carotid IMT at baseline, and then evaluated the risks of cardiovascular events and all-cause mortality by using Cox proportional hazards models. The Kaplan-Meier method and a log-rank test were used to compare event-free survival.Results SCI was present in 25 patients (35.7%) at baseline. During an average follow-up of 46.3±14.3 months (range: 19 to 56 months), 15 patients (21.4%) died and 16 (22.9%) experienced a new cardiovascular event. The presence of SCI in combination with increased carotid IMT at baseline was independently associated with cardiovascular events and all-cause mortality after adjustment for age, sex, duration of dialysis, and traditional vascular risk factors. Conclusion SCI, similar to carotid IMT, is an independent predictor of cardiovascular events and all-cause mortality in chronic HD patients.

The Association between Carotid Artery Atherosclerosis and Silent Brain Infarction: A Systematic Review and Meta-analysis

“…Ten were cross-sectional, non-prospective studies 21, 22, 24, 28–3335 , four were cross-sectional analyses of a prospective cohort 23, 25–27 , one was a case-control study 36 , and one was a retrospective study 34 . Eight studies were from Japan 21, 24, 27, 28, 30, 32, 33, 36 ; three from the United States 22, 2535 ; and one each from the Netherlands 26 , Taiwan 29 , Republic of Korea 31 , France 23 , and China 34 . All of the studies except two 26, 34 focused on subjects without a history of stroke or TIA.…”

“…All of the studies except two 26, 34 focused on subjects without a history of stroke or TIA. Eight studies included subjects who were asymptomatic, randomly sampled, or lacking known stroke risk factors 21–25, 29, 3236 , while eight studies included subjects with at least one known stroke risk factor 26–28, 30, 31, 33–35 .…”

“…The remaining study averaged the IMT measurements at the common carotid artery, carotid bulb, and internal carotid artery 27 . Four studies measured IMT at more than one location and averaged the measurements to calculate mean IMT for each subject 26, 27, 30, 33 . The most common definition of IMT was the distance between the lumina-intima and media-adventitia interfaces 23, 27 .…”

“…Seven studies reported an association between IMT and SBI 22, 23, 26–28, 30, 33 (Figure 1A). These studies report the mean IMT for a total of 1,469 subjects with MRI evidence of SBI and 5,102 subjects without SBI.…”

“…There was statistically significant heterogeneity ( Q =18.65, P =0.0048) but no significant publication bias (Kendall’s tau score=0.05, P >0.99) present in this analysis (Supplemental Figure II). Restricting the analysis to studies examining subjects with at least one stroke risk factor 26–28, 30, 33 , stroke-free subjects 22, 23, 27, 28, 30, 33 , or studies with a low risk of bias 22, 23, 27 did not significantly alter the results (Supplemental Table IV). …”