Prognostic value of valve calcification and high cardiothoracic ratio for major adverse cardiovascular events and mortality in hemodialysis patients.

Maintenance hemodialysis (MHD) patients are at high risk of valve calcification (VC) and cardiomegaly, defined as cardiothoracic ratio (CTR) ≥0.5. CTR is a widely used indicator of volume overload and left ventricular dysfunction and predicts adverse cardiovascular outcomes. However, the combined prognostic impact of VC and high CTR on cardiovascular mortality remains unclear. We conducted a retrospective, single-center, exploratory study enrolling MHD patients from October to December, 2018. Patients were stratified into four groups based on VC and CTR (<0.5 or ≥0.5). Multivariable Cox proportional hazards models and the Kaplan-Meier method were used to evaluate risks and cumulative incidence of major adverse cardiovascular events (MACEs), cardiovascular mortality, and overall mortality among groups. Of 312 MHD patients, 37 had no VC with CTR <0.5, 47 had no VC with CTR ≥0.5, 96 had VC with CTR <0.5, and 132 had VC with CTR ≥0.5. Compared to MHD patients without VC and CTR <0.5, those with VC and CTR ≥0.5 had higher risks of MACEs, cardiovascular mortality and overall mortality (adjusted hazard ratios: 4.174, 6.426, and 4.031; 95% confidence intervals: 1.766-9.868, 1.503-27.48, and 1.407-11.55, respectively). During 3-year follow-up, the cumulative incidence of aforementioned outcomes was highest among MHD patients with VC and CTR ≥0.5 (log-rank test,