Abstract |
The single leading cause of mortality on hemodialysis is sudden cardiac death. Whether measures of electrophysiologic substrate independently associate with mortality is unknown. We examined measures of electrophysiologic substrate in a prospective cohort of 571 patients on incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease Study. A total of 358 participants completed both baseline 5-minute and 12-lead electrocardiogram recordings on a nondialysis day. Measures of electrophysiologic substrate included ventricular late potentials by the signal-averaged electrocardiogram and spatial mean QRS-T angle measured on the averaged beat recorded within a median of 106 days (interquartile range, 78-151 days) from dialysis initiation. The cohort was 59% men, and 73% were black, with a mean±SD age of 55±13 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%±12.0% and a mean±SD left ventricular mass index of 66.6±22.3 g/m2.7 During 864.6 person-years of follow-up, 77 patients died; 35 died from cardiovascular causes, of which 15 were sudden cardiac deaths. By Cox regression analysis, QRS-T angle ≥75° significantly associated with increased risk of cardiovascular mortality (hazard ratio, 2.99; 95% confidence interval, 1.31 to 6.82) and sudden cardiac death (hazard ratio, 4.52; 95% confidence interval, 1.17 to 17.40) after multivariable adjustment for demographic, cardiovascular, and dialysis factors. Abnormal signal-averaged electrocardiogram measures did not associate with mortality. In conclusion, spatial QRS-T angle but not abnormal signal-averaged electrocardiogram significantly associates with cardiovascular mortality and sudden cardiac death independent of traditional risk factors in patients starting hemodialysis.
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Authors | Larisa G Tereshchenko, Esther D Kim, Andrew Oehler, Lucy A Meoni, Elyar Ghafoori, Tejal Rami, Maggie Maly, Muammar Kabir, Lauren Hawkins, Gordon F Tomaselli, Joao A Lima, Bernard G Jaar, Stephen M Sozio, Michelle Estrella, W H Linda Kao, Rulan S Parekh |
Journal | Journal of the American Society of Nephrology : JASN
(J Am Soc Nephrol)
Vol. 27
Issue 11
Pg. 3413-3420
(Nov 2016)
ISSN: 1533-3450 [Electronic] United States |
PMID | 27129390
(Publication Type: Journal Article)
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Copyright | Copyright © 2016 by the American Society of Nephrology. |
Topics |
- Death, Sudden, Cardiac
(epidemiology)
- Electrocardiography
- Electrophysiological Phenomena
- Female
- Humans
- Male
- Middle Aged
- Prospective Studies
- Renal Dialysis
(mortality)
- Risk Factors
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