TY - JOUR
T1 - Electrophysiologic substrate and risk of mortality in incident hemodialysis
AU - Tereshchenko, Larisa G.
AU - Kim, Esther D.
AU - Oehler, Andrew
AU - Meoni, Lucy A.
AU - Ghafoori, Elyar
AU - Rami, Tejal
AU - Maly, Maggie
AU - Kabir, Muammar
AU - Hawkins, Lauren
AU - Tomaselli, Gordon F.
AU - Lima, Joao A.
AU - Jaar, Bernard G.
AU - Sozio, Stephen M.
AU - Estrella, Michelle
AU - Kao, W. H.Linda
AU - Parekh, Rulan S.
N1 - Publisher Copyright:
© Copyright 2016 by the American Society of Nephrology.
PY - 2016
Y1 - 2016
N2 - 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 onincident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage RenalDisease 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 55613 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%612.0% and a mean±SDleft ventricularmass index of 66.6622.3 g/m2.7. During 864.6 person-years of follow-up, 77 patients died; 35 died fromcardiovascular 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.
AB - 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 onincident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage RenalDisease 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 55613 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%612.0% and a mean±SDleft ventricularmass index of 66.6622.3 g/m2.7. During 864.6 person-years of follow-up, 77 patients died; 35 died fromcardiovascular 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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U2 - 10.1681/ASN.2015080916
DO - 10.1681/ASN.2015080916
M3 - Article
C2 - 27129390
AN - SCOPUS:84993165839
SN - 1046-6673
VL - 27
SP - 3413
EP - 3420
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 11
ER -