Electrophysiologic Substrate and Risk of Mortality in Incident Hemodialysis
| Autor: | Andrew Oehler, Stephen M. Sozio, Michelle M. Estrella, Lauren Hawkins, Maggie Maly, Elyar Ghafoori, Joao A.C. Lima, Rulan S. Parekh, Muammar M. Kabir, Gordon F. Tomaselli, W. H. Linda Kao, Esther Kim, Bernard G. Jaar, Tejal Rami, Larisa G. Tereshchenko, Lucy A. Meoni |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Sudden cardiac death End stage renal disease Electrocardiography 03 medical and health sciences 0302 clinical medicine Renal Dialysis Risk Factors Internal medicine medicine Risk of mortality Humans Clinical Epidemiology Prospective Studies 030212 general & internal medicine Prospective cohort study Ejection fraction medicine.diagnostic_test business.industry Hazard ratio General Medicine Middle Aged medicine.disease Electrophysiological Phenomena Death Sudden Cardiac Nephrology cardiovascular system Cardiology Female Hemodialysis business |
| Zdroj: | Journal of the American Society of Nephrology. 27:3413-3420 |
| ISSN: | 1533-3450 1046-6673 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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