QT prolongation is an independent predictor of mortality in end-stage renal disease.
BACKGROUND
Coronary artery disease (CAD) is the predominant cause of sudden cardiac death in the general population, and sudden cardiac death is the leading cause of mortality in end-stage renal disease (ESRD).


OBJECTIVE
QT-interval prolongation is an independent prognosticator in ESRD.


METHODS
We reviewed clinical, electrocardiographic, stress test, and coronary angiography data on ESRD patients evaluated for transplantation at our institution between 2000 and 2004 who underwent coronary angiography. The QT interval was corrected for heart rate and QRS duration (QTc). All-cause mortality data were prospectively collected and verified against the Social Security Death Index database.


RESULTS
During 40 +/- 28 months of follow-up, 132 of the 280 (47%) patients died prior to renal transplantation. Patients with a prolonged QTc (39%) had 1-, 3-, and 5-year death-rates of 12%, 36%, and 47%, respectively, vs 8%, 24%, and 36% for those with normal QTc (log-rank P = 0.03). In a multivariate Cox regression model that adjusted for age, gender, diabetes mellitus, myocardial infarction, presence and severity of CAD on angiography, left ventricular (LV) hypertrophy, LV ejection fraction (EF), and multiple other variables, QTc remained to be an independent predictor of survival (hazard ratio [HR]: 1.008, 95% confidence interval [CI]: 1.001-1.014, P = 0.016). Female gender, decreasing LVEF, and decreasing severity of CAD on angiography were independent predictors of prolonged QTc.


CONCLUSIONS
QTc prolongation is an independent predictor of mortality in ESRD patients being evaluated for renal transplantation. The prognostic information gained from the QTc is additive to that provided by the LVEF and the severity of CAD.
Hage
Fadi G
FG
Division of Cardiovascular Disease, University of Alabama at Birmingham, USA. fadihage@uab.edu
de Mattos
Angelo M
AM
Khamash
Hasan
H
Mehta
Shikha
S
Warnock
David
D
Iskandrian
Ami E
AE
D000200:Action Potentials; D000328:Adult; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D019992:Databases as Topic; D018572:Disease-Free Survival; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left