title: The prognostic value of electrocardiographic estimation of left ventricular hypertrophy in dialysis patients.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) is associated with poor cardiovascular outcome in CKD. Electrocardiogram (ECG) is low-cost but infrequently used to assess presence of LVH in dialysis patients. The aim of this study was to establish which ECG-determined LVH method is most sensitive in dialysis patients, and also most predictive of death.
  
  
  METHODS
  This was a longitudinal observational study in dialysis patients from a single center, undergoing interval ECGs. Fourteen methods of ECG LVH assessment were compared. Survival was also compared between four LVH evolutionary categories: persistent LVH; new LVH; LVH regression; and no LVH.
  
  
  RESULTS
  The study included 418 dialysis patients (46.3% women, mean age 51 years, mean follow up 67 months, 76 deaths, 37 cardiovascular deaths). LVH prevalence varied according to method (range 13.4-41.9%). No measurement predicted all-cause mortality. After Cox regression, there was an independent association between LVH and cardiovascular mortality using Novacode (HR = 3.04; 95% [CI] = 1.11-8.28, P < 0.05), but not with other methods. Patients with persistent ECG changes of LVH had increased risk of cardiovascular mortality compared to other LVH evolutionary categories (P < 0.044).
  
  
  CONCLUSIONS
  ECG scoring of LVH can be predictive of cardiovascular mortality. The Novacode method, based on repolarization abnormalities, is a better predictor than standard ECG techniques that are based on voltage criteria. Novacode LVH estimation at dialysis initiation may prove to be a noninvasive and cost-effective bedside tool for cardiovascular risk stratification in patients receiving dialysis.
authors.affiliation: Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Covic
authors.forename: Laura-Dumitriţa
authors.initials: LD
authors.lastname: Buimistriuc
authors.forename: Darren
authors.initials: D
authors.lastname: Green
authors.forename: Alina
authors.initials: A
authors.lastname: Stefan
authors.forename: Silvia
authors.initials: S
authors.lastname: Badarau
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis