title: Clinical determinants and prognostic significance of the electrocardiographic strain pattern in chronic kidney disease patients.
abstract: The electrocardiographic (ECG) strain pattern (Strain) is a marker of left ventricular hypertrophy (LVH) severity that provides additional prognostic information beyond echocardiography (ECHO) in the community level. We sought to evaluate its clinical determinants and prognostic usefulness in chronic kidney disease (CKD) patients. We evaluated 284 non-dialysis-dependent patients with CKD stages 3 to 5 (mean age, 61 years [interquartile range, 53-67 years]; 62% men). Patients were followed for 23 months (range, 13-32 months) for cardiovascular (CV) events and/or death. Strain patients (n = 37; 13%) were using more antihypertensive drugs, had higher prevalence of peripheral vascular disease and smoking, and higher levels of C-reactive protein, cardiac troponin, and brain natriuretic peptide (BNP). The independent predictors of Strain were: left ventricular mass index (LVMI), BNP, and smoking. During follow-up, there were 44 cardiovascular events (fatal and non-fatal) and 22 non-CV deaths; and Strain was associated with a worse prognosis independently of LVMI. Adding Strain to a prognostic model of LVMI improved in 15% the risk discrimination for the composite endpoint and in 12% for the CV events. Strain associates with CV risk factors and adds prognostic information over and above that of ECHO-assessed LVMI. Its routine screening may allow early identification of high risk CKD patients.
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. Electronic address: accordeirojr@uol.com.br.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Cordeiro
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Aline A I
authors.initials: AA
authors.lastname: Moraes
authors.affiliation: Department of Tele-Electrocardiography, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Virginia
authors.initials: V
authors.lastname: Cerutti
authors.affiliation: Department of Tele-Electrocardiography, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Faustino
authors.initials: F
authors.lastname: França
authors.affiliation: Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Quiroga
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Celso
authors.initials: C
authors.lastname: Amodeo
authors.affiliation: Department of Echocardiography, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Juliano C
authors.initials: JC
authors.lastname: Picotti
authors.affiliation: Department of Echocardiography, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Lucas V
authors.initials: LV
authors.lastname: Dutra
authors.affiliation: Department of Echocardiography, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Gabriel D
authors.initials: GD
authors.lastname: Rodrigues
authors.affiliation: Department of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Amparo
authors.affiliation: Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000401:mortality*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012907:Smoking / Q000453:epidemiology; D014336:Troponin / Q000097:blood
chemical_list: D000959:Antihypertensive Agents; D014336:Troponin; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Coronary artery disease; inflammation; myocardial ischemia; uremia