The prognostic value of positive T-wave in lead aVR in hemodialysis patients.
BACKGROUND
Given that cardiac disease is the leading cause of mortality in hemodialysis (HD) patients, identification of patients at risk for cardiac mortality is crucial. The aim of this study was to determine if positive T-wave amplitude in lead aVR (TaVR) was predictive of cardiovascular (CV) mortality and sudden cardiac death (SCD) in a group of HD patients.


RESULTS
After exclusion, 223 HD patients were prospectively followed-up for 25.43 ± 3.56 months. Patients were divided into TaVR negative (n = 186) and TaVR positive (n = 37) groups. Myocardial infarction, diabetes and beta-blocker therapy were more frequent in positive TaVR patients. Patients with upright TaVR were older, had higher left ventricular mass index, lower ejection fraction, higher calcium × phosphate product, higher troponin T level, higher prevalence of ST-T abnormalities, and increased width of QRS complex and QT interval, compared with patients with negative TaVR. A Kaplan-Meier analysis showed that the cumulative incidences of CV mortality as well as SCD were higher in patients with positive TaVR compared with those with negative TaVR (log-rank, p < 0.001 in both cases). A multivariate analysis selected age [hazard ratio (HR) 1.71, p < 0.001], heart rate (HR 1.42, p = 0.016), and positive TaVR (HR 2.21, p = 0.001) as well as age (HR 1.88, p < 0.001), and positive TaVR (HR 1.53, p = 0.014) as independent predictors of CV mortality and SCD, respectively.


CONCLUSIONS
In HD patients, positive TaVR is an independent and powerful predictor of CV mortality as well as SCD. This simple ECG parameter provides additional information beyond what is available with other known traditional risk factors and allows the identification of patients most at risk of CV events.
Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081, Lublin, Poland. jaroszynskiaj@interia.pl.
Andrzej
A
Jaroszyński
Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Anna
A
Jaroszyńska
Department of Family Medicine, University Center for Cardiology, Medical University of Gdańsk, Gdańsk, Poland.
Janusz
J
Siebert
Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland.
Wojciech
W
Dąbrowski
Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081, Lublin, Poland.
Jarosław
J
Niedziałek
Department of Nephrology, Medical University of Lublin, Lublin, Poland.
Anna
A
Bednarek-Skublewska
Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Tomasz
T
Zapolski
Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Andrzej
A
Wysokiński
Department of Nephrology, Medical University of Lublin, Lublin, Poland.
Wojciech
W
Załuska
Department of Nephrology, Medical University of Lublin, Lublin, Poland.
Andrzej
A
Książek
NASA Johnson Space Center, Houston, TX, USA.
Todd T
TT
Schlegel
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D053208:Kaplan-Meier Estimate; D008133:Long QT Syndrome / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis; D014463:Ultrasonography
D000319:Adrenergic beta-Antagonists
Cardiovascular mortality; Electrocardiogram; End-stage renal disease; Lead aVR; Sudden cardiac death; T-wave amplitude