title: Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD.
abstract: Limited studies have assessed the resting 12-lead electrocardiogram (ECG) as a screening test in intermediate risk populations. We evaluated whether a panel of common ECG parameters are independent predictors of mortality risk in a prospective cohort of participants with CKD. The Chronic Renal Insufficiency Cohort (CRIC) study enrolled 3939 participants with eGFR<70 ml/min per 1.73 m(2) from June 2003 to September 2008. Over a median follow-up of 7.5 years, 750 participants died. After adjudicating the initial 497 deaths, we identified 256 cardiovascular and 241 noncardiovascular deaths. ECG metrics were independent risk markers for cardiovascular death (hazard ratio, 95% confidence interval): PR interval ≥200 ms (1.62, 1.19-2.19); QRS interval 100-119 ms (1.64, 1.20-2.25) and ≥120 ms (1.75, 1.17-2.62); corrected QT (QTc) interval ≥450 ms in men or ≥460 ms in women (1.72, 1.19-2.49); and heart rate 60-90 beats per minute (1.21, 0.89-1.63) and ≥90 beats per minute (2.35, 1.03-5.33). Most ECG measures were stronger markers of risk for cardiovascular death than for all-cause mortality or noncardiovascular death. Adding these intervals to a comprehensive model of cardiorenal risk factors increased the C-statistic for cardiovascular death from 0.77 to 0.81 (P<0.001). Furthermore, adding ECG metrics to the model adjusted for standard risk factors resulted in a net reclassification of 12.1% (95% confidence interval 8.1%-16.0%). These data suggest common ECG metrics are independent risk factors for cardiovascular death and enhance the ability to predict death events in a population with CKD.
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Rajat.Deo@uphs.upenn.edu.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Haochang
authors.initials: H
authors.lastname: Shou
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina;
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Arkin
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Division of Research, Kaiser Permanent Northern California, Oakland, California; Department of Health Research and Policy, Stanford University, Palo Alto, California; Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; and.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; and Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality*; D012307:Risk Factors
keywords: chronic kidney disease; electrophysiology; epidemiology and outcomes; mortality risk; risk factors