NDT Advance Access originally published online on April 23, 2007
Nephrology Dialysis Transplantation 2007 22(9):2645-2652; doi:10.1093/ndt/gfm238
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Analysis of T-wave morphology from the 12-lead electrocardiogram for prediction of long-term prognosis in patients initiating haemodialysis
1Department of Internal Medicine of Nephrology, En Chu Kong Hospital, 2Department of Internal Medicine of Cardiology, National Taiwan University Hospital, Taipei, Taiwan and 3Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
Correspondence and offprint requests to: Pau-Chung Chen, MD, PhD, Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, No.17 Syujhou Road, Taipei 10055, Taiwan. Email: pchen{at}ntu.edu.tw
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Abstract |
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Background. Cardiovascular disease remains the most common cause of death in end-stage renal disease (ESRD). Recently, novel descriptors of T-wave morphology have been suggested as measures of repolarization heterogeneity and adverse prognosis in non-uraemic populations. However, whether these T-wave descriptors provide prognostic information in uraemic populations has not been examined. The present study aimed to determine the prognostic value of novel T-wave morphology variables in predicting total, cardiovascular and arrhythmia-related mortality in ESRD patients initiating haemodialysis.
Methods. The study was a retrospective cohort of adult ESRD patients starting haemodialysis between 1998 and 2005; follow-up was until September 2006. A total of 325 patients were studied. Novel ECG variables characterizing repolarization and the T-wave loop were analysed.
Results. Of 325 patients with technically analysable data, 154 (47.4%) died after a mean follow-up of 25.5 ± 21.7 months. Direct comparison between cardiovascular death and non-cardiovascular death patients showed that the relative T-wave residuum (TWR) predicted cardiovascular mortality (0.20 ± 0.21% vs 0.24 ± 0.17%, P = 0.005). In Cox modeling, relative TWR was an independent predictor of cardiovascular [relative risk (RR) = 1.86; P = 0.013] and arrhythmia-related mortality (RR = 2.102; P = 0.012).
Conclusions. The heterogeneity of myocardial repolarization, measured by the relative T-wave residuum in the ECG, appears to be an independent predictor of cardiovascular and arrhythmia-related mortality in patients initiating haemodialysis.
Keywords: cardiovascular mortality; end stage renal disease; relative T-wave residuum; T-wave morphology; ventricular repolarization
Received for publication: 17.12.06
Accepted in revised form: 28. 3.07