NDT Advance Access originally published online on October 31, 2008
Nephrology Dialysis Transplantation 2009 24(3):1003-1008; doi:10.1093/ndt/gfn581
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Spatial QRS-T angle in peritoneal dialysis patients: association with carotid artery atherosclerosis, coronary artery calcification and troponin T
bieta Czekajska-Chechab2
ek51 Department of Nephrology 2 Department of Radiology 3 Department of Interventional Radiology and Neuroradiology 4 Department of Cardiology 5 Chair and Department of Nephrology, Medical University of Lublin, Lublin, Poland
Correspondence and offprint requests to: Andrzej J. Jaroszy
ski, Nephrology Department, Medical University of Lublin, 20–950 Lublin, ul. Jaczewskiego 8, Poland. Tel/fax: +48815320416; E-mail: jaroszynskiaj{at}interia.pl
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Abstract |
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Background. Abnormal values of the spatial angle between the directions of ventricular depolarization and repolarization (QRS-T) predict potently arrhythmic events and mortality in various patients groups. The study was designed to estimate QRS-T in a group of peritoneal dialysis (PD) patients, and to assess the possible association between QRS-T and coronary artery calcification (CAC), atherosclerosis, and some biochemical measurements.
Methods. The angular differences between the maximum spatial QRS and T vectors were reconstructed from ECGs in 57 selected PD patients and in 54 controls. In patients CAC score was performed by using multi-row computed tomography. Atherosclerotic disease was assessed by measuring carotid arteries' intima-media thickness (IMT) and plaque score (sum of the maximum thicknesses in mm of all plaques on both sides) by using an ultrasound scanner.
Results. QRS-T was higher in patients compared with controls (34.79% B111.97 and 14.95% B17.87 respectively; P < 0.001). Median CAC score equalled 104.5 Agatson units (Au) (range, 0–2478). IMT was 0.832% B10.208, and atherosclerotic plaques were detected in 82.5% of patients. The plaque score was 7.97% B14.49. QRS-T was higher in patients with CAC score >400 Au compared with patients with CAC score <400 Au (P = 0.011). The results of univariate linear regression analysis showed correlation between QRT-T and dialysis duration (r = 0.305, P = 0,020), LVMI (r = 0.311, P = 0.017), HDL (r = –0.361, P = 0.006), cTnT (r = 0.442, P < 0.001), plaque score (r = 0.403, P = 0.001) and CAC score (r = 0.451, P < 0.001). On multivariate analysis, CAC score, plaque score and troponine T were found to be independent predictors of QRS-T values.
Conclusions. QRS-T is high in PD patients and is mainly associated with coronary artery calcium burden, atherosclerosis and troponin T elevation. The possible clinical importance of the higher QRS-T in PD patients remains to be confirmed in further studies.
Keywords: arrhythmias; atherosclerosis; peritoneal dialysis; QRS-T angle; vascular calcification
Received for publication: 13. 4.08
Accepted in revised form: 24. 9.08