Effects of upright T-wave in lead aVR on left ventricular volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease.

Abstract

Numerous studies have shown the association between chronic kidney disease (CKD) and adverse cardiac events. We investigated whether or not the upright T-wave in lead aVR (TaVR) could predict left ventricular (LV) volume and function derived from ECG-gated SPECT in patients with advanced CKD. Two hundred and sixty-one patients with advanced CKD [estimated glomerular filtration rate (eGFR)<45ml/min/1.73m2] were enrolled. Upright TaVR was defined as a wave with a positive deflection of> 0mV. Enlarged LV end-diastolic volume (LVEDV) was defined as LVEDV index of>76ml/m2 in men and>57ml/m2 in women. Reduced LV ejection fraction (LVEF) was defined as LVEF of<40%. Forty-six patients (18%) had upright TaVR, and 215 patients (82%) had negative TaVR. Summed redistribution score (SRS) [ 6 (1-12) vs. 2 (0-5), p<0.001] and summed difference score (SDS) [4 (1-6) vs. 2 (0-4), p=0.004] were significantly larger in patients with upright TaVR than those with negative TaVR. Patients with upright TaVR had larger LVEDV index (75±33ml/m2 vs. 50±18ml/m2, p<0.001) and lower LVEF (43±14% vs. 58±11%, p<0.001) compared to those with negative TaVR. After adjusted for other variables including SRS and SDS, upright TaVR remained a significant predictor of enlarged LVEDV (odds ratio 5.45; 95% CI 2.16-14.22; p<0.001) and reduced LVEF (odds ratio 4.54; 95% CI 1.70-12.23; p=0.003). Our data suggested that upright TaVR could predict LV volume and function derived from ECG-gated SPECT in patients with advanced CKD.