Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients

Matthias C Braunisch,Christopher C Mayer,Axel Krieter,Roman Günthner,Julia Matschkal,Bernhard Haller,Stephan Kemmner,Georg Lorenz,Marek Malik,Carolin Schaller,Axel Bauer,Lutz Renders,Peter Gundel,Stanislas Werfel,Uwe Heemann,Siegfried Wassertheurer,Johannes F.e Mann ,Christopher Holzmann‐Littig ,Susanne Angermann,Georg Schmidt,Christoph Schmaderer

doi:10.1007/s40620-021-01068-0

Abstract

BackgroundIn hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages.MethodsA total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score.ResultsThe Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti.ConclusionsThe post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages.Graphical abstract

Highlights

End-stage kidney disease patients on hemodialysis have a markedly increased risk of cardiovascular morbidity and mortality [1]
Measuring the ECG left ventricular hypertrophy (LVH) parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages
Peguero-Lo Presti voltage criteria were predictive of sudden cardiac death in the general population [17] and have improved the identification of LVH in hemodialysis patients [18]. Keeping all this in mind, we examined the association of ECG-based LVH indices with cardiovascular mortality in hemodialysis patients

Summary

Introduction

End-stage kidney disease patients on hemodialysis have a markedly increased risk of cardiovascular morbidity and mortality [1]. A decline in renal function is associated with left ventricular hypertrophy (LVH) [2]. Impaired electrophysiology and reduced left ventricular performance, both caused by structural heart disease, increase cardiovascular mortality in dialysis patients. Left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti

Methods

Results

Conclusion