Electrophysiologic substrate and risk of mortality in incident hemodialysis

Larisa Tereshchenko, Esther D. Kim, Andrew Oehler, Lucy A. Meoni, Elyar Ghafoori, Tejal Rami, Maggie Maly, Muammar Kabir, Lauren Hawkins, Gordon F. Tomaselli, Joao A. Lima, Bernard G. Jaar, Stephen M. Sozio, Michelle Estrella, W. H Linda Kao, Rulan S. Parekh

    Research output: Contribution to journalArticle

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    Abstract

    The single leading cause of mortality on hemodialysis is sudden cardiac death. Whether measures of electrophysiologic substrate independently associate with mortality is unknown. We examined measures of electrophysiologic substrate in a prospective cohort of 571 patients onincident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage RenalDisease Study. A total of 358 participants completed both baseline 5-minute and 12-lead electrocardiogram recordings on a nondialysis day. Measures of electrophysiologic substrate included ventricular late potentials by the signal-Averaged electrocardiogram and spatial mean QRS-T angle measured on the averaged beat recorded within a median of 106 days (interquartile range, 78-151 days) from dialysis initiation. The cohort was 59% men, and 73% were black, with a mean±SD age of 55613 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%612.0% and a mean±SDleft ventricularmass index of 66.6622.3 g/m2.7. During 864.6 person-years of follow-up, 77 patients died; 35 died fromcardiovascular causes, of which 15 were sudden cardiac deaths. By Cox regression analysis, QRS-T angle ≥75° significantly associated with increased risk of cardiovascular mortality (hazard ratio, 2.99; 95% confidence interval, 1.31 to 6.82) and sudden cardiac death (hazard ratio, 4.52; 95% confidence interval, 1.17 to 17.40) after multivariable adjustment for demographic, cardiovascular, and dialysis factors. Abnormal signal-Averaged electrocardiogram measures did not associate with mortality. In conclusion, spatial QRS-T angle but not abnormal signal-Averaged electrocardiogram significantly associates with cardiovascular mortality and sudden cardiac death independent of traditional risk factors in patients starting hemodialysis.

    Original languageEnglish (US)
    Pages (from-to)3413-3420
    Number of pages8
    JournalJournal of the American Society of Nephrology
    Volume27
    Issue number11
    DOIs
    StatePublished - 2016

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    Sudden Cardiac Death
    Renal Dialysis
    Electrocardiography
    Mortality
    Dialysis
    Confidence Intervals
    Echocardiography
    Regression Analysis
    Demography

    ASJC Scopus subject areas

    • Nephrology

    Cite this

    Electrophysiologic substrate and risk of mortality in incident hemodialysis. / Tereshchenko, Larisa; Kim, Esther D.; Oehler, Andrew; Meoni, Lucy A.; Ghafoori, Elyar; Rami, Tejal; Maly, Maggie; Kabir, Muammar; Hawkins, Lauren; Tomaselli, Gordon F.; Lima, Joao A.; Jaar, Bernard G.; Sozio, Stephen M.; Estrella, Michelle; Kao, W. H Linda; Parekh, Rulan S.

    In: Journal of the American Society of Nephrology, Vol. 27, No. 11, 2016, p. 3413-3420.

    Research output: Contribution to journalArticle

    Tereshchenko, L, Kim, ED, Oehler, A, Meoni, LA, Ghafoori, E, Rami, T, Maly, M, Kabir, M, Hawkins, L, Tomaselli, GF, Lima, JA, Jaar, BG, Sozio, SM, Estrella, M, Kao, WHL & Parekh, RS 2016, 'Electrophysiologic substrate and risk of mortality in incident hemodialysis', Journal of the American Society of Nephrology, vol. 27, no. 11, pp. 3413-3420. https://doi.org/10.1681/ASN.2015080916
    Tereshchenko, Larisa ; Kim, Esther D. ; Oehler, Andrew ; Meoni, Lucy A. ; Ghafoori, Elyar ; Rami, Tejal ; Maly, Maggie ; Kabir, Muammar ; Hawkins, Lauren ; Tomaselli, Gordon F. ; Lima, Joao A. ; Jaar, Bernard G. ; Sozio, Stephen M. ; Estrella, Michelle ; Kao, W. H Linda ; Parekh, Rulan S. / Electrophysiologic substrate and risk of mortality in incident hemodialysis. In: Journal of the American Society of Nephrology. 2016 ; Vol. 27, No. 11. pp. 3413-3420.
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    abstract = "The single leading cause of mortality on hemodialysis is sudden cardiac death. Whether measures of electrophysiologic substrate independently associate with mortality is unknown. We examined measures of electrophysiologic substrate in a prospective cohort of 571 patients onincident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage RenalDisease Study. A total of 358 participants completed both baseline 5-minute and 12-lead electrocardiogram recordings on a nondialysis day. Measures of electrophysiologic substrate included ventricular late potentials by the signal-Averaged electrocardiogram and spatial mean QRS-T angle measured on the averaged beat recorded within a median of 106 days (interquartile range, 78-151 days) from dialysis initiation. The cohort was 59{\%} men, and 73{\%} were black, with a mean±SD age of 55613 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5{\%}612.0{\%} and a mean±SDleft ventricularmass index of 66.6622.3 g/m2.7. During 864.6 person-years of follow-up, 77 patients died; 35 died fromcardiovascular causes, of which 15 were sudden cardiac deaths. By Cox regression analysis, QRS-T angle ≥75° significantly associated with increased risk of cardiovascular mortality (hazard ratio, 2.99; 95{\%} confidence interval, 1.31 to 6.82) and sudden cardiac death (hazard ratio, 4.52; 95{\%} confidence interval, 1.17 to 17.40) after multivariable adjustment for demographic, cardiovascular, and dialysis factors. Abnormal signal-Averaged electrocardiogram measures did not associate with mortality. In conclusion, spatial QRS-T angle but not abnormal signal-Averaged electrocardiogram significantly associates with cardiovascular mortality and sudden cardiac death independent of traditional risk factors in patients starting hemodialysis.",
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    AU - Tereshchenko, Larisa

    AU - Kim, Esther D.

    AU - Oehler, Andrew

    AU - Meoni, Lucy A.

    AU - Ghafoori, Elyar

    AU - Rami, Tejal

    AU - Maly, Maggie

    AU - Kabir, Muammar

    AU - Hawkins, Lauren

    AU - Tomaselli, Gordon F.

    AU - Lima, Joao A.

    AU - Jaar, Bernard G.

    AU - Sozio, Stephen M.

    AU - Estrella, Michelle

    AU - Kao, W. H Linda

    AU - Parekh, Rulan S.

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