Open AccessAssociation of QRS ‐T angle and heart rate variability with major cardiac events and mortality in hemodialysis patients
Author(s) -
Poulikakos Dimitrios,
Hnatkova Katerina,
Banerjee Debasish,
Malik Marek
Publication year - 2018
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12570
Subject(s) - medicine , mace , cardiology , qrs complex , hemodialysis , heart failure , dialysis , proportional hazards model , heart rate variability , heart rate , electrocardiography , blood pressure , myocardial infarction , conventional pci
Mortality in hemodialysis ( HD ) patients is high with significant proportion attributed to fatal arrhythmias. In a pilot study, we showed that intradialytic electrocardiographic ( ECG ) monitoring can yield stable profiles of selected repolarisation descriptors and heart rate variability ( HRV ) parameters. This study investigated the relationship of these ECG markers with major adverse cardiac events ( MACE ) and mortality. Methods Continuous ECG s were obtained during HD and repeated five times at 2‐week intervals. The QRS ‐T angle calculated as Total Cosine R to T ( TCRT ) and T‐wave morphology dispersion ( TMD ) were calculated in overlapping 10 s ECG segments. High‐ ( HF ) and low ( LF )‐frequency components and the LF / HF ratio of HRV were calculated every 5 min. These indices were averaged during the first hour of dialysis and subsequently overall recordings in each subject. Results All ECG parameters were available in 72 patients aged 61 ± 15, 23 (31.9%) females and 26 (36.1%) diabetics. After a median follow up of 54.8 months, 16 patients died, 20 were transplanted, and 9 suffered MACE . TCRT (in degrees) was higher and LF / HF was lower in patients who died compared to survivors (112 ± 30 vs. 73 ± 35, p = 0.000 and 0.222 ± 0.418 vs. 0.401 ± 0.274, p = 0.000, respectively) and in MACE positive compared to negative (117 ± 40 vs. 77 ± 34, p = 0.017 and 0.125 ± 0.333 vs.0.401 ± 0.274, p = 0.007 respectively). In multivariate Cox regression analysis of mortality risk adjusted for age, diabetes mellitus, and coronary artery disease, TCRT and LF / HF remained significant predictors ( p < 0.05). Conclusion QRS ‐T angle and HRV may serve risk assessment in future prospective studies in HD patients.