Study of Ventricular Electrical Systole in Patients with End-Stage Kidney Disease on Hemodialysis

Valentim, Bruno; Pereira, Alexandre; Coelho, Patrícia; Pereira, Telmo

doi:10.5935/abc.20130063

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…The link between LVH and prolonged QT found in HD patients in the present study has previously been demonstrated by a number of authors in patients with hypertension and hypertrophic cardiomyopathy 13 and also in HD patients. 21 , 23 , 24 However, the correlation between QTcd and LVH in HD patients is uncertain with some studies reporting positive correlation 14 , 21 , 24 and others, corroborating our findings, absence of correlation between these variables. 22 , 30 The current review of literature on the electric heterogeneity in LVH allows us to conclude that electrical disturbances do indicate ventricular structural abnormalities.…”

Section: Discussionsupporting

confidence: 85%

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Reproducibility and Reliability Of QTc and QTcd Measurements and Their Relationships with Left Ventricular Hypertrophy in Hemodialysis Patients

Alonso

Lima

Carreira

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundLeft ventricular hypertrophy (LVH) is very common in hemodialysis patients and an independent risk factor for mortality in this population. The myocardial remodeling underlying the LVH can affect ventricular repolarization causing abnormalities in QT interval.Objectiveto evaluate the reproducibility and reliability of measurements of corrected QT interval (QTc) and its dispersion (QTcd) and correlate these parameters with LVH in hemodialysis patients.MethodsCase-control study involving hemodialysis patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, and electrocardiogram were performed. Intra- and interobserver correlation and concordance tests were performed by Pearson´s correlation, Cohen’s Kappa coefficient and Bland Altman diagram. Linear regression was used to analyze association of QTc or QTcd with HVE.ResultsForty-one HD patients and 37 controls concluded the study. Hemodialysis patients tended to have higher values of QTc, QTcd and left ventricular mass index (LVMi) than controls but statistical significance was not found. Correlation and concordance tests depicted better results for QTc than for QTcd. In HD patients, a poor but significant correlation was found between QTc and LVMi (R2 = 0.12; p = 0.03). No correlation was found between values of QTcd and LVMi (R2= 0.00; p=0.940). For the control group, the correspondent values were R2= 0.00; p = 0.67 and R2= 0.00; p = 0.94, respectively.ConclusionWe found that QTc interval, in contrast to QTcd, is a reproducible and reliable measure and had a weak but positive correlation with LVMi in HD patients.

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Section: Discussionsupporting

confidence: 85%

“… 11 Furthermore, we chose to record the electrocardiogram in the interdialytic period, instead of during the HD procedure, in contrast to most of the studies that addressed the relationship between electrolyte disturbances and QT changes. 23 , 24 , 26…”

Section: Discussionmentioning

confidence: 99%

Reproducibility and Reliability Of QTc and QTcd Measurements and Their Relationships with Left Ventricular Hypertrophy in Hemodialysis Patients

Alonso

Lima

Carreira

et al. 2017

Arquivos Brasileiros De Cardiologia

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“…Other studies have shown that the QT interval is significantly longer in dialysis patients than in healthy subjects. Furthermore, it has been demonstrated that the QT interval increases during dialysis and is associated with AE 27 - 32 . In our study, the mean QTc interval (436.4 ± 27.6 ms) was similar to the results reported by Suzuki et al 29 (432.6 ± 24.9 ms) and slightly lower than those observed in the study by Hage et al 27 (447 ± 35 ms).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

Silva¹,

Filho²,

Peixoto³

et al. 2015

Arquivos Brasileiros De Cardiologia

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BackgroundThe recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used.ObjectiveWe aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR).MethodsA prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE.ResultsDuring a mean follow-up of 424 ± 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01–26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02–1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01–7.96; p = 0.041).ConclusionsIn medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.

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“…In one of these studies, 47 patients underwent ECG tests before, during, and after a HD session. The maximum QT c interval and QT c dispersion increased after dialysis, and the difference was significant for both [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

Nie¹,

Zou²,

Liang³

et al. 2016

PLoS ONE

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BackgroundSudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD) patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs), and to explore factors that can influence the QTc interval.MethodsA total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress). Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session.ResultsBefore dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females). A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001) and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001). After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+), calcium (Ca2+), phosphorus, calcium* phosphorus (Ca*P), and higher concentrations of plasma brain natriuretic peptide (BNP) were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD) and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD). When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac construction abnormalities were found in this group. In multiple regression analyses, serum Ca2+ concentration before HD and LAD were independent variables of QTc interval prolongation. UA, ferritin, and interventricular septum were independent variables of ΔQTc.ConclusionProlonged QT interval is very common in HD patients and is associated with several risk factors. An appropriate concentration of dialysate electrolytes should be chosen depending on patients’ clinical conditions.

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Study of Ventricular Electrical Systole in Patients with End-Stage Kidney Disease on Hemodialysis

Abstract: This study confirmed an increase in the QTc interval and QTc dispersion associated with dialysis. That emphasizes the dependence of ventricular repolarization on fluid and electrolyte balance, and suggests a profile of higher vulnerability to arrhythmia associated with dialysis .

Cited by 5 publications

References 15 publications

Reproducibility and Reliability Of QTc and QTcd Measurements and Their Relationships with Left Ventricular Hypertrophy in Hemodialysis Patients

Reproducibility and Reliability Of QTc and QTcd Measurements and Their Relationships with Left Ventricular Hypertrophy in Hemodialysis Patients

Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

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