The Prognostic Value of Electrocardiographic Estimation of Left Ventricular Hypertrophy in Dialysis Patients

Covic, Adrian; Buimistriuc, Laura-Dumitrita; Green, Darren; Stefan, Alina; Badarau, Silvia; Kalra, Philip A.

doi:10.1111/anec.12007

Cited by 17 publications

(13 citation statements)

References 24 publications

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“…Using a different statistical approach, we defined a new cut-off for RFO – 17.4% and showed that this value performs better than the previous one in survival analyses. Most importantly, this new threshold remains independently associated with mortality, even after adjustment for different baseline echocardiographic parameters–essential confounders for mortality risk predictions, as shown repeatedly in previous studies [ 17 – 21 ]. Thus, besides confirming data from a single previous cohort, we now robustly bring proof that bioimpedance parameters are significant predictors for outcomes, even when adjustments are made for cardiovascular comorbidities or for well-recognized predictors such as LVMI or cardiac function.…”

Section: Discussionsupporting

confidence: 71%

Overhydration, Cardiac Function and Survival in Hemodialysis Patients

et al. 2015

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Background and objectivesChronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD) patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered.Design, setting, participants and measurementsA prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE), by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup). Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO): 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort).ResultsIn the entire study population, patients considered overhydrated (using both cut-offs) had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30–3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72–4.78 for RFO>17.4%, respectively) and multivariate (HR = 1.87, 95%CI = 1.12–3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60–4.63 for RFO>17.4%, respectively) Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated patients in both univariate (HR = 2.46, 95%CI = 1.56–3.87 for RFO >15% and HR = 3.67, 95%CI = 2.29–5.89 for RFO >17.4%) and multivariate (HR = 2.31, 95%CI = 1.42–3.77 for RFO >15% and HR = 4.17, 95%CI = 2.48–7.02 for RFO >17.4%) Cox regression analysis.ConclusionsThe study shows that the hydration status is associated with the mortality risk in a HD population, independently of cardiac morphology and function. We also describe and propose a new cut-off for RFO, in order to better define the relationship between overhydration and mortality risk. Further studies are needed to properly validate this new cut-off in other HD populations.

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Section: Discussionsupporting

confidence: 71%

Overhydration, Cardiac Function and Survival in Hemodialysis Patients

et al. 2015

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“…The Peguero-Lo Presti and Cornell voltage therefore provide valuable independent information for risk prediction in these patients. Hence, in agreement with previous reports, the Peguero-Lo Presti voltage might be preferable for risk prediction in this population [11,29,31]. As expected, and comparable to previous studies, not only did the Sokolow-Lyon voltage identify fewer positive patients, but it was also not predictive of mortality [29,35].…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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Background In 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. Methods A 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. Results The 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. Conclusions The 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

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“…Cardiac function was also improved in the aldosterone antagonists group. Left ventricular mass (LVM) is a powerful independent predictor of cardiovascular morbidity and mortality [ 25 ]. Increased LVM has also been associated with coronary artery disease, all-cause mortality, and sudden death [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis

Xie

Liang

2019

Evidence-Based Complementary and Alternative Medicine

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Background and Purpose. Cardiovascular disease is the major cause of death in dialysis patients. Although aldosterone antagonists were considered a treatment for severe heart failure patients to reduce cardiac mortality, whether treating patients undergoing maintenance dialysis with aldosterone antagonists could reduce the risk of cardiocerebrovascular (CCV) remains unclear. We aim to systematically assess the efficacy and tolerability of the addition of aldosterone antagonists to conventional therapy in patients undergoing maintenance dialysis. Materials and Methods. We searched PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database (CBM), and the China National Knowledge Infrastructure (CNKI) for relevant articles. The primary endpoint of interest was CCV mortality. The secondary endpoints were all-cause mortality, left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF). Publication bias was evaluated using funnel plots and Egger’s test. The meta-analysis was performed using Review Manager software version 5.3. Results. This analysis included 10 randomized controlled trials (RCTs) with 1172 total chronic dialysis patients. The use of aldosterone antagonists in the dialysis population resulted in a marked reduction in CCV mortality (RR 0.42, 95% CI 0.26-0.65, P=0.0002) and all-cause mortality (RR0.46, 95%CI 0.32-0.66, P<0.0001). The LVEF was improved by treatment with aldosterone antagonists (WMD 6.35%, P<0.00001). Moreover, aldosterone antagonists decreased the LVMI (WMD -8.69 g/m2, P=0.0006), whereas aldosterone antagonists increased the occurrence of hyperkalemia (RR1.70, 95%CI 1-2.88, P=0.05) and gynecomastia (RR 8.01, 95% CI 2.44- 26.27, P=0.0006). Conclusions. Addition of aldosterone antagonists to conventional treatment in chronic dialysis patients may reduce CCV mortality, improve cardiac function, and simultaneously decrease LVMI.

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The Prognostic Value of Electrocardiographic Estimation of Left Ventricular Hypertrophy in Dialysis Patients

Cited by 17 publications

References 24 publications

Overhydration, Cardiac Function and Survival in Hemodialysis Patients

Overhydration, Cardiac Function and Survival in Hemodialysis Patients

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

Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis

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