Cardiac Repolarization Abnormalities Among Patients With Various Stages of Chronic Kidney Disease
Cardiac Repolarization Abnormalities Among Patients With Various Stages of Chronic Kidney Disease
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DOI：
10.1002/clc.22277
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发表时间：
2014-07-01
影响因子：
2.7
通讯作者：
Tuncel, Meryem
中科院分区：
文献类型：
--
作者：
Sherif, Khaled A.;Abo-Salem, Elsayed;Tuncel, Meryem
背景：慢性肾脏病（CKD）患者发生危及生命的心血管心律失常的风险增加。虽然这些心律失常通常继发于通常与CKD相关的结构性心脏病，但很大一部分心源性猝死病例没有明显的结构性心脏病。本研究旨在探讨慢性肾脏病患者心脏复极与肾功能恶化的关系。假设：慢性肾脏病患者存在心脏复极异常。方法：对2005年至2010年诊断为慢性肾脏病的大学医院住院或门诊患者进行回顾性、图表回顾性研究。入选标准选择了在24小时内进行12导联体表心电图（ECG）、肾功能检查和6个月内进行经胸超声心动图检查的患者。病例与记录的病因校正QT（QTc）间期延长，包括结构性心脏病，QT延长药物，或相关疾病conditions.Results：我们的样本量为154心电图。三分之二的CKD患者QTc间期延长，约20%的患者QTc间期>500 ms。使用Bazett（P < 0.006）或Fridericia（P = 0.03）公式计算，QTc间期显著不同，并随CKD的每个连续阶段而增加。QTc间期与血肌酐显著相关（P = 0.01）。这些发现是独立的年龄，性别，钾，钙concentration.Conclusions：CKD的进展导致心脏复极的显着延迟，独立于其他危险因素。这种效应可能会增加心脏性猝死的风险，也可能增加药物诱导的心律失常的易感性。
Background: Patients with chronic kidney disease (CKD) are at increased risk of life-threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function.Hypothesis: There is cardiac repolarization abnormalities among patients with chronic kidney disease.Methods: This was a retrospective, chart-review study of admissions or clinic visits to a university hospital between 2005 and 2010 by patients with a diagnosis of CKD. Inclusion criteria selected patients who had 12-lead surface electrocardiography (ECG), renal function tests within 24 hours, and transthoracic echocardiography within 6 months. Cases with a documented etiology for the corrected Qt (Qtc) interval prolongation including structural heart disease, QT prolonging drugs, or relevant disease conditions, were excluded.Results: Our sample size was 154 ECGs. Two-thirds of patients with CKD had QTc interval prolongation, and about 20% had a QTc interval >500 ms. QTc interval was significantly different and increased with each successive stage of CKD using the Bazett (P < 0.006) or Fridericia (P = 0.03) formula. QTc interval correlated significantly with serum creatinine (P = 0.01). These finding were independent of age, gender, potassium, and calcium concentrations.Conclusions: The progression of CKD resulted in a significant delay of cardiac repolarization, independent of other risk factors. This effect may potentially increase the risk of sudden cardiac death, and may also increase the susceptibility of drug-induced arrhythmia.