Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events
Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events
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血液透析开始时的心电图结果以及随后心血管事件的类型
DOI：
10.1038/s41440-020-00592-z
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发表时间：
2021
影响因子：
5.4
通讯作者：
Isaka Yoshitaka
中科院分区：
文献类型：
--
作者：
Yamaguchi Satoshi;Hamano Takayuki;Oka Tatsufumi;Doi Yohei;Kajimoto Sachio;Yasuda Seiichi;Shimada Karin;Matsumoto Ayumi;Sakaguchi Yusuke;Inoue Kazunori;Matsui Isao;Suzuki Akira;Isaka Yoshitaka
在透析前患者中报告了心电图（ECG）的预后价值，但在发生水化过度和电解质紊乱的血液透析患者中未报告，这两种情况都可能影响ECG结果。我们进行了一项回顾性多中心队列研究，涉及事件血液透析患者，并使用考克斯比例风险模型检查血液透析开始前即刻的ECG参数是否可以预测随后的心血管疾病（CVD）。我们探讨了几种电解质对ECG异常预测能力的潜在影响。在618例入组患者中，根据电压标准，分别有16%、10%、46%和22%的患者显示PR间期≥ 200 ms、QRS间期≥120 ms、QTc间期≥ 450/460 ms（男性/女性）和左心室肥大（LVH）。在中位3年的随访中，分别有19%和16%的患者发生了动脉粥样硬化和非动脉粥样硬化性CVD。考克斯回归模型结果显示，PR、QRS和QT间期异常数量的总和是非动脉粥样硬化性CVD的显著风险因素（风险比（HR）[95%置信区间（CI）]：1.58 [1.24-2.01]/异常数量）。LVH对动脉粥样硬化性CVD的预测价值随着时间的推移而减弱。在长达36个月时，尽管符合比例风险假设，但LVH与动脉粥样硬化CVD显著相关（HR [95% CI]：1.89 [1.15-3.11]）。在血清镁水平最低的三分位数患者中，校正的HR特别高（HR [95% CI]：4.02 [1.68-9.60]）（相互作用P = 0.04）。PR、QRS和QT延长可预测非动脉粥样硬化性CVD，而LVH可预测短期内动脉粥样硬化性CVD。
The prognostic value of electrocardiograms (ECGs) has been reported in predialysis patients but not in incident hemodialysis patients with overhydration and electrolyte disturbances, both of which potentially affect ECG results. We performed a retrospective multicenter cohort study involving incident hemodialysis patients and examined whether ECG parameters immediately before hemodialysis initiation can predict subsequent cardiovascular disease (CVD) using Cox proportional hazards models. We explored potential effect modifications by several electrolytes on the predictive power of ECG abnormalities. Among the 618 enrolled patients, 16%, 10%, 46%, and 22% showed a PR interval ≥ 200 ms, QRS interval ≥120 ms, QTc interval ≥ 450/460 ms (male/female), and left ventricular hypertrophy (LVH) by voltage criteria, respectively. Over a median 3-year follow-up, 19% and 16% of the patients developed atherosclerotic and nonatherosclerotic CVD, respectively. The Cox regression model results revealed that the sum of the number of abnormalities in PR, QRS, and QT intervals was a significant risk factor for nonatherosclerotic CVD (hazard ratios (HRs) [95% confidence interval (CI)]: 1.58 [1.24–2.01] per number of abnormalities). The predictive value of LVH for atherosclerotic CVD was attenuated over time. At up to 36 months, although the proportional hazards assumption was met, LVH was significantly associated with atherosclerotic CVD (HR [95% CI]: 1.89 [1.15–3.11]). The adjusted HR was particularly high (HR [95% CI]: 4.02 [1.68–9.60]) among patients who were in the lowest tertile of serum magnesium levels (Pfor interaction = 0.04). PR, QRS, and QT prolongation additively predicted nonatherosclerotic CVD, while LVH predicted atherosclerotic CVD in the short term.
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影响因子：
1.3
作者：
D. Poulikakos;M. Malik
通讯作者：
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DOI：
10.2215/cjn.04231206
发表时间：
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影响因子：
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Namdar M;Biaggi P;Stähli B;Bütler B;Casado-Arroyo R;Ricciardi D;Rodríguez-Mañero M;Steffel J;Hürlimann D;Schmied C;de Asmundis C;Chierchia GB;Sarkozy A;Lüscher TF;Jenni R;Duru F;Paulus WJ;Brugada P
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