Badarau Silvia, Siriopol Dimitrie, Drugus Daniela, Dumea Raluca, Hogas Simona, Blaj Mihaela, Voroneanu Luminita, Gramaticu Angelica, Petris Antoniu, Burlacu Alexandru, Covic Adrian
Department of Nephrology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Gr. T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115, Iasi, Romania.
Int Urol Nephrol. 2015 Oct;47(10):1703-8. doi: 10.1007/s11255-015-1063-4. Epub 2015 Sep 2.
The aim of the study was to evaluate the correlation between electrocardiographic parameters and heart rate variability with cardiovascular events and mortality among chronic hemodialysis patients.
In this prospective study, we enrolled 116 asymptomatic patients in whom we performed ambulatory 24-h electrocardiographic Holter monitoring and before and after hemodialysis electrocardiographs. We measured the interval (PR, QRS, QTc, QTc dispersion) differences on the surface electrocardiographs and obtained frequency-domain measures from Holter monitoring (VLF, LF, HF and the LF/HF ratio).
During the follow-up period, 13 participants died (11.2 %) and 16 (13.8 %) patients experienced a cardiovascular event. The pre-post-dialysis difference in QTc interval was the best predictor for cardiovascular events (95 % CI 0.453-0.786), while pre-dialysis QRS interval was the predictor for all-cause mortality (95 % CI 1.134-3.136). Also, both outcomes were predicted by pre-post-dialysis difference in PR interval and VLF.
Interval changes during hemodialysis are predictive for cardiovascular events and mortality. Autonomic dysfunction and changes in PR should be monitored routinely, particularly in patients with suspected coronary artery disease.
本研究旨在评估慢性血液透析患者的心电图参数和心率变异性与心血管事件及死亡率之间的相关性。
在这项前瞻性研究中，我们纳入了116例无症状患者，对其进行了24小时动态心电图Holter监测以及血液透析前后的心电图检查。我们测量了体表心电图上的间期（PR、QRS、QTc、QTc离散度）差异，并从Holter监测中获得频域指标（极低频、低频、高频以及低频/高频比值）。
在随访期间，13名参与者死亡（11.2%），16名（13.8%）患者发生了心血管事件。透析前后QTc间期的差异是心血管事件的最佳预测指标（95%置信区间0.453 - 0.786），而透析前QRS间期是全因死亡率的预测指标（95%置信区间1.134 - 3.136）。此外，PR间期和极低频的透析前后差异均能预测这两种结局。
血液透析期间的间期变化可预测心血管事件和死亡率。应常规监测自主神经功能障碍和PR间期的变化，尤其是疑似冠心病患者。
