Chen Szu-Chia, Su Ho-Ming, Huang Jiun-Chi, Chang Ko, Tsai Yi-Chun, Chen Ling-I, Chang Jer-Ming, Hwang Shang-Jyh, Chen Hung-Chun
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Am J Nephrol. 2015;42(3):198-205. doi: 10.1159/000440776. Epub 2015 Oct 1.
BACKGROUND/AIMS: The P-wave parameters that are measured using a 12-lead electrocardiogram are commonly used as noninvasive tools for assessing left atrial enlargement. This study was designed to assess whether P-wave dispersion is associated with overall and cardiovascular mortality in hemodialysis patients.
This study enrolled 209 hemodialysis patients. We measured the P-wave dispersion corrected by heart rate, that is, the corrected P-wave dispersion (PWdisperC), and assessed its correlation with overall and cardiovascular mortalities.
The mean PWdisperC of all the patients was 93.3 ± 21.1 ms. During the follow-up period (mean 5.4 years), 58 deaths and 37 cardiovascular deaths were recorded. The adjusted value of PWdisperC was also associated with overall (hazards ratio (HR) 1.018, 95% CI 1.004-1.033, p = 0.014) and cardiovascular (HR 1.032, 95% CI 1.012-1.053, p = 0.002) mortalities. Multivariate Cox regression analysis identified tertile 3 of PWdisperC (vs. tertile 1) to be associated with overall (HR 2.472, 95% CI 1.181-5.174, p = 0.016) and cardiovascular (HR 3.896, 95% CI 1.463-10.376, p = 0.007) mortalities, after adjustment for demographic, clinical and biochemical parameters. Adding PWdisperC to a model of clinical features could significantly improve the predictive value for overall (p = 0.044) and cardiovascular (p = 0.002) mortalities.
We concluded that PWdisperC was positively associated with overall and cardiovascular mortalities in hemodialysis patients and could provide additional prognostic values. Screening hemodialysis patients by using PWdisperC may facilitate identifying a group of patients with poor prognosis.
背景/目的：使用12导联心电图测量的P波参数通常作为评估左心房扩大的无创工具。本研究旨在评估P波离散度是否与血液透析患者的全因死亡率和心血管死亡率相关。
本研究纳入了209例血液透析患者。我们测量了经心率校正的P波离散度，即校正后的P波离散度（PWdisperC），并评估其与全因死亡率和心血管死亡率的相关性。
所有患者的平均PWdisperC为93.3±21.1毫秒。在随访期间（平均5.4年），记录了58例死亡和37例心血管死亡。校正后的PWdisperC值也与全因死亡率（风险比[HR]1.018，95%可信区间1.004-1.033，p=0.014）和心血管死亡率（HR 1.032，95%可信区间1.012-1.053，p=0.002）相关。多因素Cox回归分析确定，在校正人口统计学、临床和生化参数后，PWdisperC的三分位数3（与三分位数1相比）与全因死亡率（HR 2.472，95%可信区间1.181-5.174，p=0.016）和心血管死亡率（HR 3.896，95%可信区间1.463-10.376，p=0.007）相关。将PWdisperC添加到临床特征模型中可显著提高对全因死亡率（p=0.044）和心血管死亡率（p=0.002）的预测价值。
我们得出结论，PWdisperC与血液透析患者的全因死亡率和心血管死亡率呈正相关，并可提供额外的预后价值。使用PWdisperC对血液透析患者进行筛查可能有助于识别一组预后不良的患者。
