Poulikakos Dimitrios, Hnatkova Katerina, Banerjee Debasish, Malik Marek
Renal Unit, Centre for Cardiac Research, Institute of Cardiovascular Sciences, Salford Royal NHS Foundation Trust, Manchester, UK.
Imperial College, National Heart and Lung Institute, London, UK.
Ann Noninvasive Electrocardiol. 2018 Nov;23(6):e12570. doi: 10.1111/anec.12570. Epub 2018 Jun 25.
Mortality in hemodialysis (HD) patients is high with significant proportion attributed to fatal arrhythmias. In a pilot study, we showed that intradialytic electrocardiographic (ECG) monitoring can yield stable profiles of selected repolarisation descriptors and heart rate variability (HRV) parameters. This study investigated the relationship of these ECG markers with major adverse cardiac events (MACE) and mortality.
Continuous ECGs were obtained during HD and repeated five times at 2-week intervals. The QRS-T angle calculated as Total Cosine R to T (TCRT) and T-wave morphology dispersion (TMD) were calculated in overlapping 10 s ECG segments. High- (HF) and low (LF)-frequency components and the LF/HF ratio of HRV were calculated every 5 min. These indices were averaged during the first hour of dialysis and subsequently overall recordings in each subject.
All ECG parameters were available in 72 patients aged 61 ± 15, 23 (31.9%) females and 26 (36.1%) diabetics. After a median follow up of 54.8 months, 16 patients died, 20 were transplanted, and 9 suffered MACE. TCRT (in degrees) was higher and LF/HF was lower in patients who died compared to survivors (112 ± 30 vs. 73 ± 35, p = 0.000 and 0.222 ± 0.418 vs. 0.401 ± 0.274, p = 0.000, respectively) and in MACE positive compared to negative (117 ± 40 vs. 77 ± 34, p = 0.017 and 0.125 ± 0.333 vs.0.401 ± 0.274, p = 0.007 respectively). In multivariate Cox regression analysis of mortality risk adjusted for age, diabetes mellitus, and coronary artery disease, TCRT and LF/HF remained significant predictors (p < 0.05).
QRS-T angle and HRV may serve risk assessment in future prospective studies in HD patients.
血液透析（HD）患者的死亡率很高，其中很大一部分归因于致命性心律失常。在一项初步研究中，我们表明透析期间的心电图（ECG）监测可以得出选定复极描述符和心率变异性（HRV）参数的稳定概况。本研究调查了这些心电图标志物与主要不良心脏事件（MACE）和死亡率之间的关系。
在血液透析期间获取连续心电图，并每隔2周重复5次。在重叠的10秒心电图片段中计算以总余弦R到T（TCRT）计算的QRS-T角和T波形态离散度（TMD）。每5分钟计算一次HRV的高频（HF）和低频（LF）成分以及LF/HF比值。这些指标在透析的第一个小时内进行平均，随后对每个受试者的总体记录进行平均。
72名年龄为61±15岁的患者提供了所有心电图参数，其中23名（31.9%）为女性，26名（36.1%）为糖尿病患者。在中位随访54.8个月后，16名患者死亡，20名接受移植，9名发生MACE。与幸存者相比，死亡患者的TCRT（度数）更高，LF/HF更低（分别为112±30 vs. 73±35，p = 0.000和0.222±0.418 vs. 0.401±0.274，p = 0.000），与MACE阴性患者相比，MACE阳性患者的情况也是如此（分别为117±40 vs. 77±34，p = 0.017和0.125±0.333 vs. 0.4
