Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia.
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Postgrad Med. 2022 Nov;134(8):795-800. doi: 10.1080/00325481.2022.2109336. Epub 2022 Aug 8.
Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity.
This study aims to determine the predictive value of initial and terminal T wave angle in detecting hyperkalemia among CKD patients.
A cross-sectional study was conducted at Dr. Soetomo General Hospital, including all adult hospitalized CKD patients. A caliper was used to measure T wave morphology. The initial deflection angle (Tia) and terminal deflection angle (Tta) were calculated from an arctan of T peak amplitude and the respective initial or terminal length. The receiver operating characteristics (ROC) curve was analyzed to determine the area under the curve (AUC) and optimal cutoff.
A total of 220 CKD patients were enrolled in this study, with 98 patients with hyperkalemia (potassium >5.0). The majority of the patients were male, with a mean age of 51.12 ± 12.58 years. Ti-Tp duration, Tp-Tt duration, Tia, Tta, and Tp amplitude were significantly higher in the hyperkalemia group (all p < 0.05). A Spearman correlation analysis demonstrated a significant positive correlation of Tia (r = 0.346 and p < 0.001) and Tta (r = 0.445 and p < 0.001) with potassium levels in the participants. The optimal cutoff angle for Tta was 66.20° (sensitivity = 67.3% and specificity = 73.8%) and Tia was 61.07° (sensitivity = 66.3% and specificity = 69.7%).
The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.
高钾血症是慢性肾脏病的一种常见并发症，因其可能导致恶性心律失常和死亡而被认为是致命的。它与心电图（ECG）变化有关，例如所有 ECG 导联中的尖峰 T 波。然而，尖峰 T 波的通用定义仍不清楚，其灵敏度和特异性均较低。
本研究旨在确定初始 T 波和终末 T 波角度在检测慢性肾脏病患者高钾血症中的预测价值。
这是一项横断面研究，在苏加诺-苏特罗综合医院进行，纳入所有成年住院慢性肾脏病患者。使用卡尺测量 T 波形态。初始偏转角（Tia）和终末偏转角（Tta）是通过尖峰 T 波幅度和各自初始或终末长度的反正切计算得出的。分析受试者工作特征（ROC）曲线以确定曲线下面积（AUC）和最佳截断值。
本研究共纳入 220 例慢性肾脏病患者，其中 98 例患者存在高钾血症（血钾＞5.0）。大多数患者为男性，平均年龄为 51.12±12.58 岁。高钾血症组的 Ti-Tp 持续时间、Tp-Tt 持续时间、Tia、Tta 和 Tp 幅度均显著升高（均 P＜0.05）。Spearman 相关分析显示，参与者的 Tia（r=0.346，P＜0.001）和 Tta（r=0.445，P＜0.001）与钾水平呈显著正相关。Tta 的最佳截断角为 66.20°（灵敏度=67.3%，特异性=73.8%），Tia 为 61.07°（灵敏度=66.3%，特异性=69.7%）。
终末 T 波角度在预测慢性肾脏病患者高钾血症方面优于初始角度。
