Table 1.
Select studies investigating association between ECG parameters and cardiovascular outcomes among persons on hemodialysis
| Author (Year) |
Patients (n) |
ECG Parameter |
Time on HD | Mean Age (yrs) |
% Male | % CAD | % LVH | Mean LVEF (%) |
Study Findings |
|---|---|---|---|---|---|---|---|---|---|
| Genovesi (2013) [11] |
122 | QTc | 3 yrs* | 71* | 65 | 38 | -- | 60* | QTc >450 ms in men and >460 ms in women associated with total mortality (adjusted HR 2.16, p=0.011) and SCD (adjusted HR 8.33, p=0.009). |
| Hage (2010) [17] |
280 | QTc | 19 mo | 53 | 62 | 63 | 47 | 47 | QTc associated with total mortality (adjusted HR 1.008 per 1 ms increase in QTc, p=0.016). SCD not assessed. |
| Beaubien (2002) [18] |
147 (49 on HD) |
QT dispersion |
≥ 3 mo | 59 | 62 | 35 | -- | 69% with LVEF >60% |
Corrected QT dispersion ≥74 ms associated with total mortality (adjusted HR 1.53 per 50 ms increase, p=0.001) and cardiovascular mortality (adjusted HR 1.57 per 50 ms increase, p=0.028), but not SCD/fatal arrhythmia (p=0.061) |
| Nakamura (2005) [51] |
48 (all with cardiac symptoms) |
QT dispersion |
3.9 yrs | 61 | 83 | 54 | -- | -- | Post-HD corrected QT dispersion associated with cardiovascular mortality (adjusted HR 1.02 per 1 ms increase, p<0.05), but not with total mortality (p=0.66). SCD not assessed. |
| Guney (2014) [52] |
72 | QT dispersion |
> 6 mo | 44 | 46 | -- | -- | -- | Corrected QT dispersion associated with total mortality (adjusted HR 1.03 per 1 ms increase, p=0.01). SCD not assessed. |
| de Bie (2013) [21] |
277 | Spatial QRS-T angle |
139 d | 56 | 62 | 25 | 20 | -- | Spatial QRS-T angle as ≥130° in men and ≥116° in women associated with total mortality (adjusted HR 2.33, p<0.01) and SCD (adjusted HR 2.99, p=0.04). |
| Tereshchenko (2016) [22] |
358 | Spatial QRS-T angle |
< 6 mo | 55 | 59 | 37 | 75 | 66 | Spatial QRS-T angle ≥75° associated with all-cause mortality (adjusted HR 2.38, p=0.001), cardiovascular mortality (adjusted HR 2.99, p=0.01), and SCD (adjusted HR 4.52, p=0.03). |
| Roithinger (1992) [26] |
50 | SAECG | 33 mo | 55 | 58 | 10 | 78 | -- | Abnormal SAECG not associated with cardiovascular or arrhythmic mortality |
| Tereshchenko (2016) [22] |
358 | SAECG | < 6 mo | 55 | 59 | 37 | 75 | 66 | Abnormal SAECG not associated with all-cause mortality, CV mortality, or SCD. |
| Hayano (1994) [35] |
31 | HRV: TI | 9 yrs | 56 | 74 | 45 | 71 | 60 | TI <22 associated with total mortality (adjusted HR 8.1, p<0.05), and SCD (adjusted HR 12.6, p<0.05). TI strongest predictor of SCD (better than CAD, LVEF, ventricular tachycardia). SDNN not associated with SCD after multivariable adjustment. |
| Fukuta (2003) [50] |
120 | HRV: TI and ULF Power |
50 mo | 61 | 51 | 6 | -- | -- | TI associated with cardiac mortality (adjusted HR 3.28 per 1 standard deviation decrease, p<0.05). Log transformed ULF power associated with cardiac mortality (adjusted HR 1.92 per 1 standard deviation decrease, p<0.05). LF/HF power ratio and SDNN not associated with cardiac mortality. |
| Oikawa (2009) [33] |
383 | HRV: SDNN | 5 y | 57 | 57 | -- | -- | 65 | SDNN <75 ms associated with total mortality (adjusted HR 2.18, p<0.001) and cardiovascular mortality (adjusted HR 2.11, p=0.01). SDNN also associated with total mortality and cardiovascular death as continuous variable. |
| Nishimura (2010) [34] |
196 | HRV: LF/HF Power ratio |
91 mo | 65 | 58 | -- | 100 | 56 | Increased LF/HF power ratio associated with SCD (adjusted HR 1.42, p<0.001). SCD-free survival at 5 years: 98.1% if LF/HF power ratio <1.9 and 29.4% if LF/HF power ratio ≥1.9. |
| Green (2012) [39] |
48 | TWA | 2.7 yrs | 63 | 53 | 16 | -- | 63 | No association between TWA and total mortality or combined endpoint of major cardiovascular events or death. SCD not assessed. |
*
Median value
Abbreviations: LVEF-left ventricular ejection fraction; LVH-left ventricular hypertrophy; CAD-coronary artery disease; HD-hemodialysis; ULF-ultra-low frequency; TI-triangular index; SDNN-standard deviation of RR intervals; HR-hazard ratio; TWA-T wave alternans; QTc-corrected QT interval; HRV-heart rate variability; LF-low frequency; HF-high frequency