Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients

Seung Jun Kim, Hyung Jung Oh, Dong Eun Yoo, Dong Ho Shin, Mi Jung Lee, Hyoung Rae Kim, Jung Tak Park, Seung Hyeok Han, Tae Hyun Yoo, Kyu Hun Choi, Shin Wook Kang

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and Aims: Electrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity. Methods: This prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008. Results: A total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95% confidence interval (CI): 1.57-87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95% CI: 1.32-8.92; P = 0.011) and CP (HR: 3.07; 95% CI: 1.16-8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. Conclusions: The product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.

Original languageEnglish
Article numbere35534
JournalPloS one
Volume7
Issue number4
DOIs
Publication statusPublished - 2012 Apr 17

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hemodialysis
Left Ventricular Hypertrophy
hypertrophy
Renal Dialysis
electrocardiography
Electrocardiography
Electric potential
confidence interval
Hazards
Confidence Intervals
kidney diseases
Chronic Kidney Failure
duration
Mortality
Echocardiography
echocardiography
observational studies
Observational Studies
Screening
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Kim, Seung Jun ; Oh, Hyung Jung ; Yoo, Dong Eun ; Shin, Dong Ho ; Lee, Mi Jung ; Kim, Hyoung Rae ; Park, Jung Tak ; Han, Seung Hyeok ; Yoo, Tae Hyun ; Choi, Kyu Hun ; Kang, Shin Wook. / Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients. In: PloS one. 2012 ; Vol. 7, No. 4.
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title = "Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients",
abstract = "Background and Aims: Electrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity. Methods: This prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008. Results: A total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95{\%} confidence interval (CI): 1.57-87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95{\%} CI: 1.32-8.92; P = 0.011) and CP (HR: 3.07; 95{\%} CI: 1.16-8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. Conclusions: The product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.",
author = "Kim, {Seung Jun} and Oh, {Hyung Jung} and Yoo, {Dong Eun} and Shin, {Dong Ho} and Lee, {Mi Jung} and Kim, {Hyoung Rae} and Park, {Jung Tak} and Han, {Seung Hyeok} and Yoo, {Tae Hyun} and Choi, {Kyu Hun} and Kang, {Shin Wook}",
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Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients. / Kim, Seung Jun; Oh, Hyung Jung; Yoo, Dong Eun; Shin, Dong Ho; Lee, Mi Jung; Kim, Hyoung Rae; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae Hyun; Choi, Kyu Hun; Kang, Shin Wook.

In: PloS one, Vol. 7, No. 4, e35534, 17.04.2012.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Electrocardiographic left ventricular hypertrophy and outcome in hemodialysis patients

AU - Kim, Seung Jun

AU - Oh, Hyung Jung

AU - Yoo, Dong Eun

AU - Shin, Dong Ho

AU - Lee, Mi Jung

AU - Kim, Hyoung Rae

AU - Park, Jung Tak

AU - Han, Seung Hyeok

AU - Yoo, Tae Hyun

AU - Choi, Kyu Hun

AU - Kang, Shin Wook

PY - 2012/4/17

Y1 - 2012/4/17

N2 - Background and Aims: Electrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity. Methods: This prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008. Results: A total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95% confidence interval (CI): 1.57-87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95% CI: 1.32-8.92; P = 0.011) and CP (HR: 3.07; 95% CI: 1.16-8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. Conclusions: The product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.

AB - Background and Aims: Electrocardiography (ECG) is the most widely used initial screening test for the assessment of left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). However, traditional ECG criteria based only on voltage to detect LVH have limited clinical utility for the detection of LVH because of their poor sensitivity. Methods: This prospective observational study was undertaken to compare the prognostic significance of commonly used ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-duration product (CP) criteria, and to investigate the association between echocardiographic LV mass index (LVMI) and ECG-LVH criteria in ESRD patients, who consecutively started maintenance hemodialysis (HD) between January 2006 and December 2008. Results: A total of 317 patients, who underwent both ECG and echocardiography, were included. Compared to SV and CV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patients with ECG-LVH by each criterion. In multivariate analyses, echocardiographic LVH [adjusted hazard ratio (HR): 11.71; 95% confidence interval (CI): 1.57-87.18; P = 0.016] and ECG-LVH by SP (HR: 3.43; 95% CI: 1.32-8.92; P = 0.011) and CP (HR: 3.07; 95% CI: 1.16-8.11; P = 0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. Conclusions: The product of QRS voltage and duration is helpful in identifying the presence of LVH and predicting cardiovascular mortality in incident HD patients.

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