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. 2022 Jan;35(1):233-244.
doi: 10.1007/s40620-021-01068-0. Epub 2021 May 20.

Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients

Matthias C Braunisch  1 , Peter Gundel  2   3 , Stanislas Werfel  2 , Christopher C Mayer  4 , Axel Bauer  5   6 , Bernhard Haller  7 , Roman Günthner  2 , Georg Lorenz  2 , Susanne Angermann  2 , Julia Matschkal  2 , Carolin Schaller  2 , Christopher Holzmann-Littig  2   8 , Stephan Kemmner  2   9 , Johannes Mann  10   11 , Axel Krieter  12 , Lutz Renders  2 , Siegfried Wassertheurer  4 , Georg Schmidt  13 , Uwe Heemann  2 , Marek Malik  14   15 , Christoph Schmaderer  16
Affiliations

Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients

Matthias C Braunisch et al. J Nephrol. 2022 Jan.

Abstract

Background: In hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages.

Methods: A total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score.

Results: The Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti.

Conclusions: The post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages.

Keywords: Cardiovascular mortality; Hemodialysis; Left ventricular hypertrophy; Peguero-Lo presti.

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Conflict of interest statement

The authors declare no conflicts of interest. Matthias Christoph Braunisch reports received personal fees from Vifor Pharma unrelated to the project.

Figures

Fig. 1
Fig. 1
Flow-chart of participants. Abbreviations: CV cardiovascular; ECG electrocardiogram; LBBB left bundle branch block; RBBB right bundle branch block
Fig. 2
Fig. 2
Changes in pre- to post-dialysis voltages. A–C show Bland–Altman plots for the agreement of pre- and post-dialysis voltages. The black line depicts the mean difference between the two measurements, the dotted lines depict the limits of agreement (mean delta − 1.96 × standard deviation to mean delta + 1.96 × standard deviation). The blue dotted line describes the regression line. D–F show the changes in voltage cut-offs from pre- to post-dialysis which were compared using the McNemar test
Fig. 3
Fig. 3
Area-proportional Euler diagrams of positive ECG LVH voltage criteria measured after dialysis. Peguero-Lo Presti (n = 59): ≥ 2.3 mV (women), ≥ 2.8 (men); Cornell (n = 24): > 2.0 mV (women), > 2.8 mV (men); Sokolow-Lyon (n = 16): ≥ 3.5 mV
Fig. 4
Fig. 4
Cumulative cardiovascular mortality curves stratified by post-dialysis A Peguero-Lo Presti, B Cornell, and C Sokolow-Lyon cut-offs. Hazard ratio after adjustment for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Abbreviations: CI confidence interval; HR hazard ratio; NA not applicable since there were no mortality events in the positive group
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