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. 2022 Mar;27(2):e12923.
doi: 10.1111/anec.12923. Epub 2021 Dec 6.

Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES-CKD) study

Kenichi Hashimoto  1 , Toshio Kinoshita  2 , Yosuke Miwa  3 , Mari Amino  4 , Koichiro Yoshioka  4 , Kenji Yodogawa  5 , Mikiko Nakagawa  6 , Kohki Nakamura  7 , Eiichi Watanabe  8 , Kentaro Nakamura  9 , Tetsu Watanabe  10 , Yuji Kasamaki  11 , Takanori Ikeda  2
Affiliations

Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES-CKD) study

Kenichi Hashimoto et al. Ann Noninvasive Electrocardiol. 2022 Mar.

Abstract

Background: Noninvasive electrocardiographic markers (NIEMs) are promising arrhythmic risk stratification tools for assessing the risk of sudden cardiac death. However, little is known about their utility in patients with chronic kidney disease (CKD) and organic heart disease. This study aimed to determine whether NIEMs can predict cardiac events in patients with CKD and structural heart disease (CKD-SHD).

Methods: We prospectively analyzed 183 CKD-SHD patients (median age, 69 years [interquartile range, 61-77 years]) who underwent 24-h ambulatory electrocardiographic monitoring and assessed the worst values for ambulatory-based late potentials (w-LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT). The primary endpoint was the occurrence of documented lethal ventricular tachyarrhythmias (ventricular fibrillation or sustained ventricular tachycardia) or cardiac death. The secondary endpoint was admission for cardiovascular causes.

Results: Thirteen patients reached the primary endpoint during a follow-up period of 24 ± 11 months. Cox univariate regression analysis showed that existence of w-LPs (hazard ratio [HR] = 6.04, 95% confidence interval [CI]: 1.4-22.3, p = .007) and NSVT [HR = 8.72, 95% CI: 2.8-26.5: p < .001] was significantly associated with the primary endpoint. Kaplan-Meier analysis demonstrated that the combination of w-LPs and NSVT resulted in a lower event-free survival rate than did other NIEMs (p < .0001). No NIEM was useful in predicting the secondary endpoint, although the left ventricular mass index was correlated with the secondary endpoint.

Conclusion: The combination of w-LPs and NSVT was a significant risk factor for lethal ventricular tachyarrhythmias and cardiac death in CKD-SHD patients.

Keywords: ambulatory electrocardiography; chronic kidney disease; late potentials; nonsustained ventricular tachycardia; sudden cardiac death; ventricular tachycardia.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Study population. Patients were enrolled from April 2012 to March 2015. Follow‐up data collection was performed every 6 months until September 2015. CKD, chronic kidney disease; JANIES‐CKD, The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease; SHD, structural heart disease
FIGURE 2
FIGURE 2
Kaplan–Meier event‐free survival curves of NIEMs for cardiac death and lethal arrhythmias (primary endpoint). The combination of a‐LP and NSVT was associated with a significantly lower event‐free survival rate than was any other combination. NIEMs, noninvasive electrocardiographic markers; NSVT, nonsustained ventricular tachycardia; w‐LPs, worst values of ambulatory‐based late potentials
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