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J Am Soc Nephrol. 2016 Feb;27(2):559-69. doi: 10.1681/ASN.2014101045. Epub 2015 Jul 9.

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD.

Author information

  • 1Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Rajat.Deo@uphs.upenn.edu.
  • 2Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
  • 3Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina;
  • 4Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
  • 5Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
  • 6Division of Research, Kaiser Permanent Northern California, Oakland, California; Department of Health Research and Policy, Stanford University, Palo Alto, California; Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; and.
  • 7Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California; and Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California.
  • 8Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;

Abstract

Limited studies have assessed the resting 12-lead electrocardiogram (ECG) as a screening test in intermediate risk populations. We evaluated whether a panel of common ECG parameters are independent predictors of mortality risk in a prospective cohort of participants with CKD. The Chronic Renal Insufficiency Cohort (CRIC) study enrolled 3939 participants with eGFR<70 ml/min per 1.73 m(2) from June 2003 to September 2008. Over a median follow-up of 7.5 years, 750 participants died. After adjudicating the initial 497 deaths, we identified 256 cardiovascular and 241 noncardiovascular deaths. ECG metrics were independent risk markers for cardiovascular death (hazard ratio, 95% confidence interval): PR interval ≥200 ms (1.62, 1.19-2.19); QRS interval 100-119 ms (1.64, 1.20-2.25) and ≥120 ms (1.75, 1.17-2.62); corrected QT (QTc) interval ≥450 ms in men or ≥460 ms in women (1.72, 1.19-2.49); and heart rate 60-90 beats per minute (1.21, 0.89-1.63) and ≥90 beats per minute (2.35, 1.03-5.33). Most ECG measures were stronger markers of risk for cardiovascular death than for all-cause mortality or noncardiovascular death. Adding these intervals to a comprehensive model of cardiorenal risk factors increased the C-statistic for cardiovascular death from 0.77 to 0.81 (P<0.001). Furthermore, adding ECG metrics to the model adjusted for standard risk factors resulted in a net reclassification of 12.1% (95% confidence interval 8.1%-16.0%). These data suggest common ECG metrics are independent risk factors for cardiovascular death and enhance the ability to predict death events in a population with CKD.

KEYWORDS:

chronic kidney disease; electrophysiology; epidemiology and outcomes; mortality risk; risk factors

PMID:
26160896
PMCID:
PMC4731112
DOI:
10.1681/ASN.2014101045
[PubMed - indexed for MEDLINE]
Free PMC Article

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