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TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? / TpTe e TpTe/QT: novos marcadores para prever morte súbita cardíaca na DRT?
Saour, Basil M; Wang, Jeffrey H; Lavelle, Michael P; Mathew, Roy O; Sidhu, Mandeep S; Boden, William E; Sacco, Joseph D; Costanzo, Eric J; Hossain, Mohammad A; Vachharanji, Tuhsar; Alrefaee, Anas; Asif, Arif.
  • Saour, Basil M; Albany Medical College. Albany. US
  • Wang, Jeffrey H; Hennepin County Medical Center. Department of Medicine. Division of Nephrology. Minneapolis. US
  • Lavelle, Michael P; Albany Medical College. Albany. US
  • Mathew, Roy O; WJB Dorn VA Medical Center. Department of Medicine. Division of Nephrology. Columbia. US
  • Sidhu, Mandeep S; Stratton VA Medical Center. Department of Medicine. Division of Cardiology. Albany. US
  • Boden, William E; Stratton VA Medical Center. Department of Medicine. Division of Cardiology. Albany. US
  • Sacco, Joseph D; Stratton VA Medical Center. Department of Medicine. Division of Cardiology. Albany. US
  • Costanzo, Eric J; Jersey Shore University Medical College. Seton Hall Hackensack-Meridian School of Medicine. Department of Medicine. Neptune. US
  • Hossain, Mohammad A; Jersey Shore University Medical College. Seton Hall Hackensack-Meridian School of Medicine. Department of Medicine. Neptune. US
  • Vachharanji, Tuhsar; Salisbury VA Health Care System. Department of Nephrology. US
  • Alrefaee, Anas; Jersey Shore University Medical College. Seton Hall Hackensack-Meridian School of Medicine. Department of Medicine. Neptune. US
  • Asif, Arif; Jersey Shore University Medical College. Seton Hall Hackensack-Meridian School of Medicine. Department of Medicine. Neptune. US
J. bras. nefrol ; 41(1): 38-47, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002422
ABSTRACT
ABSTRACT

Introduction:

Reliable markers to predict sudden cardiac death (SCD) in patients with end stage renal disease (ESRD) remain elusive, but echocardiogram (ECG) parameters may help stratify patients. Given their roles as markers for myocardial dispersion especially in high risk populations such as those with Brugada syndrome, we hypothesized that the Tpeak to Tend (TpTe) interval and TpTe/QT are independent risk factors for SCD in ESRD.

Methods:

Retrospective chart review was conducted on a cohort of patients with ESRD starting hemodialysis. Patients were US veterans who utilized the Veterans Affairs medical centers for health care. Average age of all participants was 66 years and the majority were males, consistent with a US veteran population. ECGs that were performed within 18 months of dialysis initiation were manually evaluated for TpTe and TpTe/QT. The primary outcomes were SCD and all-cause mortality, and these were assessed up to 5 years following dialysis initiation.

Results:

After exclusion criteria, 205 patients were identified, of whom 94 had a prolonged TpTe, and 61 had a prolonged TpTe/QT interval (not mutually exclusive). Overall mortality was 70.2% at 5 years and SCD was 15.2%. No significant difference was observed in the primary outcomes when examining TpTe (SCD prolonged 16.0% vs. normal 14.4%, p=0.73; all-cause mortality prolonged 55.3% vs. normal 47.7%, p=0.43). Likewise, no significant difference was found for TpTe/QT (SCD prolonged 15.4% vs. normal 15.0%, p=0.51; all-cause mortality prolonged 80.7% vs. normal 66.7%, p=0.39).

Conclusions:

In ESRD patients on hemodialysis, prolonged TpTe or TpTe/QT was not associated with a significant increase in SCD or all-cause mortality.
RESUMO
RESUMO

Introdução:

Marcadores confiáveis para predizer morte súbita cardíaca (MSC) em pacientes com doença renal terminal (DRT) permanecem elusivos, mas os parâmetros do ecocardiograma (ECG) podem ajudar a estratificar os pacientes. Devido a seus papéis como marcadores para a dispersão miocárdica, especialmente em populações de alto risco, como aquelas com síndrome de Brugada, nós hipotetizamos que o intervalo pico da onda T ao final da onda T (TpTe) e TpTe/QT são fatores de risco independentes para MSC na DRT.

Métodos:

Revisão retrospectiva do prontuário foi realizada em uma coorte de pacientes com DRT iniciando a hemodiálise. Os pacientes eram veteranos de guerra americanos que utilizavam os centros médicos do Veterans Affairs para atendimento médico. A idade média de todos os participantes foi de 66 anos e a maioria era do sexo masculino, consistente com uma população veterana dos EUA. ECGs que foram realizados dentro de 18 meses após o início da diálise, e foram avaliados manualmente para TpTe e TpTe/QT. Os desfechos primários foram MSC e mortalidade por todas as causas, e estes foram avaliados até 5 anos após o início da diálise.

Resultados:

Após o critério de exclusão, foram identificados 205 pacientes, dos quais 94 com TpTe prolongado e 61 com intervalo TpTe/QT prolongado (não mutuamente exclusivo). A mortalidade geral foi de 70,2% em 5 anos e a MSC foi de 15,2%. Nenhuma diferença significativa foi observada nos desfechos primários ao se avaliar o TpTe (MSC prolongado 16,0% versus normal 14,4%, p = 0,73; mortalidade por todas as causas prolongado 55,3% vs. normal 47,7%, p = 0,43). Da mesma forma, nenhuma diferença significativa foi encontrada para TpTe/QT (MSC prolongado 15,4% vs. normal 15,0%, p = 0,51; mortalidade por todas as causas prolongado 80,7% vs. normal 66,7%, p = 0,39).

Conclusões:

Em pacientes com insuficiência renal terminal em hemodiálise, TpTe ou TpTe/QT prolongados não foram associados a um aumento significativo da morte súbita ou mortalidade por todas as causas.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Death, Sudden, Cardiac / Electrocardiography / Kidney Failure, Chronic Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Aged80 / Female / Humans / Male Language: English Journal: J. bras. nefrol Journal subject: Nephrology Year: 2019 Type: Article Affiliation country: United States Institution/Affiliation country: Albany Medical College/US / Hennepin County Medical Center/US / Jersey Shore University Medical College/US / Salisbury VA Health Care System/US / Stratton VA Medical Center/US / WJB Dorn VA Medical Center/US

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Full text: Available Index: LILACS (Americas) Main subject: Death, Sudden, Cardiac / Electrocardiography / Kidney Failure, Chronic Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Aged80 / Female / Humans / Male Language: English Journal: J. bras. nefrol Journal subject: Nephrology Year: 2019 Type: Article Affiliation country: United States Institution/Affiliation country: Albany Medical College/US / Hennepin County Medical Center/US / Jersey Shore University Medical College/US / Salisbury VA Health Care System/US / Stratton VA Medical Center/US / WJB Dorn VA Medical Center/US