The Relationship Between Patient Survival and ECG aVR T Wave Positivity in Hemodialysis Patients

Year 2023, , 19 - 27, 30.04.2023

Engin Onan , Saime Paydas , Çağlar Emre Çağlayan , Gokhan Gök , Mustafa Balal , Aziz İnan Celık

https://doi.org/10.36516/jocass.1221859

Abstract

Introduction: Evidence suggests a relationship between electrocardiography (ECG) aVR (augmented voltage right) T wave and cardiovascular mortality in hemodialysis patients. The aim of our study was to investigate the relationship between ECG T aVR positivity and overall mortality together with other known risk factors in hemodialysis patients.

Materials and methods: One hundred and one hemodialysis patients were retrospectively screened for ECG T aVR wave positivity. In parallel, the relationship between T aVR positivity and age, gender, calcium phosphorus index, heart rate, ECG and echocardiographic parameters, mortality, smoking, presence of diabetes mellitus, hypertension, myocardial infarction were investigated.

RESULTS: Univariate analyzes revealed that patients with positive T aVR (16%) had a statistically lower dialysis time and ejection fraction compared to patient with negative T aVR (p=0.041 and p=0.046, respectively). Survival analysis revealed statistically significantly better prognosis for T aVR-negative patients compared to T aVR-positive patients (5-year survival 70.9%, and 45.5%, respectively; p=0.027). Among tested parameters, independent risk factors affecting survival in hemodialysis patients were found to be age (hazard ratio, HR: 1.03), high heart rate (HR: 1.03), smoking (HR: 3.37) and presence of diabetes mellitus (HR: 2.91).

CONCLUSIONS: Our results indicate that routine monitorization of T wave in aVR derivation together with evaluation of other risk factors may provide information about the cardiovascular risk profile, mortality and life habits of hemodialysis patients.

Keywords

Electrocardiography, hemodialysis, mortality

HEMODİYALİZ HASTALARINDA ELEKTROKARDİYOGRAFİK AVR DERİVASYONU T DALGA POZİTİFLİĞİ İLE HASTA SAĞ KALIMI ARASINDAKİ İLİŞKİ

Abstract

Giriş: Hemodiyaliz hastalarında elektrokardiyografi (EKG) aVR (augmented voltage right) derivasyonu T dalgası pozitifliği ile kardiyovasküler mortalite ve sağkalım arasında ilişki olduğu düşünülmektedir. Çalışmamızın amacı hemodiyaliz hastalarında bilinen diğer risk faktörleri ile birlikte EKG’de aVR derivasyonunda T dalgası pozitifliği ve hasta sağkalımı arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntemler:Yüzbir hemodiyaliz hastası retrospektif olarak EKG T aVR dalga pozitifliği açısından tarandı. Buna paralel olarak T aVR pozitifliği ile yaş, cinsiyet, kalsiyum fosfor indeksi, kalp hızı, EKG ve ekokardiyografik parametreler, mortalite, sigara kullanımı, diabetes mellitus varlığı, hipertansiyon, miyokard enfarktüsü arasındaki ilişki araştırıldı.

Sonuç: Çalışmamızda T aVR'si pozitif olan hastaların (%16) negatif T aVR'si olan hastalara kıyasla istatistiksel olarak daha düşük diyaliz süresine ve ejeksiyon fraksiyonuna sahip olduğunu gösterildi (sırasıyla p=0,041 ve p=0,046). Sağkalım analizi, TaVR-pozitif hastalara kıyasla TaVR-negatif hastalar için prognozun istatistiksel olarak anlamlı şekilde daha iyi olduğunu ortaya koydu (5 yıllık sağkalım sırasıyla %70,9 ve %45,5; p=0,027). Test edilen parametreler arasında hemodiyaliz hastalarında sağkalımı etkileyen bağımsız risk faktörleri yaş (Hazard Ratio, HR: 1,03), yüksek kalp hızı (HR: 1,03), sigara içme (HR: 3,37) ve diabetes mellitus varlığı (HR: 2,91) olarak bulundu.

Tartışma: Sonuçlarımız diğer risk faktörleri ile birlikte aVR derivasyonunda T dalgasının rutin olarak izlenmesinin hemodiyaliz hastalarında sağ kalım ve kardiyovasküler açıdan bilgi sağlayabileceğini göstermektedir.

Keywords

Elektrokardiyografi, hemodiyaliz, mortalite, Electrocardiography, hemodialysis, mortality

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