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Sympathetic overactivity and sudden cardiac death among hemodialysis patients with left ventricular hypertrophy

Masato Nishimura1, Toshiko Tokoro, Masasya Nishida

  • 1Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan. mnishimura@tea.ocn.ne.jp

International Journal of Cardiology
|January 27, 2009
PubMed

Insights

Cardiac autonomic imbalance, indicated by a high LF/HF ratio, predicts sudden cardiac death (SCD) in hemodialysis patients with left ventricular hypertrophy (LVH). Lower parasympathetic activity (pNN50) also correlates with increased SCD risk.

Area of Science:

  • Cardiology
  • Nephrology
  • Autonomic Nervous System Research

Background:

  • Cardiac autonomic imbalance is a concern in hemodialysis patients with left ventricular hypertrophy (LVH).
  • The association between autonomic dysfunction and sudden cardiac death (SCD) in this population requires investigation.

Purpose of the Study:

  • To prospectively investigate the link between cardiac autonomic imbalance and SCD risk.
  • To identify predictors of SCD in asymptomatic hemodialysis patients with LVH.

Main Methods:

  • Prospective cohort study of 196 hemodialysis patients with LVH.
  • Analysis of heart rate variability using 24-hour Holter ECG to assess parasympathetic (pNN50, HF) and sympathetic (LF/HF ratio) activity.
  • Stepwise Cox hazard and Kaplan-Meier analyses for SCD prediction.

Main Results:

  • SCD occurred in 23 of 175 analyzed patients over 4.5 years.
  • SCD was positively associated with age and the LF/HF ratio.
  • A lower LF/HF ratio (<1.9) was associated with significantly higher 5-year SCD-free survival (98.1% vs. 29.4%).

Conclusions:

  • Cardiac sympathetic overactivity, reflected by a high LF/HF ratio, may predict SCD.
  • Autonomic imbalance is a significant risk factor for SCD in hemodialysis patients with LVH.
  • These findings highlight the importance of assessing autonomic function in this high-risk group.
Abstract

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