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QT prolongation is an independent predictor of mortality in end-stage renal disease
Fadi G Hage1, Angelo M de Mattos, Hasan Khamash
1Division of Cardiovascular Disease, University of Alabama at Birmingham, USA. fadihage@uab.edu
Insights
QT interval prolongation independently predicts mortality in end-stage renal disease (ESRD) patients awaiting transplantation. This finding adds crucial prognostic information beyond left ventricular ejection fraction and coronary artery disease severity.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Coronary artery disease (CAD) is a major cause of sudden cardiac death.
- Sudden cardiac death is the leading cause of mortality in end-stage renal disease (ESRD).
Purpose of the Study:
- To determine if QT interval prolongation is an independent prognosticator of mortality in ESRD patients.
- To evaluate the additive prognostic value of QT interval prolongation compared to other clinical factors.
Main Methods:
- Retrospective review of clinical, electrocardiographic, and angiographic data from ESRD patients evaluated for transplantation (2000-2004).
- QT interval was corrected for heart rate and QRS duration (QTc).
- All-cause mortality data were prospectively collected and verified.
Main Results:
- During follow-up, 47% of patients died before transplantation.
- Prolonged QTc was associated with significantly higher 1-, 3-, and 5-year death rates compared to normal QTc.
- QTc prolongation remained an independent predictor of survival in multivariate analysis, even after adjusting for CAD severity, left ventricular ejection fraction, and other factors.
Conclusions:
- QTc prolongation is an independent predictor of mortality in ESRD patients undergoing evaluation for renal transplantation.
- QTc provides prognostic information that is additive to left ventricular ejection fraction and coronary artery disease severity.
Background:
Coronary artery disease (CAD) is the predominant cause of sudden cardiac death in the general population, and sudden cardiac death is the leading cause of mortality in end-stage renal disease (ESRD).
Hypothesis:
QT-interval prolongation is an independent prognosticator in ESRD.
Methods:
We reviewed clinical, electrocardiographic, stress test, and coronary angiography data on ESRD patients evaluated for transplantation at our institution between 2000 and 2004 who underwent coronary angiography. The QT interval was corrected for heart rate and QRS duration (QTc). All-cause mortality data were prospectively collected and verified against the Social Security Death Index database.
Results:
During 40 +/- 28 months of follow-up, 132 of the 280 (47%) patients died prior to renal transplantation. Patients with a prolonged QTc (39%) had 1-, 3-, and 5-year death-rates of 12%, 36%, and 47%, respectively, vs 8%, 24%, and 36% for those with normal QTc (log-rank P = 0.03). In a multivariate Cox regression model that adjusted for age, gender, diabetes mellitus, myocardial infarction, presence and severity of CAD on angiography, left ventricular (LV) hypertrophy, LV ejection fraction (EF), and multiple other variables, QTc remained to be an independent predictor of survival (hazard ratio [HR]: 1.008, 95% confidence interval [CI]: 1.001-1.014, P = 0.016). Female gender, decreasing LVEF, and decreasing severity of CAD on angiography were independent predictors of prolonged QTc.
Conclusions:
QTc prolongation is an independent predictor of mortality in ESRD patients being evaluated for renal transplantation. The prognostic information gained from the QTc is additive to that provided by the LVEF and the severity of CAD.
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