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Left atrial dilatation and ST-T changes predict cardiovascular outcome in chronic hemodialysis patients

Kiyotsugu Omae1, Tetsuya Ogawa, Masao Yoshikawa

  • 1Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.

Heart and Vessels
|September 29, 2011
PubMed

Insights

for chronic hemodialysis patients, enlarged left atrium (LA) and ST-T changes on ECG predict cardiovascular events. Early detection aids in monitoring cardiovascular risk and improving patient outcomes.

Area of Science:

  • Cardiology
  • Nephrology
  • Diagnostic Imaging

Background:

  • The left atrium (LA) is sensitive to afterload, with reported volumetric remodeling.
  • Left atrial enlargement and ST-T changes are potential indicators of cardiovascular risk.

Purpose of the Study:

  • To prospectively examine the effects of LA enlargement and ST-T changes on cardiovascular outcomes in chronic hemodialysis (HD) patients.
  • To investigate the prognostic value of ST-T changes and LA dilatation for cardiovascular events in HD patients.

Main Methods:

  • Prospective study of 112 chronic HD patients with serial echocardiography over a mean of 2.1 years.
  • Evaluation of LA size, left ventricular mass index (LVMI), and other echocardiographic indices.
  • Analysis of ST-T changes on ECG and their association with cardiovascular events using Cox proportional hazard and Kaplan-Meier analyses.

Main Results:

  • HD patients with ST-T changes and LA dilatation showed higher LVDd, interventricular septum thickness, fractional shortening, and LVMI.
  • Left ventricular hypertrophy (LVH) and new cardiovascular events were more frequent in patients with both ST-T changes and LA dilatation (p = 0.0127).
  • Cox analysis identified coronary artery disease, ST-T changes, LA dilatation, and serum albumin as significant predictors of cardiovascular events (HRs: 3.898, 5.182, 0.185 respectively).
  • Kaplan-Meier analysis showed significantly fewer events in patients without ST-T changes and LA dilatation (p < 0.0001).

Conclusions:

  • ST-T changes and LA dilatation are significant predictors of cardiovascular outcomes in chronic HD patients.
  • Detecting ST-T changes on ECG and LA dilatation is valuable for cardiovascular risk monitoring in this population.

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