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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD
Rajat Deo1, Haochang Shou2, Elsayed Z Soliman3
1Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Rajat.Deo@uphs.upenn.edu.
Insights
Common electrocardiogram (ECG) metrics are strong predictors of cardiovascular death risk in individuals with chronic kidney disease (CKD). Incorporating these ECG findings significantly improves the prediction of mortality events in this high-risk population.
Area of Science:
- Cardiology
- Nephrology
- Medical Diagnostics
Background:
- Limited research exists on the utility of resting 12-lead electrocardiogram (ECG) for screening intermediate-risk populations.
- Chronic kidney disease (CKD) is associated with increased cardiovascular risk, necessitating effective screening tools.
Purpose of the Study:
- To determine if common ECG parameters independently predict mortality risk in a prospective cohort of patients with CKD.
- To assess the incremental value of ECG metrics in predicting cardiovascular death when added to existing risk models.
Main Methods:
- Prospective cohort study of 3939 participants in the Chronic Renal Insufficiency Cohort (CRIC) with estimated glomerular filtration rate (eGFR) < 70 ml/min per 1.73 m².
- Median follow-up of 7.5 years, with adjudication of 497 initial deaths into cardiovascular and noncardiovascular causes.
- Analysis of common ECG parameters including PR interval, QRS duration, corrected QT (QTc) interval, and heart rate as independent risk markers.
Main Results:
- Several ECG metrics were identified as independent risk markers for cardiovascular death, including prolonged PR interval, QRS duration, abnormal QTc interval, and elevated heart rate.
- These ECG measures demonstrated stronger association with cardiovascular death compared to all-cause or noncardiovascular mortality.
- Adding ECG metrics to a comprehensive cardiorenal risk model significantly improved the prediction of cardiovascular death (C-statistic increased from 0.77 to 0.81) and reclassified 12.1% of participants.
Conclusions:
- Commonly measured ECG parameters serve as independent risk factors for cardiovascular death in individuals with CKD.
- The integration of standard ECG findings enhances the predictive accuracy for mortality events in the CKD population.
- Resting ECG is a valuable, accessible tool for risk stratification in patients with chronic kidney disease.
Abstract:
Limited studies have assessed the resting 12-lead electrocardiogram (ECG) as a screening test in intermediate risk populations. We evaluated whether a panel of common ECG parameters are independent predictors of mortality risk in a prospective cohort of participants with CKD. The Chronic Renal Insufficiency Cohort (CRIC) study enrolled 3939 participants with eGFR<70 ml/min per 1.73 m(2) from June 2003 to September 2008. Over a median follow-up of 7.5 years, 750 participants died. After adjudicating the initial 497 deaths, we identified 256 cardiovascular and 241 noncardiovascular deaths. ECG metrics were independent risk markers for cardiovascular death (hazard ratio, 95% confidence interval): PR interval ≥200 ms (1.62, 1.19-2.19); QRS interval 100-119 ms (1.64, 1.20-2.25) and ≥120 ms (1.75, 1.17-2.62); corrected QT (QTc) interval ≥450 ms in men or ≥460 ms in women (1.72, 1.19-2.49); and heart rate 60-90 beats per minute (1.21, 0.89-1.63) and ≥90 beats per minute (2.35, 1.03-5.33). Most ECG measures were stronger markers of risk for cardiovascular death than for all-cause mortality or noncardiovascular death. Adding these intervals to a comprehensive model of cardiorenal risk factors increased the C-statistic for cardiovascular death from 0.77 to 0.81 (P<0.001). Furthermore, adding ECG metrics to the model adjusted for standard risk factors resulted in a net reclassification of 12.1% (95% confidence interval 8.1%-16.0%). These data suggest common ECG metrics are independent risk factors for cardiovascular death and enhance the ability to predict death events in a population with CKD.
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