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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Initial and terminal T wave angle as hyperkalemia indicator in chronic kidney disease
Eka Prasetya Budi Mulia1, Kevin Luke2, Filipus Michael Yofrido3
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia.
Insights
The terminal T wave angle is a more effective predictor of hyperkalemia in chronic kidney disease (CKD) patients than the initial T wave angle. This ECG measurement can help identify dangerous potassium levels in CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Diagnostics
Background:
- Hyperkalemia is a dangerous complication of chronic kidney disease (CKD), potentially causing fatal arrhythmias.
- Electrocardiography (ECG) changes, like peaked T waves, are associated with hyperkalemia, but definitions lack clarity.
- Current methods for identifying peaked T waves in hyperkalemia lack sensitivity and specificity.
Purpose of the Study:
- To evaluate the predictive value of initial and terminal T wave angles for detecting hyperkalemia in CKD patients.
- To establish quantitative ECG markers for hyperkalemia in a CKD population.
Main Methods:
- A cross-sectional study involving 220 hospitalized adult CKD patients.
- Measurement of T wave morphology using calipers to calculate initial deflection angle (Tia) and terminal deflection angle (Tta).
- Receiver operating characteristic (ROC) curve analysis to determine optimal cutoffs and diagnostic performance.
Main Results:
- Hyperkalemia (potassium >5.0 mEq/L) was present in 98 patients.
- Significantly higher Tia and Tta values were observed in the hyperkalemia group (p < 0.05).
- Tia and Tta showed significant positive correlations with serum potassium levels (r=0.346 and r=0.445, respectively).
- Optimal cutoff for Tta was 66.20° (sensitivity 67.3%, specificity 73.8%); for Tia, it was 61.07° (sensitivity 66.3%, specificity 69.7%).
Conclusions:
- The terminal T wave angle demonstrates superior predictive performance for hyperkalemia in CKD patients compared to the initial T wave angle.
- T wave angle measurements offer a valuable, non-invasive tool for assessing hyperkalemia risk in CKD.
- Further research may refine T wave angle analysis for improved hyperkalemia detection in clinical practice.
Background:
Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity.
Aim:
This study aims to determine the predictive value of initial and terminal T wave angle in detecting hyperkalemia among CKD patients.
Methods:
A cross-sectional study was conducted at Dr. Soetomo General Hospital, including all adult hospitalized CKD patients. A caliper was used to measure T wave morphology. The initial deflection angle (Tia) and terminal deflection angle (Tta) were calculated from an arctan of T peak amplitude and the respective initial or terminal length. The receiver operating characteristics (ROC) curve was analyzed to determine the area under the curve (AUC) and optimal cutoff.
Results:
A total of 220 CKD patients were enrolled in this study, with 98 patients with hyperkalemia (potassium >5.0). The majority of the patients were male, with a mean age of 51.12 ± 12.58 years. Ti-Tp duration, Tp-Tt duration, Tia, Tta, and Tp amplitude were significantly higher in the hyperkalemia group (all p < 0.05). A Spearman correlation analysis demonstrated a significant positive correlation of Tia (r = 0.346 and p < 0.001) and Tta (r = 0.445 and p < 0.001) with potassium levels in the participants. The optimal cutoff angle for Tta was 66.20° (sensitivity = 67.3% and specificity = 73.8%) and Tia was 61.07° (sensitivity = 66.3% and specificity = 69.7%).
Conclusion:
The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.
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