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Incidence and long-term significance of transient ST segment deviation in hemodialysis patients
P J Conlon1, M W Krucoff, S Minda
1Division of Nephrology, Duke University Medical Center, Durham, NC, USA.
Insights
Silent ischemia, indicated by ST segment depression during ambulatory electrocardiography, is common in end-stage renal disease (ESRD) patients. However, this study found no link between silent ischemia and increased long-term mortality in hemodialysis patients.
Area of Science:
- Nephrology
- Cardiology
- Clinical Electrophysiology
Background:
- Coronary artery disease (CAD) is a common complication in end-stage renal disease (ESRD).
- Silent ischemia, identified by ST segment depression on ambulatory electrocardiography, is a potential marker for cardiovascular events.
- The significance of silent ischemia in ESRD patients, who often have left ventricular hypertrophy and electrolyte shifts, remains unclear.
Purpose of the Study:
- To determine the incidence of transient ST segment depression during Holter monitoring in hemodialysis patients.
- To assess the association between ST segment depression and long-term cardiovascular mortality in this population.
Main Methods:
- Seventy hemodialysis patients underwent ambulatory Holter monitoring for at least 12 hours.
- The incidence of 1 mm ST segment depression lasting at least one minute was recorded.
- Patient survival free of death, myocardial infarction, or coronary bypass grafting was tracked for two years.
Main Results:
- Twenty-three percent (16 out of 67) of patients exhibited at least one minute of ST segment depression.
- No significant association was found between ST segment depression and CAD, diabetes, left ventricular hypertrophy, sex, or race.
- Two-year survival rates were similar for patients with and without ST segment depression (70% free of adverse events).
Conclusions:
- Transient ST segment depression is frequent in hemodialysis patients.
- The presence of ST segment depression on Holter monitoring does not appear to predict increased long-term mortality in ESRD patients.
Abstract:
Coronary artery disease is a frequent complication of end-stage renal disease (ESRD). ST segment depression on ambulatory electrocardiography without patient awareness is a marker of what has been termed "silent ischemia". It has been suggested that in patients with coronary artery disease these transient ST segment depressions are associated with increased cardiovascular mortality. Up to 30% of patients with ESRD may display transient ST segment depression, however the significance of this finding in these group of patients who frequently have associated LV hypertrophy, and rapid electrolyte changes has not been clear. We therefore set out to determine the incidence of transient ST segment depression during ambulatory Holter monitoring in 70 consecutively studied hemodialysis patients. Sixty-seven patients wore the monitor for at least 12 hours and 16 patients (23%) demonstrated at least one minute of 1 mm ST segment depression. The presence of clinically apparent coronary artery disease, diabetes, left ventricular hypertrophy, sex or race were not significantly associated with the probability of demonstrating transient ST segment depression. The survival of patients with or without transient ST segment depression was the same at 2 years with 70% of patients remaining free of death, nonfatal myocardial infarction, or coronary bypass grafting. We conclude that patients with ESRD frequently demonstrate transient ST segment depression, however, the presence of these findings on ambulatory Holter monitoring does not appear to be associated with increased long-term mortality.