Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES-CKD) study

Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

article

Kenichi Hashimoto MD, PhD¹  Toshio Kinoshita MD, PhD²  Yosuke Miwa MD, PhD³  Mari Amino MD, PhD⁴  Koichiro Yoshioka MD, PhD⁴  Kenji Yodogawa MD, PhD⁵  Mikiko Nakagawa MD, PhD⁶  Kohki Nakamura MD, PhD⁷  Eiichi Watanabe MD, PhD⁸  Kentaro Nakamura MD, PhD⁹  Tetsu Watanabe MD, PhD^1,10  Yuji Kasamaki MD, PhD^1,11  Takanori Ikeda MD, PhD² 

[1] Department of General Medicine, National Defense Medical College;Department of Cardiovascular Medicine, Toho University;Department of Cardiology, Kyorin University Hospital;Department of Cardiovascular Medicine, Tokai University;Department of Cardiovascular Medicine, Nippon Medical School;Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University;Division of Cardiology, Gunma Prefectural Cardiovascular Center;Department of Cardiology, Fujita Health University Bantane Hospital;Division of Cardiovascular Medicine, Shin-Yamanote Hospital;Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine;Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital

关键词: ambulatory electrocardiography;    chronic kidney disease;    late potentials;    nonsustained ventricular tachycardia;    sudden cardiac death;    ventricular tachycardia;   

DOI  :  10.1111/anec.12923

来源: Wiley

【 摘 要 】

Background Noninvasive electrocardiographic markers (NIEMs) are promising arrhythmic risk stratification tools for assessing the risk of sudden cardiac death. However, little is known about their utility in patients with chronic kidney disease (CKD) and organic heart disease. This study aimed to determine whether NIEMs can predict cardiac events in patients with CKD and structural heart disease (CKD-SHD). Methods We prospectively analyzed 183 CKD-SHD patients (median age, 69 years [interquartile range, 61−77 years]) who underwent 24-h ambulatory electrocardiographic monitoring and assessed the worst values for ambulatory-based late potentials (w-LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT). The primary endpoint was the occurrence of documented lethal ventricular tachyarrhythmias (ventricular fibrillation or sustained ventricular tachycardia) or cardiac death. The secondary endpoint was admission for cardiovascular causes. Results Thirteen patients reached the primary endpoint during a follow-up period of 24 ± 11 months. Cox univariate regression analysis showed that existence of w-LPs (hazard ratio [HR] = 6.04, 95% confidence interval [CI]: 1.4−22.3, p  = .007) and NSVT [HR = 8.72, 95% CI: 2.8−26.5: p  < .001] was significantly associated with the primary endpoint. Kaplan–Meier analysis demonstrated that the combination of w-LPs and NSVT resulted in a lower event-free survival rate than did other NIEMs ( p  < .0001). No NIEM was useful in predicting the secondary endpoint, although the left ventricular mass index was correlated with the secondary endpoint. Conclusion The combination of w-LPs and NSVT was a significant risk factor for lethal ventricular tachyarrhythmias and cardiac death in CKD-SHD patients.

【 授权许可】

Unknown