Electrocardiographic Left Ventricular Hypertrophy and Outcome in Hemodialysis Patients 英文参考文献.docVIP

ElectrocardiographicLeftVentricularHypertrophyand OutcomeinHemodialysisPatients SeungJunKim1,HyungJungOh1,DongEunYoo1,DongHoShin1,MiJungLee1,HyoungRaeKim1 ,Jung TakPark1,SeungHyeokHan1,Tae-HyunYoo1,KyuHunChoi1,Shin-WookKang1,2* 1DepartmentofInternalMedicine,CollegeofMedicine,YonseiUniversity,Seoul,Korea,2SeveranceBiomedicalScienceInstitute,BrainKorea21,YonseiUniversity,Seoul, Korea Abstract BackgroundandAims:Electrocardiography(ECG)isthemostwidelyusedinitialscreeningtestfortheassessmentofleft ventricularhypertrophy(LVH),anindependentpredictorofcardiovascularmortalityinpatientswithend-stagerenaldisease (ESRD).However,traditionalECGcriteriabasedonlyonvoltagetodetectLVHhavelimitedclinicalutilityforthedetectionof LVHbecauseoftheirpoorsensitivity. Methods:Thisprospectiveobservationalstudywasundertakentocomparetheprognosticsignificanceofcommonlyused ECG criteria for LVH, namely Sokolow-Lyon voltage (SV) or voltage-duration product (SP) and Cornell voltage (CV) or voltage-durationproduct(CP)criteria,andtoinvestigatetheassociationbetweenechocardiographicLVmassindex(LVMI) andECG-LVHcriteriainESRDpatients,whoconsecutivelystartedmaintenancehemodialysis(HD)betweenJanuary2006 andDecember2008. Results:Atotalof317patients,whounderwentbothECGandechocardiography,wereincluded.ComparedtoSVandCV criteria, SP and CP criteria, respectively, correlated more closely with LVMI. In addition, CP criteria provided the highest positive predictive value for echocardiographic LVH. The 5-year cardiovascular survival rates were significantly lower in patientswithECG-LVHbyeachcriterion.Inmultivariateanalyses,echocardiographicLVH[adjustedhazardratio(HR):11.71; 95%confidenceinterval(CI):1.57–87.18;P=0.016]andECG-LVHbySP(HR:3.43;95%CI:1.32–8.92;P=0.011)andCP(HR: 3.07; 95% CI: 1.16–8.11; P=0.024) criteria, but not SV and CV criteria, were significantly associated with cardiovascular mortality. Conclusions: The product of QRS voltage and duration is helpful in identifying the presence of LVH and predic