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Braunisch, Matthias C.; Gundel, Peter; Werfel, Stanislas; Mayer, Christopher C.; Bauer, Axel; Haller, Bernhard; Guenthner, Roman; Lorenz, Georg; Angermann, Susanne; Matschkal, Julia; Schaller, Carolin; Holzmann-Littig, Christopher; Kemmner, Stephan; Mann, Johannes; Krieter, Axel; Renders, Lutz; Wassertheurer, Siegfried; Schmidt, Georg; Heemann, Uwe; Malik, Marek and Schmaderer, Christoph (2021): Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients. In: Journal of Nephrology, Vol. 35, No. 1: pp. 233-244

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Background In hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages. Methods A total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results The Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti. Conclusions The post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages.Y

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