Analysis of T-wave morphology from the 12-lead electrocardiogram for prediction of long-term prognosis in patients initiating haemodialysis.

BACKGROUND Cardiovascular disease remains the most common cause of death in end-stage renal disease (ESRD). Recently, novel descriptors of T-wave morphology have been suggested as measures of repolarization heterogeneity and adverse prognosis in non-uraemic populations. However, whether these T-wave descriptors provide prognostic information in uraemic populations has not been examined. The present study aimed to determine the prognostic value of novel T-wave morphology variables in predicting total, cardiovascular and arrhythmia-related mortality in ESRD patients initiating haemodialysis. METHODS The study was a retrospective cohort of adult ESRD patients starting haemodialysis between 1998 and 2005; follow-up was until September 2006. A total of 325 patients were studied. Novel ECG variables characterizing repolarization and the T-wave loop were analysed. RESULTS Of 325 patients with technically analysable data, 154 (47.4%) died after a mean follow-up of 25.5+/-21.7 months. Direct comparison between cardiovascular death and non-cardiovascular death patients showed that the relative T-wave residuum (TWR) predicted cardiovascular mortality (0.20+/-0.21% vs 0.24+/-0.17%, P=0.005). In Cox modeling, relative TWR was an independent predictor of cardiovascular [relative risk (RR)=1.86; P=0.013] and arrhythmia-related mortality (RR=2.102; P=0.012). CONCLUSIONS The heterogeneity of myocardial repolarization, measured by the relative T-wave residuum in the ECG, appears to be an independent predictor of cardiovascular and arrhythmia-related mortality in patients initiating haemodialysis.