The prognostic value of electrocardiographic estimation of left ventricular hypertrophy in dialysis patients

Adrian C Covic, Laura-Dumitriţa Buimistriuc, Darren Green, Alina Stefan, Silvia Badarau, Philip A Kalra

    Research output: Contribution to journalArticlepeer-review


    BACKGROUND: Left ventricular hypertrophy (LVH) is associated with poor cardiovascular outcome in CKD. Electrocardiogram (ECG) is low-cost but infrequently used to assess presence of LVH in dialysis patients. The aim of this study was to establish which ECG-determined LVH method is most sensitive in dialysis patients, and also most predictive of death.

    METHODS: This was a longitudinal observational study in dialysis patients from a single center, undergoing interval ECGs. Fourteen methods of ECG LVH assessment were compared. Survival was also compared between four LVH evolutionary categories: persistent LVH; new LVH; LVH regression; and no LVH.

    RESULTS: The study included 418 dialysis patients (46.3% women, mean age 51 years, mean follow up 67 months, 76 deaths, 37 cardiovascular deaths). LVH prevalence varied according to method (range 13.4-41.9%). No measurement predicted all-cause mortality. After Cox regression, there was an independent association between LVH and cardiovascular mortality using Novacode (HR = 3.04; 95% [CI] = 1.11-8.28, P < 0.05), but not with other methods. Patients with persistent ECG changes of LVH had increased risk of cardiovascular mortality compared to other LVH evolutionary categories (P < 0.044).

    CONCLUSIONS: ECG scoring of LVH can be predictive of cardiovascular mortality. The Novacode method, based on repolarization abnormalities, is a better predictor than standard ECG techniques that are based on voltage criteria. Novacode LVH estimation at dialysis initiation may prove to be a noninvasive and cost-effective bedside tool for cardiovascular risk stratification in patients receiving dialysis.

    Original languageEnglish
    Pages (from-to)188-98
    Number of pages11
    JournalAnnals of Noninvasive Electrocardiology
    Issue number2
    Publication statusPublished - Mar 2013


    • Adult
    • Aged
    • Cohort Studies
    • Electrocardiography
    • Female
    • Humans
    • Hypertrophy, Left Ventricular
    • Longitudinal Studies
    • Male
    • Middle Aged
    • Predictive Value of Tests
    • Prognosis
    • Renal Dialysis
    • Renal Insufficiency, Chronic
    • Retrospective Studies
    • Risk Factors
    • Sensitivity and Specificity
    • Survival Analysis
    • Journal Article


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