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.

Center for Health and Bioresources Biomedical Systems AIT Austrian Institute of Technology GmbH Vienna Austria

Department of Cardiology Munich University Clinic DZHK Ludwig Maximilians University Munich Germany

Department of Internal Medicine and Cardiology Faculty of Medicine Masaryk University Brno Czech Republic

Department of Nephrology School of Medicine Klinikum Rechts der Isar Technical University of Munich Munich Germany

Department of Nephrology University of Erlangen Nürnberg Erlangen Germany

Institute of Medical Informatics Statistics and Epidemiology School of Medicine Klinikum Rechts der Isar Technische Universität München Munich Germany

KfH Kidney Center Munich Isoldenstraße 15 Munich Germany

Klinik für Innere Medizin 4 Schwerpunkt Nephrologie und Hypertensiologie Klinikum Nürnberg Nuremberg Germany

National Heart and Lung Institute Imperial College London London UK

Nephrocare München Ost Rosenkavalierplatz 5 Munich Germany

School of Medicine Klinik für Innere Medizin 1 Klinikum Rechts der Isar Technical University of Munich Munich Germany

Transplant Center University Hospital Munich Ludwig Maximillians University Munich Germany

TUM Medical Education Center School of Medicine Technical University of Munich Munich Germany

University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

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