Document Detail

Heart rate as independent prognostic factor for mortality in normotensive hemodialysed patients.
MedLine Citation:
PMID:  18949725     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several epidemiological studies have reported heart rate (HR) as a predictor of cardiovascular and noncardiovascular mortality in the general population. Aim of the present study was to investigate a possible relation between increased HR and mortality in normotensive end-stage renal disease (ERSD) patients. METHODS: Between 1997 and 2001 we recruited 407 normotensive ESRD patients (mean age 56.6 +/- 3.3 years) without coronary artery disease, left ventricular systolic dysfunction or on antiarrhythmic therapy. Baseline electrocardiography (ECG) at rest, 48-hour ambulatory Holter ECG monitoring and standard echocardiography were performed. After a mean follow-up of 46 months (range 12-60 months), cardiovascular and sudden death were considered as end points. RESULTS: Echocardiogram showed a normal left ventricular ejection fraction (>55%) in 370 patients (91%) and left ventricular hypertrophy (LVH) in 290 patients (71.2%). Mean HR by 48-hour Holter ECG was 81 +/- 10.6 bpm. During the follow-up, all-cause mortality rate was 12% (49 patients); 40 patients died from cardiac cause (9.8%) of which 20 patients (4.9%) by sudden death. By univariate analysis, age, diabetes, ECG-LVH with signs of left ventricular strain, and increased mean HR by 48-hour Holter ECG were all significantly related to global, cardiovascular and sudden death. ROC curve analysis identified optimal cutoff points for HR >85 bpm and age >65 years associated with increased cardiovascular risk (p<0.001). By Cox regression analysis, only age >65 years (p<0.0001) and mean HR >85 bpm (p<0.0001) were independent predictors of cardiovascular events. CONCLUSIONS: In normotensive ERSD patients, increased mean HR detected by 48-hour Holter ECG is an independent determinant of global and cardiovascular mortality.
Gennaro Cice; Attilio Di Benedetto; Antonello D'Andrea; Salvatore D'Isa; Paola De Gregorio; Daniele Marcelli; Emanuele Gatti; Raffaele Calabrò
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nephrology     Volume:  21     ISSN:  1121-8428     ISO Abbreviation:  J. Nephrol.     Publication Date:    2008 Sep-Oct
Date Detail:
Created Date:  2008-10-24     Completed Date:  2009-03-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  704-12     Citation Subset:  IM    
Department of Cardiology, Second University of Naples, Naples - Italy.
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MeSH Terms
Blood Pressure*
Cardiovascular Diseases / diagnosis,  mortality*
Cause of Death
Death, Sudden
Electrocardiography, Ambulatory
Heart Rate*
Kidney Failure, Chronic / physiopathology*,  therapy
Middle Aged
Renal Dialysis*
Stroke Volume
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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