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

Nephrol Dial Transplant. 2007 Sep;22(9):2645-52. doi: 10.1093/ndt/gfm238. Epub 2007 Apr 23.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Demography
  • Electrocardiography / methods*
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / mortality
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Renal Dialysis*
  • Time Factors