Abstract English: Objective: The thesis aimed to assess the structural and functional abnormalities of the heart, employing electrocardiography, in patients afflicted with chronic kidney disease (CKD) who are receiving maintenance hemodialysis and have experienced a major adverse cardiac event (MACE) subsequent to the commencement of renal replacement therapy (RRT). This chosen cohort was then compared with a second cohort of comparable size and overall characteristics, except for the absence of major adverse cardiac events (MACE) in the latter group. Methods: Our study involved a retrospective observation of the electrocardiograms (ECGs) of the patients at two distinct time intervals. Firstly, we evaluated the earliest ECG obtained after the initiation of renal replacement therapy (RRT) [T0]. Subsequently, we examined the last ECG obtained prior to the occurrence of the major adverse cardiac event (MACE) [T1]. By adopting this approach, we were able to gauge the progression of ECG parameter abnormalities that are widely acknowledged to be linked with increased morbidity and mortality, with the ultimate objective being to assess the correlation between these ECG markers and the incidence of MACE and mortality. Results: The T/R ratio stands out as the only parameter consistently predicting an increased risk of experiencing a MACE at both T0 and T1. P wave dispersion (PWD) and T peak to end (Tpe) increased the MACE risk at T0, while QT dispersion increased the MACE risk at T1. Conclusions: This study shows evidence that an elevated T:R ratio, particularly in inferior ECG leads, in ESRD patients undergoing hemodialysis can predict the occurrence of MACE.
Abstract Italiano: Obiettivo: La tesi aveva lo scopo di valutare le anomalie strutturali e funzionali del cuore, utilizzando l'elettrocardiografia, nei pazienti affetti da malattia renale cronica (CKD) che ricevono emodialisi di mantenimento e hanno subito un evento cardiaco avverso maggiore (MACE) successivo all'inizio della terapia di sostituzione renale (RRT). Questa coorte selezionata è stata poi confrontata con una seconda coorte di dimensioni e caratteristiche complessive simili, ad eccezione dell'assenza di eventi cardiaci avversi maggiori (MACE) nel secondo gruppo. Metodi: Il nostro studio ha coinvolto un'osservazione retrospettiva degli elettrocardiogrammi (ECG) dei pazienti in due intervalli di tempo distinti. In primo luogo, abbiamo valutato il primo ECG ottenuto dopo l'inizio della terapia di sostituzione renale (RRT) [T0]. Successivamente, abbiamo esaminato l'ultimo ECG ottenuto prima dell'evento cardiaco avverso maggiore (MACE) [T1]. Adottando questo approccio, siamo stati in grado di valutare la progressione delle anomalie dei parametri dell'ECG che sono ampiamente riconosciute come correlate a un aumento della morbilità e della mortalità, con l'obiettivo finale di valutare la correlazione tra questi marcatori dell'ECG e l'incidenza di MACE e mortalità. Risultati: Il T/R ratio spicca come unico parametro che predice costantemente un aumento del rischio di esperienza di MACE sia a T0 che a T1. La P wave dispersion (PWD) e T peak to end (Tpe) aumentano il rischio di MACE a T0, mentre la QT dispersion aumenta il rischio di MACE a T1. Conclusioni: Questo studio mostra evidenze che un T:R ratio elevato, in particolare nelle derivazioni inferiori dell'ECG, nei pazienti affetti da insufficienza renale in stadio terminale sottoposti ad emodialisi può predire l'insorgenza di MACE.
CARDIOVASCULAR EVENTS IN HEMODIALYSIS: THE VALUE OF NON-INVASIVE ELECTROPHYSIOLOGY
BASSIL, DAVID
2022/2023
Abstract
Abstract English: Objective: The thesis aimed to assess the structural and functional abnormalities of the heart, employing electrocardiography, in patients afflicted with chronic kidney disease (CKD) who are receiving maintenance hemodialysis and have experienced a major adverse cardiac event (MACE) subsequent to the commencement of renal replacement therapy (RRT). This chosen cohort was then compared with a second cohort of comparable size and overall characteristics, except for the absence of major adverse cardiac events (MACE) in the latter group. Methods: Our study involved a retrospective observation of the electrocardiograms (ECGs) of the patients at two distinct time intervals. Firstly, we evaluated the earliest ECG obtained after the initiation of renal replacement therapy (RRT) [T0]. Subsequently, we examined the last ECG obtained prior to the occurrence of the major adverse cardiac event (MACE) [T1]. By adopting this approach, we were able to gauge the progression of ECG parameter abnormalities that are widely acknowledged to be linked with increased morbidity and mortality, with the ultimate objective being to assess the correlation between these ECG markers and the incidence of MACE and mortality. Results: The T/R ratio stands out as the only parameter consistently predicting an increased risk of experiencing a MACE at both T0 and T1. P wave dispersion (PWD) and T peak to end (Tpe) increased the MACE risk at T0, while QT dispersion increased the MACE risk at T1. Conclusions: This study shows evidence that an elevated T:R ratio, particularly in inferior ECG leads, in ESRD patients undergoing hemodialysis can predict the occurrence of MACE.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/16052