Electrocardiographic T-wave Parameters To Predict Prognosis In Patients With Type 4 Cardio-renal Syndrome

Objective: To investigate the role of ECG T-wave parameters in risk stratification and prognostic assessment of end-stage renal disease（ESRD）patients with cardiorenal syndrome type 4（CRS-4）,to clarify the predictive value of corrected QT interval（QTc）and the ratio of T-wave height to R-wave amplitude（T:R）for patient survival,to clarify whether QTc prolongation has a significant effect on patient survival,to determine whether T:R predicts patient all-cause The predictive value of T:R for predicting all-cause mortality and 1-year cardiovascular events,and to compare the predictive value of T-wave parameters when applied in combination.Methods: A retrospective collection of 144 patients with chronic kidney disease（CKD）clearly combined with type 4 cardiorenal syndrome who were hospitalized at the First Hospital of Jilin University from January 1,2018 to January 1,2021 and met the inclusion and exclusion criteria were followed up for a mean of 19.99 ± 9.78 months,with a follow-up deadline of December 31,2021.General information,past medical history and relevant test results were collected during the patients’ hospitalisation.The prognostic impact of ECG T-wave parameters（QTc and T:R）was assessed to determine whether they were independent risk factors for all-cause mortality and the occurrence of cardiovascular events,and to determine the threshold values for T:R to predict all-cause mortality and the occurrence of cardiovascular events at 1 year.Factors influencing the prolongation of QTc in patients and associated with T:R in the inferior wall leads were also assessed.Results and conclusions: 1.In ESRD patients with CRS-4,the prognosis was significantly worse in patients with prolonged QTc compared with those with normal QTc.2.In multivariate analysis age and QTc were independent predictors of the presence of all-cause mortality in ESRD patients with CRS-4,with age being the strongest independent predictor.3.Prolonged QTc interval and inferior wall lead T:R>0.4 were associated with a higher risk of all-cause mortality in ESRD patients with CRS-4 when present together.4.The presence of prolonged QTc in CRS-4 patients is positively correlated with triglycerides（TG）,total cholesterol（TC）,myoglobin,troponin I（c Tn I）,and B-type natriuretic peptide precursor（pro-BNP）,with the strongest positive correlation with c Tn I.5.Increased T:R in the inferior wall leads is an independent risk factor for cardiovascular events at 1 year in patients with CRS-4,with a critical value of 0.295 for predicting the occurrence of cardiovascular events at 1 year.6.In patients with CRS-4,inferior wall lead T:R has a positive correlation with left ventricular ejection fraction（LVEF）and a negative correlation with TG and serum calcium ions.Higher inferior wall lead T:R was present in male CRS-4 patients than in female CRS-4patients.