Abstract: FR-PO0397
Lead aVR T Wave Predicts Cardiovascular Events in Patients Receiving Hemodialysis: Enhanced Risk Stratification Using the E/e′ Ratio
Session Information
- Dialysis: Measuring and Managing Symptoms and Syndromes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Shin, Dong Ho, Kangdong Sacred Heart Hospital, Gangdong-gu, Seoul, Korea (the Republic of)
- Han, In Mee, Yonsei Hanmaeum Internal Medicine Clinic, Seoul, Korea (the Republic of)
- Park, Juyeon, Kangdong Sacred Heart Hospital, Gangdong-gu, Seoul, Korea (the Republic of)
Background
Positive T wave in lead aVR (positive TaVR) has predicted cardiovascular events in non-dialysis cohorts, but its value in hemodialysis remains uncertain. We assessed the prognostic significance of positive TaVR and tested whether adding the echocardiographic E/e′—an indicator of diastolic load—improves risk stratification for major adverse cardiovascular events (MACE).
Methods
We performed a single-center retrospective study of 296 adult patients receiving hemodialysis who had interpretable baseline 12-lead ECG and transthoracic echocardiography (October 2018 – April 2024). Positive TaVR was defined as T-wave amplitude > 0 mV; high E/e′ as ≥ 19.0 (cohort median). The primary outcome was time to first MACE (cardiovascular death, nonfatal myocardial infarction or stroke, hospitalization for heart failure, or coronary revascularization). Multivariable Cox models and reclassification statistics (ΔC-index, IDI, continuous NRI) quantified incremental predictive value.
Results
Median age was 64 yr; 49.7 % were men; 37.5 % had positive TaVR. Over a median 56.5 months (1325 person-years), 118 MACE occurred (8.9/100 person-years). Incidence was higher with positive TaVR than negative TaVR (15.98 vs 3.70/100 person-years; P < 0.001). Positive TaVR independently predicted MACE (adjusted HR 3.31; 95 % CI, 2.09–5.26), as did high E/e′ (HR 2.55; 95 % CI, 1.56–4.17). Adding high E/e′ to the clinical base model raised the C-index from 0.65 to 0.71 (Δ 0.06; P < 0.001); adding positive TaVR increased it to 0.72 (Δ 0.07). The combination of positive TaVR and high E/e′ provided the greatest improvement (C-index 0.75; Δ 0.10; IDI 0.09; NRI 0.12; all P < 0.01).
Conclusion
Positive TaVR is a powerful, readily available predictor of cardiovascular events in hemodialysis. Integrating E/e′ with TaVR affords additive prognostic information, supporting a pragmatic two-step approach (ECG triage followed by focused echocardiography) for risk stratification in this high-risk population.