ArticleKidney research and clinical practice2026
Lead augmented vector right T wave and elevated E/e' ratio identify hemodialysis patients at high cardiovascular risk.
Article in Kidney research and clinical practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study was performed to evaluate the prognostic utility of a positive T wave in lead augmented vector right (TaVR) and elevated E/e' ratio in predicting major adverse cardiovascular events (MACE) in patients receiving maintenance hemodialysis.
methodsWe retrospectively examined 296 adults on thrice-weekly hemodialysis with baseline electrocardiography and transthoracic echocardiography (October 2018-April 2024). TaVR positivity was T-wave amplitude, >0 mV and high E/e', ≥19. Primary outcome was the first MACE-cardiovascular death, myocardial infarction, stroke, heart-failure admission, or revascularization. Multivariable Cox models adjusted for clinical covariates; incremental value was gauged with Harrell's C-index, integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI). Sensitivity analysis was performed using a guideline-recommended E/e' threshold of ≥15 to assess robustness.
resultsOver 56.5 months (1,325 patient-years), 118 MACE occurred (8.9/100 patient-years). Incidence was higher with TaVR positivity than negativity (16.0/100 patient-years vs. 3.7/100 patient-years; log-rank p < 0.001). Adjusted hazard ratios were 3.19 (95% confidence interval [CI], 2.00-5.08) for TaVR and 2.92 (95% CI, 1.71-4.96) for high E/e'. Adding both markers to the clinical model increased the C-index from 0.65 to 0.75 (Δ 0.10) and improved IDI (0.10) and NRI (0.16) (all p < 0.01). A significant negative interaction (hazard ratio, 0.21; p = 0.01) indicated complementary but partly overlapping information. Sensitivity results were similar.
conclusionTaVR positivity is a strong independent electrocardiography predictor of cardiovascular events in hemodialysis. Combining TaVR with E/e' adds prognostic value and supports a pragmatic two-step strategy- electrocardiography triage followed by focused echocardiography-for cardiovascular risk stratification in this high-risk population.
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