Key result
Terminal T wave angle (cutoff 66.20°) predicted hyperkalemia in CKD patients with 67.3% sensitivity and 73.8% specificity, outperforming the initial T wave angle.
Why the study?
The universal definition of peaked T waves for detecting fatal hyperkalemia in CKD remains unclear, with low sensitivity and specificity.
Do initial and terminal T wave angles on ECG predict hyperkalemia in adult hospitalized CKD patients?
Cross-Sectional (n=220)
No
Do initial and terminal T wave angles on ECG predict hyperkalemia in adult hospitalized CKD patients?
Terminal T wave angle on ECG may serve as a useful non-invasive indicator for detecting hyperkalemia in hospitalized CKD patients.
Answers are grounded in this paper and cite their sources.
May support ECG screening for hyperkalemia in CKD; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity. AIM: This study aims to determine the predictive value of initial and terminal T wave angle in detecting hyperkalemia among CKD patients. METHODS: A cross-sectional study was conducted at Dr. Soetomo General Hospital, including all adult hospitalized CKD patients. A caliper was used to measure T wave morphology. The initial deflection angle (Tia) and terminal deflection angle (Tta) were calculated from an arctan of T peak amplitude and the respective initial or terminal length. The receiver operating characteristics (ROC) curve was analyzed to determine the area under the curve (AUC) and optimal cutoff. RESULTS: A total of 220 CKD patients were enrolled in this study, with 98 patients with hyperkalemia (potassium >5.0). The majority of the patients were male, with a mean age of 51.12 ± 12.58 years. Ti-Tp duration, Tp-Tt duration, Tia, Tta, and Tp amplitude were significantly higher in the hyperkalemia group (all p < 0.05). A Spearman correlation analysis demonstrated a significant positive correlation of Tia (r = 0.346 and p < 0.001) and Tta (r = 0.445 and p < 0.001) with potassium levels in the participants. The optimal cutoff angle for Tta was 66.20° (sensitivity = 67.3% and specificity = 73.8%) and Tia was 61.07° (sensitivity = 66.3% and specificity = 69.7%). CONCLUSION: The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.
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Mulia et al. (2022) conducted a cross-sectional in Chronic kidney disease with hyperkalemia (n=220). Initial and terminal T wave angle measurement was evaluated on Detection of hyperkalemia (potassium >5.0) (r 0.445, p=<0.001). Terminal T wave angle (cutoff 66.20°) predicted hyperkalemia in CKD patients with 67.3% sensitivity and 73.8% specificity, outperforming the initial T wave angle.
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