The correlation between heart rate variability and the voltage left ventricular mapping in patients with and without CKD

The correlation between heart rate variability and the voltage left ventricular mapping in patients with and without CKD Recently, we observed that patients with CKD stage 4 seem to be more susceptible to ventricular arrhythmias than patients without CKD, due to a larger absence of voltage in the left ventricular walls of the first ones [1].In agreement with previous studies, Carreira and colleagues [2] reported that heart rate variability (HRV) in the 24-h Holter was lower in patients with end stage of renal disease (ESRD) denoting impaired autonomic function [3][4][5][6][7].Kidney disease induces cardiac remodeling including left ventricular hypertrophy (LVH) and heart fibrosis.Several clinical studies, including those who recruited participants with mild-to-moderate reduction in estimated glomerular filtration rate (eGFR), showed an independent association between CKD and LVH [8][9][10][11].Specifically, there is a progressive increase in the prevalence of LVH, and left ventricular mass increased when the eGFR decreases.Also, among participants with more advanced kidney disease on dialysis, magnetic resonance imaging (MRI) with contrast demonstrates a diffuse pattern image with gadolinium uptake suggestive of fibrosis and non-ischemic cardiomyopathy [12].These structural changes in cardiac conduction delay ventricular activation and create late potentials in the terminal portion of the QRS complex.Furthermore, these low amplitude signals, which may be detected using a high-resolution electrocardiogram, were identified in 25% of patients on dialysis [13].According to Brotman and colleagues in their study, time and frequency domain measures were similarly and significantly associated with ESRD and CKD-related hospitalizations, suggesting that autonomic dysfunction may be an important risk factor for ESRD and CKD-related hospitalizations [14].Based on this information we aimed to correlate the LV voltage mapping and the HRV.