Electrocardiographic versus echocardiographic predictors of heart failure with preserved ejection fraction in patients on renal replacement therapy

Background: While heart failure with preserved ejection fraction (HFpEF) is prevalent among patients on renal replacement therapy (RRT), predictors of HFpEF are not fully identified. In this prospective study, we assessed electrocardiographic (ECG) and echocardiographic predictors of HFpEF in patients on RRT. Methods: A total of 83 consecutive RRT patients with ejection fraction ≥50% (mean age 61±13 years, 43% female, 88% on hemodialysis) underwent 12-lead ECG, including Sokolow-Lyon product (SLP) calculation, as well as comprehensive echocardiography with guideline-recommended diastolic function assessment. Results: HFpEF was diagnosed in 20% of patients who had significantly higher values of SLP. Normal and indeterminate diastolic function was detected in 18% and 41% of patients with HFpEF, respectively. SLP showed moderately strong correlations with left ventricular mass index (r=0.39, p<0.001), left atrial volume index (r=0.46, p<0.001), mitral E/e' ratio (r=0.39, p<0.001), and maximal tricuspid regurgitation velocity (r=0.47, p<0.001). Patients with diastolic dysfunction (2311±787 mm/ms) and indeterminate diastolic function (2198±933 mm/ms) had higher values of SLP than those with normal diastolic function (1575±675 mm/ms, p=0.001). With a cutoff value of 2038 mm/mV, SLP showed a good sensitivity (77%) and specificity (70%) for identifying HFpEF. In multivariate analysis, only SLP [odds ratio (OR) 1.001, 95% confidence interval (CI) 1.000-1.002, p=0.030] and coronary artery disease (OR 33.091, 95% CI 4.097 -267.266, p<0.001) remained independently associated with HFpEF. Conclusions: SLP is associated with structural and functional cardiac abnormalities in HFpEF patients on RRT. This simple ECG marker is associated with HFpEF and may complement echocardiographic assessment in patients on RRT.