#2496 association of abnormalities in electrocardiography and echocardiography with the occurrence of cardiovascular disease in chronic kidney disease

Abstract Background and Aims In chronic kidney disease (CKD), the incidence of cardiovascular disease (CVD) increases along with CKD progression. Although coronary artery disease (CAD) is one of the most critical CVDs, it is difficult to identify CAD because its symptom is usually atypical in CKD. Consequently, appropriate screening tests for CVD are important in this population. Electrocardiography (ECG) and transthoracic echocardiography (TTE) are commonly performed in daily clinical practice, and we researched whether these abnormalities are risk factors for CVD including CAD in patients with advanced CKD. Method This study included patients with CKD stage G4-5 who were admitted to our hospital from 2010 to 2019. Depending on the presence of ECG and/or TTE-indicated abnormalities, the study patients were divided into four groups: those without both ECG and TTE abnormalities (group A: ECG-, TTE-), those with only ECG abnormalities (group B: ECG+, TTE-), those with only TTE abnormalities (group C: ECG-, TTE+), and those with both ECG and TTE abnormalities (group D: ECG+, TTE+). The clinical characteristics, the occurrence of CVD events, their prognosis, and the prevalence of positive screening tests for CAD were compared among the four groups. CVD events were defined as CVD death and non-fatal CVD events. Results The number of study patients was 607, and they were divided into four groups as follows: 333 in group A, 106 in group B, 76 in group C, and 92 in group D, respectively. The median observational period was 21 months. The incidence of CVD events was highest in group D: 45 patients (13.5%) in group A, 25 patients (23.6%) in group B, 19 patients (25.0%) in group C, and 37 patients (40.2%) in group D, respectively. Multivariate analysis showed that the hazard ratios (HR) for CVD events was significantly higher in group C and D compared to group A as reference (HR: 1.620 in group B, p = 0.116; HR: 2.848 in group C, p = 0.001, and 4.111 in group D, p<0.001, respectively). Furthermore, group D had a higher positive rate of screening tests for CAD compared to the other three groups. Conclusion In patients with advanced CKD, ECG and TTE abnormalities were significantly associated with the occurrence of CVD events. Additionally, those with both ECG and TTE abnormalities may be at high risk for the presence of CAD.