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Colluoglu T, Aksu MH, Akın Y, Onalan O. Combined use of frontal plane QRS-T angle and platelet-to-lymphocyte ratio in the risk prediction of ischemic cardiomyopathy in STEMI. Ann Noninvasive Electrocardiol 2024; 29:e13106. [PMID: 38288513 PMCID: PMC10801668 DOI: 10.1111/anec.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/09/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Frontal plane QRS-T angle (fQRS-T) and platelet-to-lymphocyte ratio (PLR) are highly important parameters that well-predict unfavorable outcomes in patients with ST-elevated myocardial infarction (STEMI).There are limited data on the predictive significance of ischemic cardiomyopathy (I-CMP) from the combination of fQRS-T and PLR in STEMI, compared to using fQRS-T and PLR alone. AIM We aimed to evaluate the ability of the combination of fQRS-T and PLR routinely obtained on admission to identify STEMI patients at risk of I-CMP. METHOD Six hundred and thirty-eight consecutive patients with STEMI who underwent primary percutaneous coronary intervention between 2018 and 2021 were included. The assessment of I-CMP was conducted through two-dimentional (2D)-echocardiography 6 weeks post-STEMI and I-CMP was defined as a left ventricular ejection fraction (LVEF) of 50% or less. Multivariate logistic regression analysis and receiver operating curve (ROC) analysis were performed to predict the development of I-CMP. RESULTS In ROC analysis, the cut-off values of fQRS-T and PLR for best predicting I-CMP were 66.72° and 101.23, respectively. The model using the combination of two markers was the most powerful predictor of I-CMP risk (OR: 3.183, 95% CI: 1.971-5.139, p = .001) when included in a single variable such as high fQRS-T or high PLR (OR: 1.422, 95% CI: 0.870-0.232, p = .160). Additionally, the concomitant presence of high fQRS-T and high PLR exhibited the highest specificity (77%) for I-CMP relative to the individual presence of high fQRS-T (66%) or PLR (49%). CONCLUSION The combination of fQRS-T and PLR, which is a simple and cost-effective risk assessment, may serve as a more reliable prognosticator for I-CMP as opposed to the use of fQRS-T and PLR alone for STEMI.
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Affiliation(s)
- Tugce Colluoglu
- Department of Cardiology, Faculty of Medicine, Karabuk UniversityKarabukTurkey
| | - Melahat Hicran Aksu
- Department of Cardiology, Faculty of Medicine, Karabuk UniversityKarabukTurkey
| | - Yesim Akın
- Department of Cardiology, Faculty of Medicine, Karabuk UniversityKarabukTurkey
| | - Orhan Onalan
- Department of Cardiology, Faculty of Medicine, Karabuk UniversityKarabukTurkey
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Munyombwe T, Dondo TB, Hall M, Nadarajah R, Hurdus B, Aktaa S, Haris M, Keeley A, West R, Hall A, Soloveva A, Norman P, Gale CP. Cohort profile: Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) Longitudinal Cohort. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:442-446. [PMID: 37451698 PMCID: PMC10405135 DOI: 10.1093/ehjqcco/qcad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
AIMS The Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) longitudinal cohort study aims to investigate health trajectories of individuals following hospitalization for myocardial infarction (MI). METHODS AND RESULTS EMMACE is a linked multicentre prospective cohort study of 14 899 patients with MI admitted to 77 hospitals in England who participated in the EMMACE-3 and -4 studies between 1st November 2011 and 24th June 2015. Long-term follow-up of the EMMACE cohorts was conducted through the EMMACE-XL (27th September 2020 to 31st March 2022) and EMMACE-XXL (1st July 2021 to 1st July 2023) studies. EMMACE collected individual participant data for health-related quality of life (HRQoL) measured by three-level EuroQol five-dimension and visual analogy scale at admission, 1 month, 6 months, 12 months, and 10 years follow-up, as well as medications, medication adherence, beliefs about medicines, Satisfaction with Information about Medicines Scale, and illness perceptions. Participant data were deterministically linked to the Myocardial Infarction National Audit Project (MINAP) for information on baseline treatments and comorbidities, Hospital Episode Statistics Admitted Patient Care (for cause-specific hospitalization data), and the Office for National Statistics (for mortality data) up to 2020. CONCLUSION EMMACE is a nationwide prospective cohort that will provide unique insights into fatal and non-fatal outcomes, medication adherence, and HRQoL following MI.Trial registration: ClinicalTrials.gov NCT01808027 and NCT01819103.
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Affiliation(s)
- Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Tatendashe B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Ramesh Nadarajah
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Ben Hurdus
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Mohammad Haris
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Adam Keeley
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT Leeds, UK
| | - Alistair Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, 2 Akkuratova street, Saint Petersburg 197341, Russian
| | - Paul Norman
- School of Geography, University of Leeds, LS2 9JT Leeds, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Ozgul U, Turan OE, Baskurt AA, Yilancioglu RY, Dogdus M, Inevi UD, Ozcan EE. The predictive value of electrocardiographic polarization parameters on appropriate ICD shock in primary prevention heart failure patients. J Electrocardiol 2023; 77:80-84. [PMID: 36347655 DOI: 10.1016/j.jelectrocard.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECT The effect of frontal QRS-T angle, Tp-e and Tp-e/QT ratio on cardiac events have been shown in many studies. In this study, we aimed to determine the prognostic value of frontal QRS-T angle, TPe and Tp-e/QT ratio on ICD shock in patients who had ICD (Implantable Cardioverter Defibrillator) implanted due to heart failure with reduced ejection fraction (HFrEF). MATERIAL AND METHOD 158 patients with HFrEF who had previous ICD implantation were retrospectively analyzed. 27 patients were found to have an appropriate shock. Frontal QRS-T angle, Tp-e interval, Tp-e/QT ratio were calculated by evaluating the basal ECG records of the patients. Comparisons of these arrhythmogenic predictors were made in patients with and without ICD shock at follow-up. RESULT When 158 patients with previous ICD implantation were analyzed in two groups with and without ICD shock, the number of patients with frontal QRS-T angle >120°, Tp-e interval > 105 ms, Tp-e/QT > 0.2 in the shock group (n: 27) was found to be high with a different significance (p:<0.01, p:<0.01, p:<0.01). There was no significant difference between the two groups regarding other ECG parameters such as QRS duration, QT interval, PR interval, fragmented QRS and positive T wave. In addition, more amiodarone use was observed in the shock group, and more hyperlipidemia cases were observed in the non-shocked group (p:0.01; p:<0.01). CONCLUSION Increased frontal QRS-T angle, Tp-e interval, and Tp-e/QT ratio are arrhythmogenic parameters and predict appropriate ICD shock.
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Affiliation(s)
- Ufuk Ozgul
- Aydin Ataturk State Hospital, Department of Cardiology, Aydin, Turkey.
| | - Oguzhan Ekrem Turan
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey
| | - Ahmet Anil Baskurt
- Dokuz Eylul University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | | | - Mustafa Dogdus
- Usak University, Training and Research Hospital, Department of Cardiology, Usak, Turkey
| | | | - Emin Evren Ozcan
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey
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Böyük F, Çalışkan S, Demirkıran A. The Relationship Between the Frontal QRS-T Angle and High Blood Pressure Response to Exercise. ISTANBUL MEDICAL JOURNAL 2023. [DOI: 10.4274/imj.galenos.2023.70846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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Muacevic A, Adler JR. The Importance of Frontal QRS-T Angle in Predicting the Effectiveness and Success of Thrombolytic Therapy in Patients With Acute Pulmonary Embolism. Cureus 2023; 15:e33268. [PMID: 36741663 PMCID: PMC9891712 DOI: 10.7759/cureus.33268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The frontal QRS-T angle (fQRS-T) is associated with myocardial ischemia and ventricular arrhythmias. On the other hand, acute pulmonary embolism (APE) is a major risk factor for cardiac adverse events. This research aimed to determine whether the fQRS-T, a marker of ventricular heterogeneity, can be used to predict successful thrombolytic therapy in patients with APE. METHODS This was a retrospective observational study. Patients diagnosed with APE and hospitalized in the intensive care unit between 2020 and 2022 were included in the research. A total of 136 individuals with APEs were enrolled in this research. The patients were divided into two groups: thrombolytic-treated (n=64) and non-treated (moderate to severe risk, n=72). An ECG was conducted for each patient, and echocardiography was performed. RESULTS The mean age of the thrombolytic group was 58.2±17.6 years, with 35 females (55.1% of the group) and 29 males (44.9%). The non-thrombolytic group had a mean age of 63.1±16.2, with 41 females (56.5%) and 31 males (43.5%). Respiratory rate, heart rate, and fQRS-T were higher in the thrombolytic group, and oxygen saturation ratio and systolic and diastolic blood pressure were higher in the non-thrombolytic group (p=0.006, p<0.001, p=0.021; p<0.001, p=0.015, p<0.001, respectively). In the thrombolytic therapy group, comparing pre- and post-treatment ECG data revealed a statistically significant change in the fQRS-T value (p=0.019). CONCLUSION The fQRS-T may provide important clues for the successful treatment of APEs.
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Tascanov MB, Tanriverdi Z, Gungoren F, Tapar GG, Bicer A. The relationship between myocardial bridge and frontal QRS-T angle. J Arrhythm 2022; 38:772-777. [PMID: 36237851 PMCID: PMC9535755 DOI: 10.1002/joa3.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Aim Although Myocardial bridge (MB) is known as a benign condition, it has been demonstrated to be associated with cardiac arrhythmias and poor outcomes. Frontal QRS-T angle (fQRSTa) is a novel indicator of repolarization and depolarization heterogeneity. Last studies indicated that associated with fQRSTa and adverse cardiac events. No study evaluated the relationship between fQRSTa and MB. In the present study, we aimed to investigate the relationship between MB and fQRSTa. Methods This study included 91 patients with normal coronary arteries and 89 patients with MB. Coronary angiography was performed in all patients due to ischemia findings on treadmill exercise test or myocardial scintigraphy.2-lead surface electrocardiograms (ECGs) of all patients were evaluated. QT interval, fQRSTa, QTc interval were measured from surface ECGs. Results Baseline clinical, echocardiographic and laboratory parameters were similar between MB and control group. However, when compared to control group, patients with MB had importantly raised fQRSTa [27 (20-41) vs. 23 (12-37) p = 0.007]. In correlation analysis, fQRSTa was positively correlated with MB length (r = 0.411, p < 0.001). Linear regression analysis showed that MB length was the just considerable predictor of fQRSTa (β = 0.247, p = 0.041). Conclusions The fQRSTa is a novel electrocardiographic marker that can be easily obtained from surface ECG. We have shown for the first time that MB length is a significant predictor of fQRSTa.
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Affiliation(s)
| | - Zulkif Tanriverdi
- Faculty of Medicine, SanliurfaDepartment of CardiologyHarran UniversityTurkey
| | - Fatih Gungoren
- Faculty of Medicine, SanliurfaDepartment of CardiologyHarran UniversityTurkey
| | | | - Asuman Bicer
- Faculty of Medicine, SanliurfaDepartment of CardiologyHarran UniversityTurkey
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Andršová I, Hnatkova K, Toman O, Šišáková M, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Intra-subject stability of different expressions of spatial QRS-T angle and their relationship to heart rate. Front Physiol 2022; 13:939633. [DOI: 10.3389/fphys.2022.939633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Three-dimensional angle between the QRS complex and T wave vectors is a known powerful cardiovascular risk predictor. Nevertheless, several physiological properties of the angle are unknown or poorly understood. These include, among others, intra-subject profiles and stability of the angle relationship to heart rate, characteristics of angle/heart-rate hysteresis, and the changes of these characteristics with different modes of QRS-T angle calculation. These characteristics were investigated in long-term 12-lead Holter recordings of 523 healthy volunteers (259 females). Three different algorithmic methods for the angle computation were based on maximal vector magnitude of QRS and T wave loops, areas under the QRS complex and T wave curvatures in orthogonal leads, and weighted integration of all QRS and T wave vectors moving around the respective 3-dimensional loops. These methods were applied to orthogonal leads derived either by a uniform conversion matrix or by singular value decomposition (SVD) of the original 12-lead ECG, giving 6 possible ways of expressing the angle. Heart rate hysteresis was assessed using the exponential decay models. All these methods were used to measure the angle in 659,313 representative waveforms of individual 10-s ECG samples and in 7,350,733 individual beats contained in the same 10-s samples. With all measurement methods, the measured angles fitted second-degree polynomial regressions to the underlying heart rate. Independent of the measurement method, the angles were found significantly narrower in females (p < 0.00001) with the differences to males between 10o and 20o, suggesting that in future risk-assessment studies, different angle dichotomies are needed for both sexes. The integrative method combined with SVD leads showed the highest intra-subject reproducibility (p < 0.00001). No reproducible delay between heart rate changes and QRS-T angle changes was found. This was interpreted as a suggestion that the measurement of QRS-T angle might offer direct assessment of cardiac autonomic responsiveness at the ventricular level.
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8
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Tastan E, İnci Ü. The Relationship Between In-Hospital Mortality and Frontal QRS-T Angle in Patients With COVID-19. Cureus 2022; 14:e28506. [PMID: 36185844 PMCID: PMC9514156 DOI: 10.7759/cureus.28506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Recent studies have demonstrated that the frontal QRS-T angle, defined as the angle between the mean QRS and T vectors, is a strong independent predictor of mortality in patients with cardiovascular disease and in the normal population. In this study, we aimed to investigate the relationship between frontal QRS-T angle and in-hospital mortality in COVID-19 patients. Methods A total of consecutive 532 patients with positive polymerase chain reaction (PCR) tests were enrolled. The patients were divided into two groups as in-hospital mortality and survival groups. Frontal QRS-T angle was automatically calculated from the admission electrocardiography (ECG). Results The median age in the study population was 62 (49-72) years and 273 (51.4%) of the patients were male. The median frontal QRS-T angle was 40 degrees (20-67 IQR) in the in-hospital mortality group, while it was 27 (11-48 IQR) in the survival group (p=0.001). In multivariable logistic regression analysis, frontal QRS-T angle was found to be an independent predictor of mortality (Odds ratio (OR):1.01, 95% Confidence interval (CI):1.00-1.02, p=0.036). Conclusion Frontal QRS-T angle, which was observed wider in the in-hospital mortality group, was found to be associated with in-hospital mortality in patients hospitalized for COVID-19.
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9
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Gunduz R, Yildiz BS, Ozgur S, Ozen MB, Bakir EO, Ozdemir IH, Cetin N, Usalp S, Duman S. Frontal QRS/T angle can predict mortality in COVID-19 patients. Am J Emerg Med 2022; 58:66-72. [PMID: 35636045 PMCID: PMC9131483 DOI: 10.1016/j.ajem.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 10/27/2022] Open
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10
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Sakhnova TA, Blinova EV, Merkulova IN, Shakhnovich RM, Zhukova NS, Sukhinina TS, Barysheva NA, Staroverov II. [Factors associated with an increase in spatial and frontal QRS-T angles in patients with anterior myocardial infarction]. KARDIOLOGIIA 2021; 61:22-30. [PMID: 35057718 DOI: 10.18087/cardio.2021.12.n1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Aim To determine existence of a relationship between any clinical, echocardiographic and coronarographic factors and increased spatial QRS-T (sQRS-T) angle and frontal QRS-T (fQRS-T) angle in patients with anterior myocardial infarction.Material and methods This study included 137 patients aged 62 [53; 72] years with anterior acute myocardial infarction managed at the A.L. Myasnikov Institute of Clinical Cardiology. fQRS-T was calculated as the module of difference between the frontal plane QRS complex axis and the T wave axis. sQRS-T was calculated as a spatial angle between QRS and T integral vectors from a synthesized vectorcardiogram.Results fQRS-T values for a group (median [25th; 75th percentile]) were 81 [37; 120]°; sQRS-T values were 114 [80; 141]°. The correlation coefficient between fQRS-T and sQRS-T values was 0.41 (p<0.001). fQRS-T weakly but statistically significantly correlated with patients' age (r=0.28; p=0.001), left ventricular ejection fraction (LV EF, r= -0.22; p=0.01), and glomerular filtration rate (r=-0.32; p=0.0002). sQRS-T weakly but statistically significantly correlated with left ventricular end-diastolic dimension (r=0.24; p=0.0048), LV EF (r=-0.28; p=0.0009), and the number of affected segments according to echocardiography data (r=0.27; p=0.002). fQRS-T values were significantly higher in the presence of concurrent arterial hypertension. sQRS-T values were significantly higher in the presence of a history of chronic heart failure. Both fQRS-T and sQRS-T values increased with increasing number of affected blood vessels and Killip class of acute heart failure.Conclusion In patients after anterior acute myocardial infarction, increases in fQRS-T and sQRS-T are associated with more severe damage of the vasculature, decreased LV EF, and, thus, more severe clinical course of disease.
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Affiliation(s)
- T A Sakhnova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - E V Blinova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - I N Merkulova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - R M Shakhnovich
- National Medical Research Center of Cardiology, Moscow, Russia
| | - N S Zhukova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - T S Sukhinina
- National Medical Research Center of Cardiology, Moscow, Russia
| | - N A Barysheva
- National Medical Research Center of Cardiology, Moscow, Russia
| | - I I Staroverov
- National Medical Research Center of Cardiology, Moscow, Russia
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Tiller C, Reindl M, Reinstadler SJ, Klug G. The classical 12‑lead ECG: Much more to offer than just a diagnosis in STEMI? Int J Cardiol 2021; 349:29-30. [PMID: 34864076 DOI: 10.1016/j.ijcard.2021.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Christina Tiller
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria
| | - Martin Reindl
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria
| | - Gert Klug
- University Clinic for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria.
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Tekin YK, Tekin G, Nur N, Korkmaz İ, Yurtbay S. Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning. Hum Exp Toxicol 2021; 40:S583-S592. [PMID: 34818096 DOI: 10.1177/09603271211043477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. MATERIALS AND METHODS The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. RESULTS Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found (p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower (p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = -0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814-0.988, sensitivity: 87%, specificity: 84%). CONCLUSIONS The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.
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Affiliation(s)
- Yusuf K Tekin
- Faculty of Medicine, Department of Emergency Medicine, 63986Sivas Cumhuriyet University, Sivas, Turkey
| | - Gülaçan Tekin
- Faculty of Medicine, Department of Cardiology Medicine, 52954Sivas Cumhuriyet University, Sivas, Turkey
| | - Naim Nur
- Faculty of Medicine, Department of Public Health, 52954Sivas Cumhuriyet University, Sivas, Turkey
| | - İlhan Korkmaz
- Faculty of Medicine, Department of Emergency Medicine, 52954Sivas Cumhuriyet University, Sivas, Turkey
| | - Sefa Yurtbay
- Faculty of Medicine, Department of Emergency Medicine, 52954Sivas Cumhuriyet University, Sivas, Turkey
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AYDEMİR S, ŞAHAN E. The role of ECG as a mortality predictor in COVID-19 patients treated in the intensive care unit. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.980551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, Nakano Y. Associations of frontal QRS-T angle with left ventricular volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease. Ann Nucl Med 2021; 35:662-668. [PMID: 33866517 DOI: 10.1007/s12149-021-01596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The frontal QRS-T angle is one of markers of ventricular repolarization. We investigated whether or not the frontal QRS-T angle could predict left ventricular (LV) volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease (CKD). METHODS Two hundred and twelve patients with advanced CKD defined as estimated glomerular filtration rate of < 45 ml min-1/1.73 m2 were enrolled. Wide QRS-T angle was defined as its angle of > 90°, and was considered abnormal. Enlarged LV end-diastolic volume (LVEDV) was defined as LVEDV index of > 76 ml m-2 in men and > 57 ml m-2 in women. Reduced LV ejection fraction (LVEF) was defined as LVEF of < 40%. RESULTS Fifty-one patients (24%) had wide QRS-T angle, and 161 patients (76%) had normal QRS-T angle. Patients with wide QRS-T angle had larger SSS [9 (5-16) vs 4 (1-9), p < 0.001], larger LVEDV index (69 ± 29 vs 50 ± 18 ml m-2, p < 0.001) and lower LVEF (47 ± 13 vs 59 ± 12%, p < 0.001) than those with normal QRS-T angle. Multivariate analysis showed that wide QRS-T angle (odds ratio 5.93; 95% CI 2.55-14.33; p < 0.001) was significantly associated with enlarged LVEDV, whereas SSS severity was not. Severely abnormal SSS (odds ratio 3.80; 95% CI 1.16-14.05; p < 0.03) and wide QRS-T angle (odds ratio 5.67; 95% CI 2.10-16.22; p < 0.001) were significantly associated with reduced LVEF. CONCLUSIONS Our results suggest that wide QRS-T angle is associated with LV remodeling such as enlarged LVEDV or reduced LVEF in patients with advanced CKD.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
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Serum Bilirubin Level Predicts Frontal QRS-T Angle Change in Patients with Acute Coronary Syndrome. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2020. [DOI: 10.2478/jce-2020-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Abstract
Introduction: The predictive role of serum bilirubin levels on the alteration of total ischemic burden expressed via frontal QRS-T angle change has never been studied in patients with acute coronary syndrome (ACS). In this study, we aimed to investigate the relationship between serum bilirubin levels and frontal QRS-T angle change after percutaneous coronary intervention (PCI) in ACS patients.
Methods: Frontal QRS-T angle change was accepted as positive or negative according to whether the value of the baseline frontal QRS-T angle minus the post PCI frontal QRS-T angle is positive or negative. A total of 314 consecutive patients with ACS who underwent PCI were divided into two groups based on their negative frontal QRS-T angle change (n = 152 patients) and positive frontal QRS-T angle change (n = 162 patients).
Results: Multivariate logistic regression analysis showed that the C-reactive protein (CRP) to albumin ratio (CAR) (Odds ratio [OR]: 0.519, 95% CI: 0.373–0.724, p <0.001), total bilirubin (OR: 3.687, 95% CI: 1.151–8.095, p = 0.03), and low-density lipoprotein (LDL) (OR: 0.985, 95% CI: 0.970–1.000, p = 0.04) were independent predictors of positive QRS-T angle change. In receiver operating characteristics curve analysis, a cut-off value of 0.59 total bilirubin had a 69% sensitivity and a 65% specificity (area under curve: 0.739, p <0.001) for the prediction of positive QRS-T angle change.
Conclusion: In ACS patients, serum total bilirubin has been found to be a useful decision-making tool to predict positive frontal QRS-T angle change as a sign of reduced total ischemic burden, to assess early invasive strategy independently from other study parameters.
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16
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Sakhnova TA, Blinova EV, Merkulova IN, Shakhnovich RM, Zhukova NS, Sukhinina TS, Barysheva NA, Staroverov II. [Factors Associated with the Increase in Spatial and Frontal QRS-T Angles in Patients with Inferior Myocardial Infarction]. ACTA ACUST UNITED AC 2020; 60:1295. [PMID: 33487153 DOI: 10.18087/cardio.2020.11.n1295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To identify clinical, echocardiographic, and angiographic factors related with an increase in the frontal QRS-T angle (fQRS-T) and the spatial QRS-T angle (sQRS-T) in patients with inferior myocardial infarction.Material and methods The study included 128 patients aged (median [25th percentile; 75th percentile]) 59.5 [51.5; 67.0] years diagnosed with inferior wall acute myocardial infarction. fQRS-T was calculated as a module of difference between the QRS axis and the Т axis in the frontal plane. sQRS-T was calculated by a synthesized vectorcardiogram as a spatial angle between the QRS and Т integral vectors.Results The fQRS-T for the group was 54.0 [18; 80] and sQRS-T was 80.1 [53; 110]. The correlation coefficient for fQRS-T and sQRS-T values was 0.42 (p<0.001). Both fQRS-T >80° and sQRS-T >110° compared to their lower values were associated with a higher frequency of history of postinfarction cardiosclerosis (44% and 12 %, respectively; p<0.05), a lower left ventricular ejection fraction (51 [47; 60]% at fQRS-T >80° and 55 [50; 60]% at fQRS-T <80° (p<0,05); 49 [44; 57]% at sQRS-T >110° and 57 [51; 60] % at sQRS-T <110° (p<0.01); more frequent development of acute heart failure (16 and 2 %, respectively; p<0.05); and early postinfarction angina (13 and 2 %, respectively; p<0.05). The increased fQRS-T was associated with a higher incidence of damage to the circumflex artery (45 and 20 %, respectively; p<0.05). The increased sQRS-T was associated with a history of arterial hypertension (97 and 76 %, respectively; p<0.05), chronic heart failure (22 and 3 %, respectively; p<0.05), chronic kidney disease (19 and 4 %, respectively; p<0.05), and a larger myocardial lesion (mean number of damaged segments by echocardiography was 3.8 [2; 6] at sQRS-T >110° and 2.6 [1; 4] at sQRS-T <110°; p<0.01). sQRS-T was significantly greater in multivascular damage (87 [68; 121]° than in one- or two-vascular damage (72 [51; 100]°; p<0.05). sQRS-T values were significantly lower with spontaneous reperfusion (66 [29; 79] than without spontaneous reperfusion (77 [55; 115]°; p<0.05).Conclusion In patients after inferior wall acute myocardial infarction, increases in fQRS-T and sQRS-T were associated with more severe damage of coronary vasculature, decreased left ventricular ejection fraction, and more severe course of disease.
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Affiliation(s)
- T A Sakhnova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - E V Blinova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - I N Merkulova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - R M Shakhnovich
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N S Zhukova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - T S Sukhinina
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - N A Barysheva
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - I I Staroverov
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
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Evaluation of thrombolytic treatment effect on frontal plane QRS-T angle in patients with acute pulmonary embolism : A novel marker of successful thrombolysis. Herz 2020; 46:187-190. [PMID: 32975629 DOI: 10.1007/s00059-020-04978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute pulmonary embolism (APE) patients with hypotension and/or shock should be evaluated for thrombolytic therapy, and hemodynamics often improves after thrombolytic therapy. Frontal plane QRS‑T (f[QRS-T]) angle, which is between the directions QRS axis and T axis, was described as a novel marker of ventricular repolarization heterogeneity. With right ventricular pressure overload, axis of heart may be affected and thrombolytic treatment may have an effect on this situation. This study aimed to investigate thrombolytic efficiency and effect on axis of heart by using f(QRS-T) angle. METHOD A total of 61 APE patients treated with thrombolytics and 71 APE patients treated without thrombolytics were included. Clinical findings and electrocardiogram (ECG) at diagnosis were collected. Second ECGs were included for patients with thrombolytics after 24 h, without thrombolytics after 72 h on average. RESULTS No significant differences were observed with regard to gender, age, hypertension, diabetes and cardiovascular disease. In patients with thrombolytics, respiratory rate, heart rate and pulmonary artery systolic pressure were significantly higher; oxygen saturation (Sat O2) as well as systolic and diastolic pressure were significantly lower. f(QRS-T) was markedly higher in APE with right ventricular pressure overload and changed significantly after thrombolytic therapy. CONCLUSION Right ventricular pressure overload in APE has an effect on f(QRS-T). In thrombolytic treatment, the change of f(QRS-T) angle may be a marker of successful thrombolysis.
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Erturk M, Avci Y, Agus HZ, Guner A, Demir AR, Tasbulak O, Aslan S, Yildirim C, Can C, Oz K. The prognostic value of fQRSTa in patients with aortic stenosis undergoing surgical aortic valve replacement. J Card Surg 2020; 35:2627-2632. [DOI: 10.1111/jocs.14858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Mehmet Erturk
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Yalcin Avci
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Hicaz Zencirkiran Agus
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Ahmet Guner
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Ali Riza Demir
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Omer Tasbulak
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Serkan Aslan
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Ceren Yildirim
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Cemil Can
- Department of Cardiology, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
| | - Kursad Oz
- Department of Cardiovascular Surgery, University of Health Sciences Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Training and Research Hospital Istanbul Turkey
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Erdogan G, Yontar OC, Yenercag M, Gul S, Arslan U. Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction. J Electrocardiol 2020; 61:86-91. [PMID: 32554162 DOI: 10.1016/j.jelectrocard.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early risk stratification based on SYNTAX score plays a crucial role to identify the need for early invasive strategy in patients with NSTEMI. The predictive role of frontal QRS-T angle [f(QRS-T)] on the atherosclerotic burden of CAD is less clear in NSTEMI patients. In this study, we aimed to investigate the relationship between f(QRS-T) and SYNTAX score in NSTEMI patients. METHODS A total of consecutive 269 patients with the diagnosis of NSTEMI transferred to coronary care unit were included in the study. f(QRS-T) was calculated as the absolute value of the difference between the frontal plane QRS and T axes based on automatic report of ECG machine. Syntax score was computed using an online SYNTAX score calculator by well-experienced two cardiologists blinded to the study data. The study population was divided into two groups based on the SYNTAX score low SYNTAX score (≤23), and high SYNTAX score (>23). RESULTS Left ventricle ejection fraction (LVEF) (p = 0.001), hemoglobin (p = 0.03) and HDL-C (p = 0.04) levels were lower in the intermediate-high SYNTAX group. Age (72.1 ± 12.5 vs. 64.6 ± 9.4 respectively; p < 0.001), LAD as infarct-related artery 30 (%65.2) vs. 50 (%29.1) respectively; (p = 0.001), f(QRS-T) (100.5 ± 55.3 vs. 65.1 ± 53.1 respectively p = 0.006), troponin I peak (p = 0.06) were higher among patients with intermediate-high Syntax score. In receiver-operating characteristic (ROC) curve analysis, the value for f(QRS-T) to detect syntax score ≥ 23 with a sensitivity of 77% and specificity of 63% was 73,5° in NSTEMI patients(AUC = 0.69). Univariate logistic regression analysis identified that age, LVEF, HDL-C, hemoglobin, infarct-related artery, f(QRS-T) were significantly associated with SYNTAX score. Multivariate logistic regression analysis showed that age (OR: 1.135, 95% CI: 1.039-1.153, p = 0.045), infarct related artery-LAD (OR: 2.897, 95% CI: 1.023-8.209, p = 0.001) and f(QRS-T) (OR: 3.587, 95% CI: 1.093-11.772, p = 0.001) were the independent predictors of SYNTAX score. CONCLUSION In NSTEMI patients, f(QRS-T) has been found to be a useful decision-making tool to predict SYNTAX score to assess early invasive strategy.
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Affiliation(s)
- Guney Erdogan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Osman Can Yontar
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey.
| | - Mustafa Yenercag
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Sefa Gul
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Ugur Arslan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
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Kurisu S, Nitta K, Ikenaga H, Ishibashi K, Fukuda Y, Kihara Y. Frontal QRS-T angle and left ventricular diastolic function assessed by ECG-gated SPECT in the absence of significant perfusion abnormality. Heart Vessels 2020; 35:1095-1101. [PMID: 32185496 DOI: 10.1007/s00380-020-01585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
The frontal QRS-T angle, defined as the angle between QRS and T-wave axes, has recently become an area of research interest. We tested the hypothesis that the frontal QRS-T angle is associated with left ventricular (LV) diastolic function in the absence of significant perfusion abnormality using ECG-gated SPECT. One hundred twenty eight patients with no significant perfusion abnormality and preserved LV ejection fraction were enrolled. The peak filling rate (PFR) and the one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters on ECG-gated SPECT. There were 115 male and 13 female patients with a mean age of 70 ± 9 years. The PFR and 1/3 MFR were 2.1 ± 0.4/s and 1.2 ± 0.3/s, respectively. The frontal QRS-T angle was 33° ± 31°, ranging from 0° to 151°. There were significant associations of frontal QRS-T angle with PFR (r = - 0.29, p = 0.001) and 1/3 MFR (r = - 0.30, p < 0.001). Multivariate linear regression analysis showed that age (β = - 0.25, p = 0.003), heart rate (β = 0.26, p = 0.002), LV ejection fraction (β = 0.43, p < 0.001) and frontal QRS-T angle (β = - 0.16, p = 0.03) were significant factors associated with PFR. Also, heart rate (β = - 0.32, p < 0.001), LV mass index (β = - 0.19, p = 0.03), LV ejection fraction (β = 0.30, p < 0.001) and frontal QRS-T angle (β = - 0.26, p = 0.002) were significant factors associated with 1/3 MFR. Our data suggested that the frontal QRS-T angle was associated with LV diastolic function in the absence of significant perfusion abnormality.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
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Tanriverdi Z, Besli F, Gungoren F, Tascanov MB. What is the normal range of the frontal QRS-T angle? Diabetes Res Clin Pract 2020; 160:107645. [PMID: 30836133 DOI: 10.1016/j.diabres.2019.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
| | - Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Dogan A, Kahraman S. Frontal QRS-T angle predicts coronary atherosclerotic burden in patients with ST segment elevation myocardial infarction. J Electrocardiol 2020; 58:155-159. [DOI: 10.1016/j.jelectrocard.2019.11.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 01/11/2023]
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Kahraman S, Kalkan AK, Türkyılmaz AB, Doğan AC, Avcı Y, Uzun F, Ertürk M. Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease. Anatol J Cardiol 2019; 22:194-201. [PMID: 31584447 PMCID: PMC6955084 DOI: 10.14744/anatoljcardiol.2019.99692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Fractional flow reserve (FFR) measurement is used to decide the hemodynamic significance of coronary artery lesion. QRS-T angle (QRSTa) is a novel marker of myocardial repolarization abnormality and is affected by obstructive coronary artery disease. The aim of the present study was to evaluate the association between QRSTa and coronary FFR measurement in patients with isolated left anterior descending (LAD) artery stenosis. METHODS A total of 197 patients undergoing FFR measurement for isolated LAD artery stenosis were retrospectively enrolled in the present study. According to FFR value, patients were divided into two groups as 139 patients with normal FFR (>0.80, group 1) and 58 patients with low FFR (≤0.80, group 2). A 12-lead surface electrocardiography of all subjects that had been recorded before performing coronary angiography was evaluated to measure QRSTa, as well as baseline demographic and clinical variables. RESULTS The mean age of group 2 was significantly higher than that of group 1 (61±11 and 64±11, p=0.044). While there were no differences in heart rate, QRS duration, and corrected QT interval between the two groups, QT interval [377 (359-397) and 379 (367-410), p=0.045] and frontal QRSTa [59 (10-120) and 86 (22-132), p<0.001] were higher in group 2. QT interval [odds ratio (OR)=1.046, 95% confidence interval (CI)=1.010-1.084, p=0.012] and frontal QRSTa (OR=1.025, 95% CI=1.010-1.041, p=0.001) were found to be independent predictors of low FFR value in multivariate logistic regression analysis. CONCLUSION In the present study, FFR measurement was demonstrated to be correlated with wide QRSTa as a noninvasive and easy method. Thus, we suggest that the results of FFR measurement as an invasive modality can be previously predicted with a simple electrocardiographic evaluation, such as QRSTa.
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Affiliation(s)
- Serkan Kahraman
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
| | - Ali Kemal Kalkan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
| | - Ayşe Beril Türkyılmaz
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
| | - Arda Can Doğan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
| | - Yalçın Avcı
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
| | - Fatih Uzun
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
| | - Mehmet Ertürk
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital; İstanbul-Turkey
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Kahraman S, Yilmaz E, Demir AR, Avci Y, Güler A, Kalkan AK, Uzun F, Erturk M. The prognostic value of frontal QRS-T angle in patients undergoing transcatheter aortic valve implantation. J Electrocardiol 2019; 55:97-101. [DOI: 10.1016/j.jelectrocard.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/21/2019] [Accepted: 05/08/2019] [Indexed: 12/18/2022]
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25
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Myocardial perfusion defect assessed by single-photon emission computed tomography and frontal QRS-T angle in patients with prior anterior myocardial infarction. Heart Vessels 2019; 34:971-975. [DOI: 10.1007/s00380-018-01330-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
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26
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Sawant AC, Bhardwaj A, Srivatsa S, Sridhara S, Prakash MPH, Kanwar N, Rodriguez J, Tse G, Liu T, Kumar A, Beck H, Srivatsa SS. Prognostic value of frontal QRS-T angle in predicting survival after primary percutaneous coronary revascularization/coronary artery bypass grafting for ST-elevation myocardial infarction. Indian Heart J 2019; 71:481-487. [PMID: 32248922 PMCID: PMC7136356 DOI: 10.1016/j.ihj.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/20/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Frontal QRS-T angle (FQRST) has previously been correlated with mortality in patients with stable coronary artery disease, but its role as survival predictor after ST-elevation myocardial infarction (STEMI) remains unknown. METHODS We evaluated 267 consecutive patients with STEMI undergoing reperfusion or coronary artery bypass grafting. Data assessed included demographics, clinical presentation, electrocardiograms, medical therapy, and one-year mortality. RESULTS Of 267 patients, 187 (70%) were males and most (49.4%) patients were Caucasian. All-cause mortality was significantly higher among patients with the highest (101-180°) FQRST [28% vs. 15%, p = 0.02]. Patients with FQRST 1-50° had higher survival (85.6%) compared with FQRST = 51-100° (72.3%) and FQRST = 101-180° (67.9%), [log rank, p = 0.01]. Adjusting for significant variables identified during univariate analysis, FQRST (OR = 2.04 [95% CI: 1.31-13.50]) remained an independent predictor of one-year mortality. FQRST-based risk score (1-50° = 0 points, 51-100° = 2 points, 101-180° = 5 points) had excellent discriminatory ability for one-year mortality when combined with Mayo Clinic Risk Score (C statistic = 0.875 [95%CI: 0.813-0.937]. A high (>4 points) FQRST risk score was associated with greater mortality (32% vs. 19%, p = 0.02) and longer length of stay (6 vs. 2 days, p < 0.001). CONCLUSION FQRST represents a novel independent predictor of one-year mortality in patients with STEMI undergoing reperfusion. A high FQRST-based risk score was associated with greater mortality and longer length of stay and, after combining with Mayo Clinic Risk Score, improved discriminatory ability for one-year mortality.
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Affiliation(s)
- Abhishek C Sawant
- Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Aishwarya Bhardwaj
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Shantanu Srivatsa
- Department of Medicine, Community Regional Medical Center, Fresno, CA, USA
| | - Srilekha Sridhara
- Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | | | - Nidhi Kanwar
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Janelle Rodriguez
- Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, PR China
| | - Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Hiroko Beck
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sanjay S Srivatsa
- Department of Medicine, Community Regional Medical Center, Fresno, CA, USA.
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Lazzeroni D, Bini M, Camaiora U, Castiglioni P, Moderato L, Ugolotti PT, Brambilla L, Brambilla V, Coruzzi P. Prognostic value of frontal QRS-T angle in patients undergoing myocardial revascularization or cardiac valve surgery. J Electrocardiol 2018; 51:967-972. [PMID: 30497757 DOI: 10.1016/j.jelectrocard.2018.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND An abnormal frontal QRS-T angle (fQRSTa) is associated with increased risk of death in primary and secondary cardiovascular prevention. The aim of this study was to evaluate the fQRSTa prognostic role in patients undergoing myocardial revascularization and/or cardiac valve surgery. METHODS We enrolled and prospectively followed for 48 ± 26 months 939 subjects with available QRS and T axis data; mean age was 68 ± 12 years, 449 patients (48%) underwent myocardial revascularization, 333 (35%) cardiac valve surgery, 94 (10%) valve plus bypass graft surgery and 63 (7%) cardiac surgery for other cardiovascular (CV) diseases. The ECG variables were collected at the end of the cardiac rehabilitation program and fQRSTa was considered normal if <60°, abnormal if >120°, borderline otherwise. Endpoints were overall and CV mortality. RESULTS The fQRSTa was normal in 333 patients (36%), borderline in 285 (30%) and abnormal in 321 (34%). Overall (p = 0.012) and cardiovascular (p = 0.007) mortality were significantly higher in patients with abnormal fQRSTa even after adjusting separately for gender, PR-, QTc- intervals, presence of right or left bundle branch block and left atrial volume index. The predictive value was confirmed in patients with stable coronary artery disease (SCAD), not in patients with acute coronary syndrome or valve disease. SCAD patients with abnormal both fQRSTa and QRS axis had higher risk of overall (hazard ratio = 2.9, p < 0.0001) and CV (hazard ratio = 4.4, p < 0.0001) mortality compared with SCAD patients with normal fQRSTa, even after multivariate adjustment for age, gender, ECG intervals, left-ventricle ejection fraction and mass index. CONCLUSIONS In SCAD patients undergoing myocardial revascularization, abnormal fQRSTa is independent predictor of overall and CV mortality.
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Affiliation(s)
| | | | | | | | - Luca Moderato
- Department of Medicine and Surgery, University of Parma, Italy
| | | | | | | | - Paolo Coruzzi
- Department of Medicine and Surgery, University of Parma, Italy
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May O, Graversen CB, Johansen MØ, Arildsen H. The prognostic value of the frontal QRS-T angle is comparable to cardiovascular autonomic neuropathy regarding long-term mortality in people with diabetes. A population based study. Diabetes Res Clin Pract 2018; 142:264-268. [PMID: 29775674 DOI: 10.1016/j.diabres.2018.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/09/2018] [Accepted: 05/09/2018] [Indexed: 10/14/2022]
Abstract
UNLABELLED Cardiovascular autonomic neuropathy (CAN) is a well known prognostic marker in diabetes. A large angle between the QRS- and the T-wave vector (QRS-T angle) in the electrocardiogram (ECG) has recently been introduced as another marker of poor prognosis. AIM To assess and compare the long-term predictive power of the frontal plane QRS-T angle with CAN in people with diabetes. METHODS In 1992-93 people with diabetes in the municipality of Horsens, Denmark, were identified by the prescription method andan age and gender stratified sample of 240 individuals with diabetes were randomly selected. The presence of CAN was defined using the heart rate response to Valsalva manoeuvre. The QRS-T angle was read using the method described by Gandhi. In July 2015 vital statistics were obtained fromthe Danish Civil Registration System. RESULTS 178 individuals accepted to participate in the study, of which 153 (86%) completed the Valsalva manoeuvre and had sinus rhythm. Total observation time was 21.5 (0.18) years, in which 99 (65%) individuals died. An elevated QRS-T angle and the presence of cardiovascular autonomic neuropathy were both found to be significant predictors of death. In Cox regression analyses, adjusting for the effect of gender, age, duration of diabetes, BMI, total-cholesterol, diabetes type, haemoglobin A1c, smoking status, hypertension and previous MI, an independent prognostic value was found for the QRS-T angle as well as the Valsalva ratio. CONCLUSION A large QRS-T angle and the presence of cardiovascular autonomic neuropathy are both strong and independent long-term predictors of all-cause mortality in people with diabetes.
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Affiliation(s)
- O May
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark.
| | - C B Graversen
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark
| | - M Ø Johansen
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark
| | - H Arildsen
- Dept. of Infectious Dis., Aarhus University Hospital, Skejby, Denmark
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Colluoglu T, Tanriverdi Z, Unal B, Ozcan EE, Dursun H, Kaya D. The role of baseline and post-procedural frontal plane QRS-T angles for cardiac risk assessment in patients with acute STEMI. Ann Noninvasive Electrocardiol 2018; 23:e12558. [PMID: 29873439 DOI: 10.1111/anec.12558] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/20/2018] [Accepted: 05/02/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To our knowledge, no study so far investigated the importance of post-procedural frontal QRS-T angle f(QRS-T) in ST segment elevation myocardial infarction (STEMI). The aim of our study was to investigate the role of baseline and post-procedural f(QRS-T) angles for determining high risk STEMI patients, and the success of reperfusion. METHODS A total of 248 patients with first acute STEMI that underwent primary percutaneous coronary intervention (pPCI) or thrombolytic therapy (TT) between 2013 and 2014 were included in this study. Baseline f(QRS-T) angle was defined as the angle which measured from the first ECG at the time of hospital admission. Post-procedural (QRS-T) angle was defined according to the treatment strategy as follows: the angle which measured from the post-PCI ECG in patients treated with pPCI; the angle which measured from the ECG taken 90 min after onset of therapy in patients treated with TT. RESULTS The baseline (101.9° ± 48.0 vs. 72.1° ± 49.1, p = 0.014) and post-procedural f(QRS-T) angles (95.7° ± 48.1 vs. 58.1° ± 47.1, p = 0.002) were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality. Also, f(QRS-T) angle measured at 90 min was significantly lower in patients with successful thrombolysis group compared to failed thrombolysis group (53.2° ± 42.8 vs. 77.3° ± 52.9, p = 0.033), whereas baseline f(QRS-T) angle was similar between two groups (78.6° ± 53.4 vs. 78.9° ± 54.0, p = 0.976). Multivariate analysis showed that post-procedural f(QRS-T) angle ≥89.6° (odds ratio: 3.541, 95% confidence interval: 1.235-10.154, p = 0.019), but not baseline f(QRS-T) angle, was independent predictor of in-hospital mortality. CONCLUSION f(QRS-T) angle may be used as a beneficial tool for determining high risk patients in acute STEMI. Unlike previous studies, we showed for the first time that that post-procedural f(QRS-T) can predict in-hospital mortality and TT failure.
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Affiliation(s)
- Tugce Colluoglu
- Department of Cardiology, Karabuk Education and Research Hospital, Karabuk, Turkey
| | - Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Baris Unal
- Clinic of Cardiology, Cumra State Hospital, Konya, Turkey
| | - Emin Evren Ozcan
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Huseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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May O, Graversen CB, Johansen MØ, Arildsen H. A large frontal QRS-T angle is a strong predictor of the long-term risk of myocardial infarction and all-cause mortality in the diabetic population. J Diabetes Complications 2017; 31:551-555. [PMID: 28065667 DOI: 10.1016/j.jdiacomp.2016.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/16/2016] [Accepted: 12/10/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND A large angle between the QRS vector and the T-wave vector (QRS-T angle) in electrocardiograms (ECGs) has recently been introduced as a marker of poor prognosis. The prognostic value in diabetes is unknown. We assessed the long-term predictive power of the frontal plane QRS-T angle in the diabetic population. METHODS In 1992-93, the diabetic population of the municipality of Horsens, Denmark, was delineated by the prescription method, and an age- and gender-stratified sample of 240 diabetic persons was randomly selected. In 2015, 12-lead ECGs taken in 1993-94 were analyzed. Vital statistics were obtained from the Danish Civil Registration System and data regarding hospitalizations taken from The National Patient Registry in July 2015. RESULTS In total, 178 people agreed to participate (74%) in the study, with the mean (sd) age being 58.9 (10.2) years and 56% being male. The total observation time was 21.5 (0.18) years, during which time 122 (69%) persons died, 32 (18%) suffered a myocardial infarction (MI) and 126 (71%) reached the composite endpoint of non-fatal MI or all-cause death. In Cox regression multivariate analysis a QRS-T angle above 90° was found to be an independent predictor of all-cause death (HR=2.2 (95% CI: 1.3-3.8)), MI (HR=2.95 (95% CI: 1.1-7.7)) and MI or all-cause death (HR=2.0 (95% CI: 1.2-3.5)) (all p<0.05), when adjusting for the effects of co-variates (gender, age, length of diabetes, BMI, total cholesterol, diabetes type, hemoglobin A1c, smoking, hypertension and previous MI). CONCLUSION A large QRS-T angle is a strong, independent long-term predictor of all-cause mortality, MI and MI or all-cause death in the diabetic population.
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Affiliation(s)
- Ole May
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark.
| | | | - Mia Østergaard Johansen
- Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark
| | - Hanne Arildsen
- Dept. of Infectious Dis., Aarhus University Hospital, Skejby, Denmark
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Li SN, Zhang XL, Cai GL, Lin RW, Jiang H, Chen JZ, Xu B, Huang W. Prognostic Significance of Frontal QRS-T Angle in Patients with Idiopathic Dilated Cardiomyopathy. Chin Med J (Engl) 2017; 129:1904-11. [PMID: 27503013 PMCID: PMC4989419 DOI: 10.4103/0366-6999.187844] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Current risk stratification of idiopathic dilated cardiomyopathy (IDC) lacks sufficient sensitivity and specificity. The objective of this study was to investigate the predictive role of frontal QRS-T angles in IDC. METHODS A prospective study with 509 IDC patients was performed from February 2008 to December 2013 in the Affiliated Drum Tower Hospital, Nanjing University School of Medicine. Baseline values and changes in QRS-T angles were recorded. Follow-up was conducted every 6 months. Analyses by Cox Proportional Hazards model were performed to evaluate the association between QRS-T angle and outcomes. The primary outcome of interest was all-cause mortality. RESULTS During a median follow-up of 34 months, 90 of 316 patients with QRS-T angles >90° died compared to 31 of 193 patients with QRS-T angles ≤90° (hazard ratio [HR] =2.4, P < 0.001). Cardiac death was more prevalent in patients with a wide QRS-T angle (HR = 2.4, P < 0.001), similar to heart failure rehospitalization (HR = 2.5, P < 0.001). After adjustment for potential prognostic factors, the QRS-T angle was independently associated with all-cause mortality (HR = 2.5, P < 0.05), cardiac mortality (HR = 1.9, P < 0. 05), and heart failure rehospitalization (HR = 2.3, P < 0.01). Optimized therapy significantly narrowed the frontal QRS-T angle (100.9 ± 53.4° vs. 107.2 ± 54.4°, P < 0.001). The frontal QRS-T angle correlated well with established risk factors, such as left ventricular ejection fraction, brain natriuretic peptide, and New York Heart Association functional class. CONCLUSIONS The frontal QRS-T angle is a powerful predictor of all-cause mortality, cardiac mortality, and worsening heart failure in IDC patients, independent of well-established prognostic factors. Optimized therapy significantly narrows the QRS-T angle, which might be an indicator of medication compliance, but this requires further investigation.
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Affiliation(s)
- Sheng-Na Li
- Intensive Care Unit, Zhejiang Hospital, Hangzhou, Zhejiang 310031, China
| | - Xin-Lin Zhang
- Department of Cardiology, School of Medicine, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu 210008, China
| | - Guo-Long Cai
- Department of Education and Science, Zhejiang Hospital, Hangzhou, Zhejiang 310031, China
| | - Ruo-Wei Lin
- Department of Cardiology, School of Medicine, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu 210008, China
| | - He Jiang
- Department of Cardiology, School of Medicine, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu 210008, China
| | - Jian-Zhou Chen
- Department of Cardiology, School of Medicine, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu 210008, China
| | - Biao Xu
- Department of Cardiology, School of Medicine, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu 210008, China
| | - Wei Huang
- Department of Cardiology, School of Medicine, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu 210008, China
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Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis. PLoS One 2015; 10:e0136174. [PMID: 26284799 PMCID: PMC4540436 DOI: 10.1371/journal.pone.0136174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 07/31/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A number of studies have assessed the predictive effect of QRS-T angles in various populations since the last decade. The objective of this meta-analysis was to evaluate the prognostic value of spatial/frontal QRS-T angle on all-cause death and cardiac death. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from their inception until June 5, 2014. Studies reporting the predictive effect of spatial/frontal QRS-T angle on all-cause/cardiac death in all populations were included. Relative risk (RR) was used as a measure of effect. RESULTS Twenty-two studies enrolling 164,171 individuals were included. In the combined analysis in all populations, a wide spatial QRS-T angle was associated with an increase in all-cause death (maximum-adjusted RR: 1.40; 95% confidence interval [CI]: 1.32 to 1.48) and cardiac death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90), a wide frontal QRS-T angle also predicted a higher rate of all-cause death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90). Largely similar results were found using different methods of categorizing for QRS-T angles, and similar in subgroup populations such as general population, populations with suspected coronary heart disease or heart failure. Other stratified analyses and meta-analyses using unadjusted data also generated consistent findings. CONCLUSIONS Spatial QRS-T angle held promising prognostic value on all-cause death and cardiac death. Frontal QRS-T angle was also a promising predictor of all-cause death. Given the good predictive value of QRS-T angle, a combined stratification strategy in which QRS-T angle is of vital importance might be expected.
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Alabas OA, West RM, Gillott RG, Khatib R, Hall AS, Gale CP. Evaluation of the Methods and Management of Acute Coronary Events (EMMACE)-3: protocol for a longitudinal study. BMJ Open 2015; 5:e006256. [PMID: 26105029 PMCID: PMC4480017 DOI: 10.1136/bmjopen-2014-006256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients with cardiovascular disease are living longer and are more frequently accessing healthcare resources. The Evaluation of the Methods and Management of Acute Coronary Events (EMMACE)-3 national study is designed to improve understanding of the effect of quality of care on health-related outcomes for patients hospitalised with acute coronary syndrome (ACS). METHODS AND ANALYSIS EMMACE-3 is a longitudinal study of 5556 patients hospitalised with an ACS in England. The study collects repeated measures of health-related quality of life, information about medications and patient adherence profiles, a survey of hospital facilities, and morbidity and mortality data from linkages to multiple electronic health records. Together with EMMACE-3X and EMMACE-4, EMMACE-3 will assimilate detailed information for about 13 000 patients across more than 60 hospitals in England. ETHICS AND DISSEMINATION EMMACE-3 was given a favourable ethical opinion by Leeds (West) Research Ethics committee (REC reference: 10/H131374). On successful application, study data will be shared with academic collaborators. The findings from EMMACE-3 will be disseminated through peer-reviewed publications, at scientific conferences, the media, and through patient and public involvement. STUDY REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT01808027. Information about the study is also available at EMMACE.org.
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Affiliation(s)
- O A Alabas
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - R M West
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - R G Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Khatib
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A S Hall
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C P Gale
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK York Teaching Hospital NHS Foundation Trust, York, UK
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Zhang ZM, Rautaharju PM, Prineas RJ, Whitsel EA, Tereshchenko L, Soliman EZ. A wide QRS/T angle in bundle branch blocks is associated with increased risk for coronary heart disease and all-cause mortality in the Atherosclerosis Risk in Communities (ARIC) Study. J Electrocardiol 2015; 48:672-7. [PMID: 25959262 DOI: 10.1016/j.jelectrocard.2015.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study evaluated the prognostic value of QRS/T angle for mortality in the presence and absence of BBB. METHODS AND RESULTS Total 15,408 participants (mean age 54 years, 55.2% women, 26.9% blacks, 2.8% with BBB) were from the Arteriosclerosis Risk in Communities Study. Sex stratified Cox regression models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for coronary heart disease (CHD) and all-cause mortality for wide spatial QRS/T angle with and without BBB including right BBB (RBBB), left BBB (LBBB) and indetermined-type ventricular conduction defect (IVCD) and RBBB combined with left anterior fascicular block. During a median 22-year follow-up, 4767 deaths occurred, 728 of them CHD deaths. Using the No-BBB with QRS/T angle below median value as gender-specific reference groups, the mortality risk increase was significant for both women and men with No-BBB and QRS/T angle above the median value. In the pooled ICVD/LBBB group, the risk for CHD death was increased 15.9-fold in women and 6.04 fold in men, and for all-cause deaths 3.01-fold in women and 1.84-fold in men. However, the mortality risk in isolated RBBB group was only significantly increased in women but not in men. CONCLUSION A wide spatial QRS/T angle in BBB is associated with increased risk for CHD and all-cause mortality over and above the predictive value for BBB alone. The risk for women is as high as or higher than that in men.
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Affiliation(s)
- Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Pentti M Rautaharju
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ronald J Prineas
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Larisa Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Zampa HB, Moreira DAR, Ferreira Filho CAB, Souza CR, Menezes CC, Hirata HS, Armaganijan LV. Value of the Qrs-T angle in predicting the induction of ventricular tachyarrhythmias in patients with Chagas disease. Arq Bras Cardiol 2015; 103:460-7. [PMID: 25590925 PMCID: PMC4290736 DOI: 10.5935/abc.20140162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 07/29/2014] [Indexed: 11/24/2022] Open
Abstract
Background The QRS-T angle correlates with prognosis in patients with heart failure and
coronary artery disease, reflected by an increase in mortality proportional to an
increase in the difference between the axes of the QRS complex and T wave in the
frontal plane. The value of this correlation in patients with Chagas heart disease
is currently unknown. Objective Determine the correlation of the QRS-T angle and the risk of induction of
ventricular tachycardia / ventricular fibrillation (VT / VF) during
electrophysiological study (EPS) in patients with Chagas disease. Methods Case-control study at a tertiary center. Patients without induction of VT / VF on
EPS were used as controls. The QRS-T angle was categorized as normal (0-105º),
borderline (105-135º) or abnormal (135-180º). Differences between groups for
continuous variables were analyzed with the t test or Mann-Whitney test, and for
categorical variables with Fisher's exact test. P values < 0.05 were considered
significant. Results Of 116 patients undergoing EPS, 37.9% were excluded due to incomplete information
/ inactive records or due to the impossibility to correctly calculate the QRS-T
angle (presence of left bundle branch block and atrial fibrillation). Of 72
patients included in the study, 31 induced VT / VF on EPS. Of these, the QRS-T
angle was normal in 41.9%, borderline in 12.9% and abnormal in 45.2%. Among
patients without induction of VT / VF on EPS, the QRS-T angle was normal in 63.4%,
borderline in 14.6% and abnormal in 17.1% (p = 0.04). When compared with patients
with normal QRS-T angle, those with abnormal angle had a fourfold higher risk of
inducing ventricular tachycardia / ventricular fibrillation on EPS [odds ratio
(OR) 4; confidence interval (CI) 1.298-12.325; p = 0.028]. After adjustment for
other variables such as age, ejection fraction (EF) and QRS size, there was a
trend for the abnormal QRS-T angle to identify patients with increased risk of
inducing VT / VF during EPS (OR 3.95; CI 0.99-15.82; p = 0.052). The EF also
emerged as a predictor of induction of VT / VF: for each point increase in EF,
there was a 4% reduction in the rate of sustained ventricular arrhythmia on
EPS. Conclusions Changes in the QRS-T angle and decreases in EF were associated with an increased
risk of induction of VT / VF on EPS.
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Rautaharju PM, Zhang ZM, Haisty WK, Kucharska-Newton AM, Rosamond WD, Soliman EZ. Electrocardiographic repolarization-related predictors of coronary heart disease and sudden cardiac deaths in men and women with cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study. J Electrocardiol 2015; 48:101-11. [DOI: 10.1016/j.jelectrocard.2014.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Indexed: 11/28/2022]
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Abstract
For proper distribution of preventative resources, a more robust method of cardiac risk stratification should be encouraged in addition to merely reduced ejection fraction. To this end, the QRS-T angle, an electrocardiogram-derived measure of the difference in mean vectors of depolarization and repolarization, has been found associated with sudden cardiac death and other mortal and morbid outcomes in multiple observational studies over the past decade. The use of both frontal and spatial QRS-T angle in the prediction of future cardiac events including sudden cardiac death, all-cause mortality, and further cardiac morbidity is reviewed here.
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Affiliation(s)
- Andrew Oehler
- Internal Medicine Department, Oregon Health and Science University, Portland, OR
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Zhang ZM, Rautaharju PM, Prineas RJ, Loehr L, Rosamond W, Soliman EZ. Usefulness of electrocardiographic QRS/T angles with versus without bundle branch blocks to predict heart failure (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2014; 114:412-8. [PMID: 24929625 DOI: 10.1016/j.amjcard.2014.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/01/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
Repolarization abnormalities in the setting of bundle branch blocks (BBB) are generally ignored. We used Cox regression models to determine hazard ratios (HRs) with 95% confidence intervals (CIs) for incident heart failure (HF) associated with wide spatial and frontal QRS/T angle (upper twenty-fifth percentile of each) in men and women with and without BBB. This analysis included 14,478 participants (54.6% women, 26.4% blacks, 377 [2.6%] with BBB) from the Atherosclerosis Risk in Communities Study who were free of HF at baseline. Using No-BBB with normal spatial QRS/T angle as the reference group, the risk for HF in multivariable adjusted models was increased 51% for No-BBB with wide spatial QRS/T angle (HR 1.51, 95% CI 1.37 to 1.66), 48% for BBB with normal spatial QRS/T angle (HR 1.48, 95% CI 1.17 to 1.88), and the risk for incident HF was increased more than threefold for BBB with wide spatial QRS/T angle (HR 3.37, 95% CI 2.47 to 4.60). The results were consistent across subgroups by gender. Similar results were observed for the frontal plane QRS/T angle. In the pooled BBB group excluding right BBB, a positive T wave in lead aVR and heart rate 70 bpm and higher were also potent predictors of incident HF similar to the QRS/T angles. In conclusion, both BBB and wide QRS/T angles are predictive of HF, and concomitant presence of both carries a much higher risk than for either predictor alone. These findings suggest that repolarization abnormalities in the setting of BBB should not be considered benign or an expected consequence of BBB.
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Al-Zaiti SS, Fallavollita JA, Wu YWB, Tomita MR, Carey MG. Electrocardiogram-based predictors of clinical outcomes: a meta-analysis of the prognostic value of ventricular repolarization. Heart Lung 2014; 43:516-26. [PMID: 24988910 DOI: 10.1016/j.hrtlng.2014.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 05/03/2014] [Accepted: 05/04/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate age- and sex-specific prognostic values of eight electrocardiographic repolarization descriptors to predict various mortality endpoints. BACKGROUND Using electrocardiographic markers for risk stratification is well studied; however, the prognostic value of many markers is controversial, and their clinical utility remains debatable. No meta-analyses exist that address the prognostic value of ECG markers. METHODS Data were synthesized from 106 primary studies using a random-effect variance model. Age and sex subgroups were analyzed using sensitivity analysis. RESULTS Four classic (i.e., duration, amplitude, inversion, and ST-T changes) and four novel (i.e., axis, loop, wavefront direction, and waveform complexity) repolarization descriptors were studied. These novel descriptors were particularly useful in predicting sudden death. Abnormal repolarization duration, vectors, and loops have greater impact on negative cardiovascular outcomes in women compared to men; additionally, ischemic repolarization changes have greater impact on negative cardiovascular outcomes in younger versus older adults. CONCLUSIONS Assessing repolarization abnormalities is particularly helpful in women and younger adults. Researchers need to further explore the clinical utility of these abnormalities in management algorithms.
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Affiliation(s)
| | - James A Fallavollita
- The State University of New York University at Buffalo, Buffalo, NY, USA; The VA of WNY Healthcare System, Buffalo, NY, USA
| | - Yow-Wu B Wu
- The State University of New York University at Buffalo, Buffalo, NY, USA
| | - Machiko R Tomita
- The State University of New York University at Buffalo, Buffalo, NY, USA
| | - Mary G Carey
- The Strong Memorial Hospital at University of Rochester Medical Center, Rochester, NY, USA
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Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction. Am J Cardiol 2014; 113:1312-9. [PMID: 24685325 DOI: 10.1016/j.amjcard.2014.01.406] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/21/2022]
Abstract
In light of the low cost, the widespread availability of the electrocardiogram, and the increasing economic burden of the health-related problems, we aimed to analyze the prognostic value of automatic frontal QRS-T angle to predict mortality in patients with left ventricular (LV) systolic dysfunction after acute myocardial infarction (AMI). About 467 consecutive patients discharged with diagnosis of AMI and with LV ejection fraction ≤40% were followed during 3.9 years (2.1 to 5.9). From them, 217 patients (47.5%) died. The frontal QRS-T angle was higher in patients who died (116.6±52.8 vs 77.9±55.1, respectively, p<0.001). The QRS-T angle value of 90° was the most accurate to predict all-cause cardiac death. After multivariate analysis, frontal QRS-T angle remained as an excellent predictor of all-cause and cardiac deaths, increasing the mortality 6% per each 10°. For the global mortality, the hazard ratio for a QRS-T angle>90° was 2.180 (1.558 to 3.050), and for the combined end point of cardiac death and appropriate implantable cardioverter defribrillator therapy, it was 2.385 (1.570 to 3.623). This independent predictive value was maintained even after adjusting by bundle brunch block, ST-elevation AMI, and its localization. In conclusion, a wide automatic frontal QRS-T angle (>90°) is a good discriminator of long-term mortality in patients with LV systolic dysfunction after an AMI. The ability to easily measure it from a standard 12-lead electrocardiogram together with its prognostic value makes the frontal QRS-T angle an attractive tool to help clinicians to improve risk stratification of those patients.
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Balasubramaniyam N, Palaniswamy C, Aronow WS, Khera S, Balasubramanian G, Harikrishnan P, Doshi JV, Nabors C, Peterson SJ, Sule S. Association of corrected QT interval with long-term mortality in patients with syncope. Arch Med Sci 2013; 9:1049-54. [PMID: 24482649 PMCID: PMC3902715 DOI: 10.5114/aoms.2013.39383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/14/2012] [Accepted: 12/20/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The electrocardiographic parameters QRS duration, QRS-T angle and QTc can predict mortality in patients with cardiovascular disease. The prgnostic value of these parameters in hospitalized patients with syncope needs investigation. MATERIAL AND METHODS We retrospectively studied 590 consecutive patients hospitalized with syncope. After excluding patients with baseline abnormal rhythm, QT- prolonging medications, and missing data, 459 patients were analyzed. Baseline demographic characteristics, co-morbidities, medication use, San Francisco Syncope Rule (SFSR) and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score and data on mortality were collected. The categorical variables and continuous variables of the 2 groups of patients with prolonged QTc and normal QTc interval were analyzed by Fischer's exact test and Mann-Whitney Test. A stepwise Cox regression model was used for time to death analysis. RESULTS Of 459 patients, prolonged QTc interval was observed in 122 (27%). Mean follow-up was 41 months. Patients with prolonged QTc interval had higher prevalence of cardiovascular disease, OESIL score, high risk SFSR, hypertension, dyslipidemia, coronary artery disease, congestive heart failure, and increased mortality. Stepwise Cox regression analysis showed that significant independent prognostic factors for time to death were prolonged QTc interval (p = 0.005), age (p = 0.001), diabetes mellitus (p = 0.001) and history of malignancy (p = 0.006). QRS duration and QRS-T angle were not independent predictors of mortality. CONCLUSIONS A prolonged QTc interval is an independent predictor of long-term mortality in hospitalized patients with syncope.
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Affiliation(s)
- Nivas Balasubramaniyam
- Department of Medicine, Division of Internal Medicine, Westchester Medical Center/ New York Medical College, Valhalla, New York, USA
| | - Chandrasekar Palaniswamy
- Department of Medicine, Cardiology Division, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Wilbert S. Aronow
- Department of Medicine, Cardiology Division, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Sahil Khera
- Department of Medicine, Division of Internal Medicine, Westchester Medical Center/ New York Medical College, Valhalla, New York, USA
| | - Gokulakrishnan Balasubramanian
- Department of Medicine, Division of Internal Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Prakash Harikrishnan
- Department of Medicine, Division of Internal Medicine, Westchester Medical Center/ New York Medical College, Valhalla, New York, USA
| | - Jay V. Doshi
- Department of Medicine, Cardiology Division, New York Medical College at Westchester Medical Center, Valhalla, New York, USA
| | - Christopher Nabors
- Department of Medicine, Division of Internal Medicine, Westchester Medical Center/ New York Medical College, Valhalla, New York, USA
| | - Stephen J. Peterson
- Department of Medicine, Division of Internal Medicine, Westchester Medical Center/ New York Medical College, Valhalla, New York, USA
| | - Sachin Sule
- Department of Medicine, Division of Internal Medicine, Westchester Medical Center/ New York Medical College, Valhalla, New York, USA
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Shi B, Ferrier KA, Sasse A, Harding SA, Larsen PD. Correlation between vectorcardiographic measures and cardiac magnetic resonance imaging of the left ventricle in an implantable cardioverter defibrillator population. J Electrocardiol 2013; 47:52-8. [PMID: 23993862 DOI: 10.1016/j.jelectrocard.2013.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Measures of vectorcardiographic changes and LV remodelling have been associated with arrhythmic risk. However the correlation between the two modalities is not well characterised. METHODS We correlated spatial QRS-T angle and ventricular gradient with cardiac MRI derived LV global measures and scar pattern in 66 ICD recipients. RESULTS Spatial QRS-T angle was significantly larger in patients with ischaemic scar than those without scar (150°±22° vs. 119°±46°, p=0.01). Larger spatial QRS-T angle was also correlated with more depressed LV function, more dilated LV and larger LV mass. Ventricular gradient azimuth was significantly different between patients with no scar, non-ischaemic scar and ischaemic scar (20°±49° vs. 38°±62° vs. 65°±48°, p=0.009), but independent of spatial QRS-T angle and LV structure. CONCLUSIONS Spatial QRS-T angle and ventricular gradient are partially related to LV structural properties. Further investigation is warranted to examine their comparative and combined prognostic value in risk stratification of ventricular arrhythmias.
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Affiliation(s)
- Bijia Shi
- Wellington Cardiovascular Research Group, Wellington, New Zealand; Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand.
| | - Katherine A Ferrier
- Wellington Cardiovascular Research Group, Wellington, New Zealand; Cardiology Department, Hutt Hospital, Wellington, New Zealand
| | - Alexander Sasse
- Wellington Cardiovascular Research Group, Wellington, New Zealand; Cardiology Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Scott A Harding
- Wellington Cardiovascular Research Group, Wellington, New Zealand; Cardiology Department, Wellington Regional Hospital, Wellington, New Zealand
| | - Peter D Larsen
- Wellington Cardiovascular Research Group, Wellington, New Zealand; Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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Rautaharju PM, Zhang ZM, Gregg RE, Haisty WK, Z Vitolins M, Curtis AB, Warren J, Horaĉek MB, Zhou SH, Soliman EZ. Normal standards for computer-ECG programs for prognostically and diagnostically important ECG variables derived from a large ethnically diverse female cohort: the Women's Health Initiative (WHI). J Electrocardiol 2013; 46:707-16. [PMID: 23809992 DOI: 10.1016/j.jelectrocard.2013.05.136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Substantial new information has emerged recently about the prognostic value for a variety of new ECG variables. The objective of the present study was to establish reference standards for these novel risk predictors in a large, ethnically diverse cohort of healthy women from the Women's Health Initiative (WHI) study. METHODS AND RESULTS The study population consisted of 36,299 healthy women. Racial differences in rate-adjusted QT end (QT(ea)) and QT peak (QT(pa)) intervals as linear functions of RR were small, leading to the conclusion that 450 and 390 ms are applicable as thresholds for prolonged and shortened QT(ea) and similarly, 365 and 295 ms for prolonged and shortened QT(pa), respectively. As a threshold for increased dispersion of global repolarization (T(peak)T(end) interval), 110 ms was established for white and Hispanic women and 120 ms for African-American and Asian women. ST elevation and depression values for the monitoring leads of each person with limb electrodes at Mason-Likar positions and chest leads at level of V1 and V2 were first computed from standard leads using lead transformation coefficients derived from 892 body surface maps, and subsequently normal standards were determined for the monitoring leads, including vessel-specific bipolar left anterior descending, left circumflex artery and right coronary artery leads. The results support the choice 150 μV as a tentative threshold for abnormal ST-onset elevation for all monitoring leads. Body mass index (BMI) had a profound effect on Cornell voltage and Sokolow-Lyon voltage in all racial groups and their utility for left ventricular hypertrophy classification remains open. CONCLUSIONS Common thresholds for all racial groups are applicable for QT(ea), and QT(pa) intervals and ST elevation. Race-specific normal standards are required for many other ECG parameters.
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Affiliation(s)
- Pentti M Rautaharju
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Rautaharju PM, Zhang ZM, Warren J, Gregg RE, Haisty WK, Kucharska-Newton AM, Rosamond WD, Soliman EZ. Electrocardiographic predictors of coronary heart disease and sudden cardiac deaths in men and women free from cardiovascular disease in the Atherosclerosis Risk in Communities study. J Am Heart Assoc 2013; 2:e000061. [PMID: 23723252 PMCID: PMC3698763 DOI: 10.1161/jaha.113.000061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background We evaluated predictors of coronary heart disease (CHD) death and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) study. Methods and Results The study population included 13 621 men and women 45 to 65 years of age free from manifest cardiovascular disease at entry. Hazard ratios from Cox regression with 95% confidence intervals were computed for 18 dichotomized repolarization‐related ECG variables. The average follow‐up was 14 years. Independent predictors of CHD death in men were TaVR‐ and rate‐adjusted QTend (QTea), with a 2‐fold increased risk for both, and spatial angles between mean QRS and T vectors and between Tpeak (Tp) and normal R reference vectors [θ(Rm|Tm) and θ(Tp|Tref), respectively], with a >1.5‐fold increased risk for both. In women, independent predictors of the risk of CHD death were θ(Rm|Tm), with a 2‐fold increased risk for θ(Rm|Tm), and θ(Tp|Tref), with a 1.7‐fold increased risk. Independent predictors of SCD in men were θ(Tp|Tref) and QTea, with a 2‐fold increased risk, and θ(Tinit|Tterm), with a 1.6‐fold increased risk. In women, θ(Tinit|Tterm) was an independent predictor of SCD, with a >3‐fold increased risk, and θ(Rm|Tm) and TV1 were >2‐fold for both. Conclusions θ(Rm|Tm) and θ(Tp|Tref), reflecting different aspects of ventricular repolarization, were independent predictors of CHD death and SCD, and TaVR and TV1 were also independent predictors. The risk levels for independent predictors for both CHD death and SCD were stronger in women than in men, and QTea was a significant predictor in men but not in women.
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Affiliation(s)
- Pentti M Rautaharju
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Rautaharju PM, Menotti A, Blackburn H, Parapid B, Kircanski B. Isolated negative T waves as independent predictors of short-term and long-term coronary heart disease mortality in men free of manifest heart disease in the Seven Countries Study. J Electrocardiol 2012; 45:717-22. [DOI: 10.1016/j.jelectrocard.2012.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Indexed: 10/27/2022]
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