Comparison of the Prognostic Significance of the Electrocardiographic QRS/T Angles in Predicting Incident Coronary Heart Disease and Total Mortality (from the Atherosclerosis Risk In Communities Study)

Abstract

Spatial QRS/T angle and spatial T-wave axis were shown to be strong independent predictors of incident coronary heart disease (CHD) and total mortality, but they are not routinely available. We evaluated whether frontal plane QRS/T angle, easily obtained as the difference between frontal plane axes of QRS and T, provides a suitable substitute for spatial QRS/T angle as a risk predictor. Our study consisted of 13,973 participants from the ARIC Study. Outcome variables were incident CHD and total mortality during a median follow-up of 14 years. Electrocardiographic variables were categorized as abnormal (>/=95th percentile), borderline (>/=75th and <95th percentile), and normal (<75th percentile) separately for men and women. Cox regression was used to assess the effect of electrocardiographic variables on risk of each outcome. The normal category was considered the reference cell. With adjustment for demographic and clinical characteristics, both QRS/T angles were approximately equally strong predictors of total mortality with >50% increased risk. Spatial QRS/T angle was a stronger predictor of incident CHD in women, with a 114% increased risk, but it was not significantly associated with risk of incident CHD in men. Similarly, frontal plane QRS/T angle was statistically significant for only women with a 74% increased risk of incident CHD. In conclusion, frontal plane QRS/T angle as an easily derived risk measure is a suitable clinical substitute for spatial QRS/T angle for risk prediction.

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

“…Although several reports have shown that findings on the routine ECG are associated with future HF events,8, 9, 10, 11, 12, 13, 14, 15, 16, 17 few have explored whether ECG predictors vary in their ability to distinguish between HFrEF and HFpEF. A recent examination from the Framingham Heart Study has shown that left ventricular hypertrophy and left bundle‐branch block are associated with HFrEF and that atrial fibrillation is associated with HFpEF 28.…”

“…A number of studies have demonstrated that several markers detected on the routine ECG are associated with future HF events8, 9, 10, 11, 12, 13, 14, 15, 16, 17; however, it is currently unknown if a differential risk profile exists for these ECG markers in the prediction of HFrEF versus HFpEF. The ability to identify specific predictors for HFrEF and HFpEF is an important step to target appropriate preventive strategies for each HF subtype.…”

Comparison of Spatial QRS:T Angle in Different Healthy Racial Groups

“…It is known that the mean spatial QRS-T angle is, in general, higher for males than females [12]. There is a wide spectrum of normal limits for spatial QRS-T angle in the literature.…”

Changes of Virtual Planar QRS and T Vectors Derived from Holter in the Populations with and without Diabetes Mellitus

“…[62][63][64] This kind of relationship between QRS-T angle and cardiac autonomic neuropathy may suggest structural, functional, and electrical imbalance. 65 Furthermore, spatial QRS-T angel >45-50 degrees in T2DM increased the risk of incidents of cardiovascular disease by 114% total mortality increase by two folds 33 and the morbidity of silent myocardial infarction by 19%. 66 Although FQRSTA derived from planar ECG and spatial vector may be used to estimate the prognosis and morbidity of cardiac diseases mentioned above; we have not yet analyzed the influence of FQRSTA from Holter on prognosis or diagnosis of cardiac diseases in this study.…”

“…41 FQRSTA is a very powerful predictor of cardiovascular events (e.g., myocardial ischemia), 42 sudden cardiac death, [13][14][15][16][17]43 appropriate ICD therapy, 44,45 all-cause mortality, 15,[33][34][35][36][37] increased cardiac-related hospitalizations, 17,35 reduced left ventricular function, [34][35][36]46 especially in patients with postinfarction, [13][14][15][16][17] acute myocardial infarction with LVEF ࣘ40%, 47 the elderly, 12 chronic dialysis, [18][19][20] heart failure with preserved ejection fraction, 17 and ischemic stroke 48 considered stronger than any of the classical cardiovascular risk factors. 16,17 Risk factors leading to an elevation in FQRSTA were related to coronary artery disease, dialysis, poor-controlled hypertension, 49,50 pulmonary arterial hypertension, 51 left/right ventricular hypertrophy, 51-54 dilated left ventricle, 55 lower LVEF, 56 DM, 57, 58 smoking, [57][58][59] and female gender.…”