Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis

Abstract

BackgroundA 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.MethodsPubMed, 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.ResultsTwenty-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.ConclusionsSpatial 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.

Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study

“…Wide QRS/T angles might be associated with myocardial structure and functional change. Over the years, a wide spatial QRS/T angle has been repeatedly shown to be associated with increased risk of all-cause mortality, cardiac mortality, and sudden cardiac death in several cohort studies [11–20]. To our knowledge this is the first report documenting that spatial QRS/T angles also is associated with risk of incident SMI.…”

“…Abnormally wide spatial QRS/T angle has been repeatedly shown to be among the strongest ECG markers of abnormal repolarization predictive of cardiovascular disease (CVD) events and mortality [11–20]. Nevertheless, computation of the spatial QRS/T angle from the standard 12-lead ECG requires several steps which is a challenge in its wide utilization.…”

Diagnostic and prognostic values of the QRS‐T angle in patients with suspected acute decompensated heart failure

“…29 A number of previous investigations examined the prognostic value of the QRS-T angle in various populations, including patients with arterial hypertension, diabetes, CKD, myocarditis, implanted cardiac devices, chronic heart failure, and suspected and confirmed myocardial ischaemia, as well as in the general population. [4][5][6][7][8][9][10][11][12][13][14] Across the spectrum, greater QRS-T angles were associated with increased risk of adverse events, rehospitalizations, and mortality. These findings were corroborated in our study, which was the first to evaluate the prognostic value of the QRS-T angle in patients with symptoms suggestive of ADHF.…”

“…It has recently been shown to improve the diagnostic accuracy in patients with suspected non-ST-elevation myocardial infarction, and large QRS-T angles have been associated with increased risk for ventricular arrhythmias, hospitalizations, and mortality in various populations. [4][5][6][7][8][9][10][11][12][13][14] The utility of the QRS-T angle in patients with suspected ADHF has not yet been assessed. The aim of this prospective multicentre study was therefore to evaluate the diagnostic and prognostic values of the QRS-T angle in patients presenting to the ED with symptoms suggestive of ADHF.…”

Clinical Application of the Spatial QRS-T Angle for the Prediction of Pulmonary Arterial Hypertension in Patients with Acute Pulmonary Embolism

“…In patients with chronic kidney diseases, both disease duration and poor outcome of dialysis is associated with increased spatial QRS-T angle [18]. Severe coronary atherosclerosis is also an independent predictor of increased QRS-T both in patients with chronic kidney diseases and in patients with isolated coronary artery disease [18,19]. Additionally, some anaesthetics and sedatives can affect VCG and increase risk of sudden cardiac death.…”