The Electrical T-Axis and the Spatial QRS-T Angle Are Independent Predictors of Long-Term Mortality in Patients Admitted with Acute Ischemic Chest Pain

Torbal, Anneke de; Kors, Jan A.; Herpen, Gerard van; Meij, S.; Nelwan, S.P.; Simoons, Maarten L.; Boersma, Eric

doi:10.1159/000076697

Cited by 57 publications

(34 citation statements)

References 29 publications

(39 reference statements)

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“…An abnormal spatial QRS-T angle is a strong and independent predictor of cardiovascular mortality in general populations and in patients with acute ischemic chest pain. [7][8][9][10] Similarly, it has been shown to predict arrhythmic death in patients who have had myocardial infarctions and to predict cardiovascular events in women with suspected myocardial ischemia. 11,12 The calculation of the spatial QRS-T angle requires dedicated software that is not widely available and cannot be derived by visual ECG analysis after acquisition.…”

Section: Clinical Perspective P 3186mentioning

confidence: 99%

Prognostic Value and Temporal Behavior of the Planar QRS-T Angle in Patients With Nonischemic Cardiomyopathy

et al. 2008

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Background-The planar QRS-T angle can be easily obtained from standard 12-lead ECGs, but its predictive ability is not established. We sought to determine the predictive ability of the planar QRS-T angle in patients with nonischemic cardiomyopathy and to assess QRS-T angle behavior over time. Methods and Results-Baseline QRS-T angles from 455 patients in the Defibrillators in Nonischemic CardiomyopathyTreatment Evaluation (DEFINITE) trial were measured. All patients had nonischemic cardiomyopathy, New York Heart Association class I to III heart failure, and nonsustained ventricular tachycardia or frequent ventricular ectopy. The primary end point (a composite of total mortality, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest) occurred in 25 of 172 patients (14.5%) with a QRS-T angle Յ90°and in 72 of 283 patients (25.4%) with a QRS-T angle Ͼ90°(hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.05; Pϭ0.002). A QRS-T angle Ͼ90°remained a significant predictor of the primary end point (Pϭ0.039) after adjustment for treatment group, age, gender, QRS duration, left bundle-branch block, left ventricular ejection fraction, New York Heart Association class III, atrial fibrillation, and diabetes mellitus. The secondary end point (total mortality) occurred in 17 of the 172 patients (9.9%) with a QRS-T angle Յ90°and in 49 of the 283 patients (17.3%) with a QRS-T angle Ͼ90°(hazard ratio, 1.79; 95% confidence interval, 1.03 to 3.10; Pϭ0.016). A sample of 152 patients with multiple follow-up ECGs was analyzed to assess temporal QRS-T angle behavior. Changes in the QRS-T angle correlated with changes in left ventricular ejection fraction and QRS duration over time (PϽ0.001). Conclusions-A planar QRS-T angle

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Section: Clinical Perspective P 3186mentioning

confidence: 99%

Prognostic Value and Temporal Behavior of the Planar QRS-T Angle in Patients With Nonischemic Cardiomyopathy

et al. 2008

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“…Large differences between the orientations of the two wave fronts are associated with decreased survival and higher incidence of arrhythmic events in post-MI patients [22]. Also other studies have shown the prognostic value of QRSSTT angle or the T-wave axis [23][24][25]. Our QRSSTT integral parameter and mirror image in BSPM consider the amplitudes of the wave fronts, which the TCRT ignores.…”

Section: Discussionmentioning

confidence: 94%

Localization of prior myocardial infarction by repolarization variables

Vesterinen

Väänänen²,

Stenroos³

et al. 2008

International Journal of Cardiology

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“…Furthermore, there was a significant correlation between TCRT and the VG-index in all patients, but no relationship between TCRT and negative T in any of the patients. Kors et al, 1 Kardys et al, 7 and de Torbal et al, 8 demonstrated the usefulness of the orientation of the T-axis for cardiac risk stratification, which is based on diagnostic vectorcardiography. Such an abnormal T-axis reflects repolarization abnormalities and its deviation can be attributed to ischemic changes such as T-wave inversion and ST-T changes.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of a New Repolarization Descriptor Substituted for T-Wave Morphology Analysis in Patients With Cardiomyopathy and Myocardial Infarction

Ono

Saitoh

Itakura

et al. 2006

Circ J

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ors et al assessed the orientation of the T-axis for cardiac risk stratification based on the theory of diagnostic vectorcardiography. 1 The T-axis was a strong and independent predictor of fatal and non-fatal cardiac events in the population of the Rotterdam study. Furthermore, the prognostic value of an abnormal T-axis has been proved to be greater than other electrocardiogram (ECG) risk factors of T-wave inversion and ST depression. However, the physiologic meaning of an abnormal T-axis remains unclear.Recently, T-wave morphology analysis (TMA) was hypothesized to quantify the irregularities of ventricular repolarization based on singular value decomposition of standard 12-lead ECGs. 2 TMA analysis assesses both ventricular depolarization and repolarization independent of the accuracy of measuring the repolarization process, such as QT interval and QT dispersion. Thus, TMA makes important the relationship between the QRS and T-wave vectors, and the morphological varieties of the T-wave.The total cosine R-to-T (TCRT) in the TMA descriptors is dependent on the spatial angle between depolarization and repolarization, in keeping with the concept of the ventricular gradient (VG). Zabel et al reported that the TCRT is the only descriptor of TMA that is a strong and independent predictor of adverse outcome in patients with myocardial infarction (MI). 3 Both the T-axis and TCRT are derived from the computed analysis of a vectrocardiographic ECG reconstructed from the standard 12-lead ECG. 1,2 A TCRT less than -0.888 is associated with increased 5-year cardiac mortality in a population with MI. 4 Furthermore, a TCRT less than -0.888 occurs in the case of a vectorcardiographic ECG with an angle >150 degrees between the QRS loop and the T-wave loop. Thus, we propose a new indicator relating the axes of QRS and T-waves on the surface ECG. In this study, we evaluated its characteristics in patients with cardiomyopathy (CM) or MI, which often present with T-wave inversions and ST depression. The aim of this study was to assess the correlation between TCRT and the axes of QRS and T-wave on the surface ECG in patients with these conditions. Methods SubjectsPatients with CM or MI were recruited from Nippon Medical School Hospital (Tokyo, Japan) and Yashio Heart Hospital (Saitama, Japan) from February 2002 to February Background Total cosine R-to-T (TCRT) is a descriptor of T-wave morphology analysis based on singular value decomposition of 12-lead electrocardiograms (ECGs), which is useful in risk stratification of patients with myocardial infarction (MI). A new marker of standard ECG substituted for TCRT is proposed and the aim of this study was to evaluate the correlation between the new index and TCRT in patients with cardiomyopathy and MI. Methods and ResultsPatients were divided into 2 groups: patients with cardiomyopathy (group CM, n=21, male =13), and patients with MI (group MI, n=36, male =28). TCRT was calculated using a custom software package. The ventricular gradient (VG)-index was defined as the total number of l...

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The Electrical T-Axis and the Spatial QRS-T Angle Are Independent Predictors of Long-Term Mortality in Patients Admitted with Acute Ischemic Chest Pain

Cited by 57 publications

References 29 publications

Prognostic Value and Temporal Behavior of the Planar QRS-T Angle in Patients With Nonischemic Cardiomyopathy

Prognostic Value and Temporal Behavior of the Planar QRS-T Angle in Patients With Nonischemic Cardiomyopathy

Localization of prior myocardial infarction by repolarization variables

Characteristics of a New Repolarization Descriptor Substituted for T-Wave Morphology Analysis in Patients With Cardiomyopathy and Myocardial Infarction

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