The Spatial QRS-T Angle: Implications in Clinical Practice

Abstract

The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment of dispersion of repolarization, a key factor in arrythmogeneity.

Frontal QRS-T Angle and the Incidence of Intracranial Cerebral Aneurysm

“…DISCUSSION QRS-T angle, described as the angle between the mean QRS and T vectors, reflects the main orientation of electrical heart activity during ventricular depolarization and repolarization. A wider QRS-T angle indicates an abnormal set of ventricular repolarization and is considered as a novel risk marker for cardiovascular morbidity and mortality compared to other traditional cardiovascular risk factors and ECG risk parameters [2]. Recent studies demonstrated that hypertension and CAD were probably the main underlying pathophysiological conditions for an abnormal QRS-T angle [3][4][5] .…”

“…It is described as the angle between the main electrical axes of ventricular depolarization and repolarization [1]. Previous studies in literature showed that hypertension and coronary artery disease (CAD) may cause a widened QRS-T angle on electrocardiogram (ECG) [2][3][4][5].…”

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.…”

“…76 Meanwhile, the QRS-T angle depended on heterogeneity and dynamical change of the action potential duration in myocardial cells, and its gradients of transmural, apicobasal, and leftright ventricle. 65 The potentially pathophysiological mechanisms of planar QRS and T vector change were induced by the risks of multiple levels and factors, including DM, lipid metabolism, cardiac electrical disturbance, and smoking, which thus caused adverse cardiac structure, functional and autonomic change, and imbalance.…”

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

“…Indeed, Yamasaki et al found that, for a mainly male clinical population, it was the most significant predictor of cardiovascular mortality [3]. In their 2013 review, Voulgari et al published a table summarising the studies on the prognostic value of this measurement on cardiovascular morbidity and mortality [4]. They concluded that the spatial QRS-T angle is an important prognostic predictor and that it is superior to more conventional ECG parameters.…”