Usefulness of Electrocardiographic Frontal QRS-T Angle to Predict Increased Morbidity and Mortality in Patients With Chronic Heart Failure

Gotsman, Israel; Keren, Andre; Hellman, Yaron; Banker, Jeffrey; Lotan, Chaim; Zwas, Donna R.

doi:10.1016/j.amjcard.2013.01.294

Cited by 51 publications

(36 citation statements)

References 14 publications

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“…The PRIMERI study utilized hospital ECG database screening, and enrolled patients with wide QRS-T angle, or high QRS score, who are known to be at risk for cardiac arrhythmias (both AF and ventricular arrhythmias) 32, 22, 33, 34 .…”

Section: Discussionmentioning

confidence: 99%

Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study

Win¹,

Ambale-Venkatesh²,

Volpe³

et al. 2015

Heart Rhythm

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Background Abnormal P-terminal force in V1 (PTFV1) is associated with an increased risk of heart failure, stroke, atrial fibrillation (AF) and death. Objective Our goal was to explore associations of left ventricular (LV) diffuse fibrosis with left atrium (LA) function and ECG measures of LA electrical activity. Methods AF-free patients (n=91, mean age 59.5, 61.5% men, 65.9% Caucasian) with structural heart disease (wide spatial QRS-T angle≥105° ± Selvester QRS score≥5 on ECG) but LV ejection fraction >35% underwent clinical evaluation, cardiac magnetic resonance and resting ECG. LA function indices were obtained by multimodality tissue tracking using 2 and 4-chamber long-axis images. T1 mapping and late gadolinium enhancement were used to assess diffuse LV fibrosis and presence of scar. P-prime in V1 amplitude (PPaV1) and duration (PPdV1), averaged P-duration, PR interval and P-axis were automatically measured using 12SL TM algorithm. PTFV1 was calculated as product of PPaV1 by PPdV1. Results In linear regression after adjustment for demographic, body mass index, LA volumemax index, presence of scar and LV mass index, each decile increase in LV interstitial fibrosis was associated with 0.76mV*ms increase in negative abnormal PTFV1 [(95%CI −1.42 to −0.09), P=0.025], 15.3ms prolongation in PPdV1 [(95%CI 6.9 to 23.8), P=0.001], and 5.4ms widening in averaged P-duration [(95%CI 0.9 to 10.0), P=0.020]. LV fibrosis did not affect LA function. PPaV1 and PTFV1 were associated with an increase in LA volumes, decrease in LAEF and LA reservoir function. Conclusion LV interstitial fibrosis is associated with abnormal PTFV1, prolonged PPdV1 and P-duration, but does not affect LA function.

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Section: Discussionmentioning

confidence: 99%

Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study

Win¹,

Ambale-Venkatesh²,

Volpe³

et al. 2015

Heart Rhythm

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“…2–14 Frontal QRS/T angle is an alternative to the spatial QRS/T angle as an easily calculated parameter from frontal plane QRS and T axis available from computer-ECG reports. 6–11 Zhang et al evaluated the association of BBB and the risk of incident HF during 14 year follow-up in 65,975 participants in the Women’s Health initiative. 14 The results showed that a pooled BBB groups including LBBB, IVCD, and RBBB combined with LAFB was a strong predictors of incident HF in multivariable adjusted risk models.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Electrocardiographic QRS/T Angles With Versus Without Bundle Branch Blocks to Predict Heart Failure (from the Atherosclerosis Risk in Communities Study)

Zhang

Rautaharju

Prineas

et al. 2014

The American Journal of Cardiology

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Repolarization abnormalities in the setting of bundle branch blocks (BBB) are generally ignored. We used Cox regression models to determine hazard ratios (HR) with 95% confidence intervals (CI) for incident heart failure (HF) associated with wide spatial and frontal QRS/T angle (upper 25th 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, CI 1.37–1.66), 48% for BBB with normal spatial QRS/T angle (HR 1.48, CI 1.17–1.88), and the risk for incident HF was increased over 3-fold for BBB with wide spatial QRS/T angle (HR 3.37, CI 2.47–4.60). The results were consistent across subgroups by sex. Similar results were observed for the frontal plane QRS/T angle. In the pooled BBB group excluding RBBB, 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 heart failure, 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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“…A decade ago, we first reported that the frontal plane QRS/T angle was a ‘suitable clinical substitute’ for spatial QRS/T angle with respect to CHD risk prediction in the ARIC study [12]. Since then, the frontal QRS/T angle has been intensively studied in various populations, as a predictor of different outcomes including heart failure, atrial fibrillation, sudden cardiac death, and all-cause mortality [16–18,24–26]. Our study adds SMI to this list of outcomes, for the first time.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Rautaharju

Prineas

et al. 2017

Journal of Electrocardiology

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Background Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown. Methods We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54 years, 57% women, and 20% African-American), who were free of cardiovascular disease at baseline (visit 1, 1987–1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996–1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal). Results A total of 317 (3.3%) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95% CI 1.58–3.29) and spatial (HR 2.10, 95% CI 1.44–3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex. Conclusions Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.

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Usefulness of Electrocardiographic Frontal QRS-T Angle to Predict Increased Morbidity and Mortality in Patients With Chronic Heart Failure

Cited by 51 publications

References 14 publications

Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study

Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study

Usefulness of Electrocardiographic QRS/T Angles With Versus Without Bundle Branch Blocks to Predict Heart Failure (from the Atherosclerosis Risk in Communities Study)

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

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