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

Abstract

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

Electrocardiographic markers of left ventricular systolic dysfunction in patients with left bundle branch block

“…A planar QRS-T angle > 90° has been shown to be a significant predictor of a composite end point of death, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest in non-paced, mild to moderately symptomatic patients with non-ischaemic cardiomyopathy. A widening QRS-T angle has been proposed to represent a continuum of worsening underlying pathology and outcome [23]. Discordant LBBB was more frequent in patients with EF < 50% in our study.…”

Predicting Ventricular Arrhythmias in Patients With Ischemic Heart Disease

“…Previous studies demonstrated that a spatial QRS-T angle wider than 100°is associated with the presence of cardiac disease and increased cardiovascular mortality. 20,21 Pavri et al 22 recently demonstrated that a planar QRS-T angle wider than 90°is associated with an increased incidence of appropriate device shocks and mortality. In the present study, these cutoffs (100°for the spatial and 90°for the planar QRS-T angle) were applied.…”

“…29 In our population of ischemic primary prevention ICD recipients, patients with a wide planar QRS-T angle demonstrated a HR of 2.5 for the need of defibrillator backup and 3.1 for all-cause mortality. In the recently published post hoc analysis of the DEFINITE trial by Pavri et al, 22 the planar QRS-T angle was analyzed as a predictor of the composite end point of appropriate device therapy, mortality, and resuscitated cardiac arrest in a population with nonischemic cardiomyopathy. In this study, the HR of a planar QRS-T angle wider than 90°for the occurrence of appropriate device therapy was 1.95 (95% CI, 1.24 to 3.08).…”

“…20,21 Subsequently, a wide QRS-T angle was found to be associated with the increased incidence of appropriate device therapy and mortality in primary prevention ICD recipients with nonischemic cardiomyopathy. 22 However, no data are available on the value of the QRS-T angle in ICD patients with IHD.…”

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

“…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.…”