Spatial QRS-T angle predicts cardiac death in a general population

Kardys, Isabella; Kors, Jan A.; Meer, I.M. van der; Hofman, Albert; Kuip, Deirdre A. M. van der; Witteman, Jacqueline C. M.

doi:10.1016/s0195-668x(03)00203-3

Cited by 237 publications

(196 citation statements)

References 26 publications

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“…Furthermore, electrical remodeling of the heart observed as changes in the overall magnitude and direction of the heart's electrical depolarization and repolarization and manifested as an altered QRS‐T angle (Kardys et al., 2003) was detected in the HD subjects, suggesting it as another possible marker of increased risk of cardiac mortality in patients with HD.…”

Section: Discussionmentioning

confidence: 90%

“…However, numerous studies indicate that conventional ECG variables may not be the most reliable predictors of heart failure (Acar, Yi, Hnatkova, & Malik, 1999; Kardys et al., 2003; Man et al., 2012; Bacharova & Estes, 2017; Schlegel et al., 2010). …”

Section: Discussionmentioning

confidence: 99%

“…The vectorcardiogram was derived using the Frank‐lead reconstruction technique of Kors and coworkers (Kors, van Herpen, Sittig, & Bemmel, 1990) to establish several vectorcardiographic variables as previously described by Draper and coworkers (Draper, Peffer, Stallmann, Littmann, & Pipberger, 1964), including the spatial mean QRS‐T angle (Kardys et al., 2003). In this study, QRS‐T angles were determined between vectors at the peak value of the QRS complex and T‐wave (QRS‐T peak) and between the corresponding mean QRS and T‐wave vectors (QRS‐T mean).…”

Section: Methodsmentioning

confidence: 99%

“…Besides the measurement of HRV, which has been used predominantly for the assessment of sympathovagal balance, these techniques include indices of the electrical remodeling of the ventricles (e.g., the QRS‐T angle [Kardys et al., 2003]), ventricular depolarization (e.g., high‐frequency QRS [HFQRS] ECG [Abboud, Berenfeld, & Sadeh, 1991; Schlegel et al., 2004]), and ventricular repolarization. The indices of ventricular repolarization comprise various indices of QT interval variability (QTV), such as the QT variability index (QTVI) (Atiga et al., 1998; Berger et al., 1997; Starc & Schlegel, 2006) and the unexplained part of QTV (unexplained QTV), which represents an intrinsic part of QTV independent of simultaneous heart rate variability, the influence of the heart rate on QTV having been eliminated (Starc & Schlegel, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…(2003), an increased spatial QRS‐T angle had more prognostic value for fatal endpoints than any classic cardiovascular risk factor, including diabetes. Finally, a number of studies show that the index of QT interval variability QTVI (Berger et al., 1997) can identify patients at risk for sudden cardiac death (Atiga et al., 1998; Haigney et al., 2004; Piccirillo et al., 2007), possibly even more than both left ventricular ejection fraction (as assessed by ultracardiography) and T‐wave alternans (Atiga et al., 1998; Berger et al., 1997).…”

Section: Introductionmentioning

confidence: 99%

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Evidence of cardiac electrical remodeling in patients with Huntington disease

et al. 2018

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ObjectiveAlthough Huntington's disease (HD) is a disease of the central nervous system, HD mortality surveys indicate heart disease as a major cause of death. Cardiac dysfunction in HD might be a primary consequence of peripherally expressed mutant huntingtin or secondary to either a general decline in health or the onset of neurological dysfunction. The aim of the study was to clarify the heart muscle involvement.Materials and MethodsWe measured conventional and advanced resting ECG indices. Thirtyone subjects with a confirmed huntingtin gene mutation and 31 age‐ and gender‐matched controls were included. The HD subjects were divided into four groups based on their Unified Huntington Disease Rating Scale (UHDRS) motor score.ResultsWe detected changes in advanced ECG variables connected with electrical ventricular remodeling (t test, p < 0.01). The increase in the unexplained part of both QT variability and the standard deviation of normal‐to‐normal QT intervals, presumably reflecting beat‐to‐beat changes in repolarization, was most pronounced. Further, both variables correlated with the product of the cytosine–adenine–guanine (CAG) triplets’ repeat length and the subjects’ age (CAP), the former R = 0.423 (p = 0.018) and the latter R = 0.499 (p = 0.004). There was no correlation between the CAP score and any of variables representing autonomic nervous system activity.ConclusionsBoth autonomic nervous system dysfunction and cardiac electrical remodeling are present in patients with HD. The changes in advanced ECG variables observed in the study evolve with HD progression. The increased values of QT unexplained variability may be a marker of temporal inhomogeneity in ventricular repolarization associated with malignant ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence of cardiac electrical remodeling in patients with Huntington disease

et al. 2018

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Incidence and Prognosis of Transient Neurological Attacks

Bos¹,

Rijn²,

Witteman³

et al. 2007

JAMA

128

142

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HE FIRST INTERNATIONALLY ACcepted clinical classification for cerebrovascular disorders was formulated in 1975. 1 It included diagnostic criteria for transient attacks of neurological dysfunction, which in the present article we will call transient neurological attacks (TNAs). The classification attempted to create a formal distinction between TNAs with an unfavorable clinical course (which were presumed to be of vaso-occlusive origin and were therefore called transient ischemic attacks [TIAs]) and more benign attacks. Transient ischemic attacks were defined as temporary attacks (commonly 2-15 minutes, maximum 24 hours) with focal symptoms, which are attributable to dysfunction of one arterial territory of the brain. The remaining TNAs, with diffuse, nonlocalizing cerebral symptoms, were considered more benign. We will call these TNAs either nonfocal TNAs, if they present with only nonfocal symptoms, or mixed TNAs, if they present with a mix of focal and nonfocal symptoms.Although the conventional diagnostic criteria for TIA are clear, it is uncertain how mixed TNAs should be classified and treated. In our experience, mixed TNAs have mostly been classified as TIAs until now, both by neurologists and by general practitioners, 2,3 but it seems reasonable to assume that some physicians may take a wait-and-see attitude in patients with mixed attacks. For nonfocal TNAs, a wide variety of diagnoses is commonly applied and none fulfills criteria for TIA. The relations between symptoms, the conventional clinical classification, and the classification used in this article follows: conventional classifies focal symptoms as TIAs and nonfocal symptoms as nonspecific, which could include syncope, confusion or transient global amnesia. The conventional classification is ambiguous on mixed symptoms. The proposed TNA classification categorizes the symp-See also p 2912 and Patient Page.

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The Diagnostic Value of Electrocardiographic Abnormalities

Luna

2012

Clinical Electrocardiography

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Spatial QRS-T angle predicts cardiac death in a general population

Abstract: The spatial QRS-T angle is a strong and independent predictor of cardiac mortality in the elderly. It is stronger than any of the classical cardiovascular risk factors and ECG risk indicators and provides additional value to them in predicting fatal cardiac events.

Cited by 237 publications

References 26 publications

Evidence of cardiac electrical remodeling in patients with Huntington disease

Evidence of cardiac electrical remodeling in patients with Huntington disease

Incidence and Prognosis of Transient Neurological Attacks

The Diagnostic Value of Electrocardiographic Abnormalities

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