Evaluation of frontal plane QRS-T angle in patients with slow coronary flow (original) (raw)
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The Anatolian Journal of Cardiology, 2019
Frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single vessel disease Objective: Fractional flow reserve (FFR) measurement is used to decide the hemodynamic significance of coronary artery lesion. QRS-T angle (QRSTa) is a novel marker of myocardial repolarization abnormality and is affected by obstructive coronary artery disease. The aim of the present study was to evaluate the association between QRSTa and coronary FFR measurement in patients with isolated left anterior descending (LAD) artery stenosis. Methods: A total of 197 patients undergoing FFR measurement for isolated LAD artery stenosis were retrospectively enrolled in the present study. According to FFR value, patients were divided into two groups as 139 patients with normal FFR (>0.80, group 1) and 58 patients with low FFR (≤0.80, group 2). A 12-lead surface electrocardiography of all subjects that had been recorded before performing coronary angiography was evaluated to measure QRSTa, as well as baseline demographic and clinical variables. Results: The mean age of group 2 was significantly higher than that of group 1 (61±11 and 64±11, p=0.044). While there were no differences in heart rate, QRS duration, and corrected QT interval between the two groups, QT interval [377 (359-397) and 379 (367-410), p=0.045] and frontal QRSTa [59 (10-120) and 86 (22-132), p<0.001] were higher in group 2. QT interval [odds ratio (OR)=1.046, 95% confidence interval (CI)=1.010-1.084, p=0.012] and frontal QRSTa (OR=1.025, 95% CI=1.010-1.041, p=0.001) were found to be independent predictors of low FFR value in multivariate logistic regression analysis. Conclusion: In the present study, FFR measurement was demonstrated to be correlated with wide QRSTa as a noninvasive and easy method. Thus, we suggest that the results of FFR measurement as an invasive modality can be previously predicted with a simple electrocardiographic evaluation, such as QRSTa.
Assessment of the relationship between a narrow fragmented QRS complex and coronary slow flow
Cardiology journal, 2015
The coronary slow flow (CSF) phenomenon is a delayed antegrade progression of contrast agent to the distal branch of a coronary artery in the absence of obstructive coronary artery disease (CAD). A narrow fragmented QRS (fQRS) has been reported as a significant predictor of sudden cardiac death in patients with idiopathic dilated cardiomyopathy. The present study aimed to investigate the relationship between a narrow fQRS on the admission electrocardiogram (ECG) and CSF on coronary angiography. This study included 165 consecutive patients (112 CSF,53 controls) who underwent first-time diagnostic conventional coronary angiography for suspected CAD. Coronary flow was quantified by thrombolysis in myocardial infarction (TIMI) frame count (TFC). The patients were divided into two groups according to the presence or absence of a narrow fQRS complex on the admission ECG. Forty four patients were in the fQRS group (mean age, 52.97±3.13 years). There was no difference between the 2 groups w...
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 2014
Coronary slow flow (CSF) is characterized by normal or near-normal coronary arteries with delayed opacification of the distal vasculature that it may cause angina pectoris, acute myocardial infarction, life-threatening arrhythmias, and sudden cardiac death. The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are also known as predictors of ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with CSF by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. This study included 50 patients with CSF and 51 control subjects. Coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction (TIMI) frame count (TFC). Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. In electrocardiographic parameters analysis, QT, QTc, QTd, and QTcd were significantly increased in CSF patients compared with the control subjects (P...
PloS one, 2018
Heart failure (HF) is associated with considerable mortality. The electrocardiographic frontal QRS-T angle is a simple parameter to measure, reflects changes in the direction of the repolarization sequence and predicts outcome in patients with HF. Data regarding temporal changes in the frontal QRS-T angle in patients with HF and its impact on outcome is limited. To evaluate temporal changes in the frontal QRS-T angle and its effect on survival in patients with HF. Baseline and follow-up QRS-T angle were calculated from the frontal QRS and T axis of the 12-lead surface electrocardiogram. Patients were followed for survival. 2,929 HF patients were evaluated. Median interval between baseline ECG and follow-up ECG was 895 days, median follow-up time was 1526 days. Overall, the QRS-T angle tended to be stable, with minor changes in the angle over time. The median QRS-T angle change was +3° (IQR -19° to +30°). Overall survival during follow-up was 60%. Cox regression analysis after adjust...
The American Journal of Cardiology, 2013
The risk of death in heart failure (HF) is high. The electrocardiographic spatial QRS-T angle reflects changes in the direction of the repolarization sequence and predicts death in the general population. The frontal QRS-T angle is simple to measure but has not been evaluated in a large chronic HF cohort. We examined the significance of the frontal QRS-T angle in predicting the clinical outcome in a large cohort of patients with HF. The QRS-T angle was calculated from the frontal QRS and T axis of the baseline 12-lead surface electrocardiogram. The patients were followed for cardiac-related hospitalizations and death; 5,038 patients with HF were evaluated. The mean follow-up period was 576 days; 51% were men. Overall survival during the follow-up period was 83%. Cox regression analysis after adjustment for significant predictors, including age, gender, ischemic heart disease, hypertension, atrial fibrillation, body mass index, pulse, serum hemoglobin, sodium, estimated glomerular filtration rate, and urea levels, demonstrated that the QRS-T angle was an incremental predictor of increased mortality in both genders. For women, a QRS-T angle of ‡60 had a hazard ratio of 1.35 (95% confidence interval 1.04 to 1.75; p <0.05) and a QRS-T angle of ‡120 had a hazard ratio of 1.45 (95% confidence interval 1.10 to 1.92, p <0.01). For men, a QRS-T angle of ‡130 had a hazard ratio of 1.53 (95% confidence interval 1.14 to 2.06, p <0.01). For the whole cohort, a QRS-T angle of ‡125 gave a hazard ratio of 1.47 (95% confidence interval 1.20 to 1.80, p <0.0001). The QRS-T angle was also a predictor of increased cardiac-related hospitalizations. The QRS-T angle was a predictor in patients with reduced and preserved left ventricular function and in patients with a normal QRS interval. In conclusion, the QRS-T angle was a powerful predictor of outcome in patients with HF. We believe the QRS-T angle should be a part of the electrocardiographic evaluation of patients with HF.
The Egyptian Journal of Hospital Medicine
Background: When there is minimal epicardial coronary stenosis, the coronary slow flow phenomenon (CSFP) is characterized by delayed distal artery opacification. The sluggish velocity of dye in coronary arteries is known as the slow coronary flow (SCF) phenomenon. Dispersion in QT interval and P wave are 2 electrocardiographic findings which can predict predisposing of individuals for developing fatal arrhythmia. The aim of this study was to find association between QT interval and P wave dispersion in acute coronary syndrome patients with CSFP. Patients and methods: This cross-sectional study was carried out on 200 cases undergoing diagnostic coronary angiography; Group 1 included 100 patients with acute coronary syndrome and CSFP, and Group 2 included 100 patients with acute coronary syndrome without CSFP. Results: We found no statistically significant differences between Group 1 and Group 2 according to demographic data, diabetes mellitus, hypertension, dyslipidemia and smoking. QTD, PWD, CTFC LAD, CTFC LCX, CTFC RCA and CTFC were significantly higher among Group 1. QTD showed AUC of 0.996. At best cutoff value of 46.5, sensitivity was 99.75% and specificity was 99.8%. PWD showed AUC of 0.99. At best cutoff value of 23.5, sensitivity was 96.55% and specificity was 98.3%. QT interval showed significant positive correlations with PWD and CTFC. Otherwise, QT interval showed non-significant correlations with other parameters in all studied cases. Conclusion: There is an association between QT interval and PWD in acute coronary syndrome patients with slow coronary flow phenomenon.
The Status of Frontal QRS-T Angle in Hypertensive Patients with Different Left Ventricular Geometry
Sakarya Medical Journal, 2021
Objective Assessing left ventricular (LV) structure and function gives information on cardiovascular morbidity and mortality, making it essential for evaluating hypertensive heart disease. Frontal QRS-T angle (fQRSTa) is a novel approach to quantify the heterogeneity between myocardial depolarization and repolarization. The main purpose of the present study was to define the correlation between different LV geometric patterns and fQRSTa in patients with hypertension (HT). Materials and Methods 273 patients with hypertension admitted to the cardiology outpatient clinic were enrolled consecutively. All patients were evaluated by transthoracic echocardiography and classified into three groups based on LV hypertensive geometry as normal geometry (group 0), concentric remodeling (group 1), and concentric or eccentric hypertrophy (group 2). The fQRSTa was defined as the absolute angle difference between the frontal plane QRS axis and T wave axis. Results Compared with group 0, fQRSTa was higher in group 1 (12 [6-19] vs. 17 [12-24], p=0.023) and group 2 (12 [6-19] vs. 39 [28-54], p<0.001). Also, fQRSTa was higher in group 2 than group 1 (p<0.001). Correlation analysis revealed a significant correlation between fQRSTa and LV geometry (r=0.525, p<0.001). Multiple linear regression analysis revealed that fQRSTa was independently correlated with Em to Am ratio (β=0.104, p=0.045), left ventricle mass index (β=0.342, p<0.001), QTc (β=0.194, p<0.001), and LV geometry (β=0.257, p<0.001). Conclusion Patients with LVH were found to have wider fQRSTa and longer QT duration than those with normal ventricles or concentric remodeling. Keywords Left ventricular geometry; frontal QRS-T angle; hypertension Öz Amaç Hipertansif kalp hastalığının değerlendirilmesinde sol ventrikül (SV) yapısının ve fonksiyonunun incelenmesi, kardiyovasküler morbidite ve mortalite hakkında önemli bilgiler sağlar. Frontal QRS-T açısı (fQRSTa), miyokardiyal depolarizasyon ve repolarizasyon arasındaki heterojenliği ölçmek için kullanılan yeni bir yöntemdir. Bu çalışmanın temel amacı, hipertansiyonlu (HT) hastalarda farklı SV geometrik paternleri ile fQRSTa arasındaki ilişkiyi incelemektir. Gereç ve Yöntemle Kardiyoloji polikliniğine başvuran ardışık 273 hipertansiyon hastası çalışmaya dahil edildi. Tüm hastalar transtorasik ekokardiyografi ile değerlendirildi ve SV geometrik yapısına göre normal geometri (grup 0), konsantrik yeniden şekillenme (grup 1) ve konsantrik veya eksantrik hipertrofi (grup 2) olarak üç gruba ayrıldı. fQRSTa, frontol düzlem QRS aksı ile T dalga aksı arasındaki mutlak açı farkı olarak tanımlandı.
Prognostic Significance of Frontal QRS-T Angle in Patients with Idiopathic Dilated Cardiomyopathy
Chinese medical journal, 2016
Current risk stratification of idiopathic dilated cardiomyopathy (IDC) lacks sufficient sensitivity and specificity. The objective of this study was to investigate the predictive role of frontal QRS-T angles in IDC. A prospective study with 509 IDC patients was performed from February 2008 to December 2013 in the Affiliated Drum Tower Hospital, Nanjing University School of Medicine. Baseline values and changes in QRS-T angles were recorded. Follow-up was conducted every 6 months. Analyses by Cox Proportional Hazards model were performed to evaluate the association between QRS-T angle and outcomes. The primary outcome of interest was all-cause mortality. During a median follow-up of 34 months, 90 of 316 patients with QRS-T angles >90° died compared to 31 of 193 patients with QRS-T angles ≤90° (hazard ratio [HR] =2.4, P < 0.001). Cardiac death was more prevalent in patients with a wide QRS-T angle (HR = 2.4, P < 0.001), similar to heart failure rehospitalization (HR = 2.5, P ...