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The N ew P erspective of QRS-T Angle

The N ew P erspective of QRS-T Angle. 汕头大学医学院第一附属医院 谭学瑞. 1. The Concept of QRS-T Angle. The concept of QRS –T angle. The concept of QRS –T angle.

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The N ew P erspective of QRS-T Angle

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  1. TheNew Perspective of QRS-T Angle 汕头大学医学院第一附属医院 谭学瑞

  2. 1. TheConcept ofQRS-T Angle

  3. The concept of QRS –T angle

  4. The concept of QRS –T angle The QRS-T angle, defined as the angle between the directions of ventricular depolarization and repolarization, reflects underlying cardiac structural abnormalities and electrical heterogeneities causing abnormal changes in the direction of the repolarization sequence. spatial QRS-T angle frontal plane QRS-T angle frontal plane QRS-Tangle= 丨QRS axis - T axis丨(if ＞180° is subtracted from 360° to give a variable ranging from 0° to 180°) Peter W. Europace.2012,14:773-775

  5. Frontal plane QRS-T angle frontal plane QRS-T angle 10° QRS axis -3 ° T axis -13° T axis QRS axis The ECG was recorded from an apparently healthy 44-year-old man. Peter W. Europace.2012,14:773-775

  6. Frontal plane QRS-T angle QRS axis 73°, T axis 35°， frontal plane QRS-T angle38°

  7. The referenceranges Spatial QRS-T angle： normal＜105° abnormal＞135° Frontal plane QRS-T angle： normal＜50° abnormal ≥100 ° Aapo L. et al. Europace 2012 Comprehensive Electrocardiology. Oxford: Pergamon Press 1989.

  8. QRS-T angle Physiological age gender physique cardiac position …… Pathologic ventricular hypertrophy ischemia myocardial heart-block (ventricular) cardiac insufficiency …… Influence factors

  9. 2. QRS –T Angle and Cardiac Death

  10. QRS –T angle and cardiac death Purposeresearch the importance of wide frontal QRS-T angle, QRS-axis, and T-wave axis as cardiac risk predictors in general population Subjects a total 10 957 subjects between the ages of 30 and 59 years (males 52.3%) Follow-up average of 30±11 years Aapo L. et al. Europace 2012.

  11. QRS –T angle and cardiac death Characteristics of the subject at baseline by QRS-T angle classification a aPlus/minus values are means±SD. QTc denotes QT corrected for heart rate. bAdjusted for age. cAdjusted for sex. dAdjusted for age and sex. eIn leads other than V1 and aVR

  12. QRS –T angle and cardiac death 55.8% 79.7% Clinical outcomes associated with wide QRS-T angle

  13. QRS –T angle and cardiac death Kaplan–Meier survival plots for death from arrhythmia in subjects with wide QRS-T angle. Aapo L. et al. Europace 2012.

  14. QRS –T angle and cardiac death Spatial Subjects 7,052 (>40 years ,myocardial infarction, QRS duration of >120 ms or history of heart failure were excluded) Follow-up 14 years William W. et al. Am J Cardiol 2012

  15. Association between borderline and abnormal spatial QRS|T angle and all-cause and cardiovascular mortality William W. et al. Am J Cardiol 2012

  16. 3. QRS –T Angle andHeart Failure

  17. QRS –T angle and heart failure Subjects 458 patients with nonischemic dilated cardiomyopathy (21 to 80 years, LVEF≤ 35%) Behzed B. et al. Circulation 2008.

  18. QRS –T angle and heart failure Event Rates, HRs, and P Values for Primary and Secondary End Points Behzed B. et al.Circulation 2008.

  19. QRS –T angle and heart failure Subjects 5,038 patients with HF (51%male) Methods frontal QRS –T angle Flow-up mean of 576 days Israel G. et al. Am J Cardiol 2013

  20. Demographics and clinical characteristics according to QRS-Ta categories stratified by gender

  21. Kaplan-Meier survival analysis according to QRS-Ta category Usefulness of Electrocardiographic Frontal QRS-T Angle to Predict Increased Morbidity and Mortality in Patients With Chronic Heart Failure. Am J Cardiol 2013

  22. 4. QRS –T Angle and Acute Coronary Syndrome

  23. QRS –T angle and ACS Using 2-center prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort,1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Mark T. et al. Am J Cardiol 2012

  24. QRS –T angle and ACS Odds ratios (95% CI) for 2-year and 30-day all-cause mortality (Evaluation of Methods and Management of Acute Coronary Events 2 cohort) Mark T. et al. Am J Cardiol 2012

  25. Kaplan-Meier survival plots for 2-year mortality stratified by frontal QRS-T angle tertile in the EMMACE-2 cohort QRS –T angle and ACS Mark T. et al.. Am J Cardiol 2012

  26. 5. QRS –T Angle andLeft Ventricular Hypertrophy

  27. QRS –T angle and LVH by randomization, divided in 2 halves, A and B, Jeroen J. et al. Journal of Electrocardiology 2012

  28. ROCs for ECG variables QRS duration, QT duration, frontal QRS axis, and vectorcardiographic variables maxQRS, SA, VGazim, VGelev, and VGmag • Model equation: D = 4.49 × BSA − 0.015 × spatial QRS-T angle − 7.35 If D is less than 0, LVH diagnosis is predicted (LVH+), whereas D greater than or equal to 0 predicts a normal echocardiogram (LVH−).

  29. 6. Utility of QRS-T Angles inCardiac Disease Detection

  30. Utility of QRS-T angles in cardiac disease detection coronary artery disease control 370 patients hypertrophic cardiomyopathy 210 healthy left ventricular systolic dysfunction Ryanne A. et al. Journal of Electrocardiology 2011;44: 404–409

  31. Utility of QRS-T angles in cardiac disease detection Methods The areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) for distinguishing cardiac health from disease for each disease condition were statistically compared for the spatial mean QRS-T angle versus the ECG-derived frontal and VCG-derived frontal, left sagittal and horizontal planar QRS-T angles. Ryanne A. et al. Journal of Electrocardiology 2011;44: 404–409

  32. Ryanne A. et al. Journal of Electrocardiology 2011;44: 404–409

  33. 7. QRS-T Angle ofExercise ECG

  34. QRS-T angle of exercise ECG Aims bicycle stress-test 1297 patients (age 56±13 years, 67% males) follow-up:45±12 months Tuomas K. et al. Europace 2011; 13: 701–707

  35. Conclusions Loss of rate-adaptation of the spatial relationship between depolarization and repolarization wavefronts is a strong predictor of cardiac death, especially of sudden cardiac death. Tuomas K. et al. Europace 2011; 13: 701–707

  36. QRS-T angle of exercise ECG Tuomas K.et al. Heart Rhythm 2012;9:1083–1089

  37. 8. QRS –T Angle andStroke

  38. QRS –T angle and stroke Aim to investigate the prevalence of a planar QRS-T angle >90° in patients with ischemic stroke versus transient ischemic attack Patients with ischemic stroke have a higher prevalence of a planar QRS-T angle >90° than patients with transient ischemic attack. Med Sci Monit 2010

  39. The prevalence of a planar QRS-T angle ＞90° was highter in patients with ischenmic stroke than in patients with TIA Patients with ischemic stroke have a higher prevalence of a planar QRS-T angle >90° than patients with transient ischemic attack. Med Sci Monit 2010

  40. 9. QRS –T Angle andDiabetes

  41. QRS –T angle and diabetes Subjects594patients with type 2 diabetes(＜80 years old, BMI＜40kg/m2,Cr≥2 mg/dL) Factors associated with abnormal T-wave axis and increased QRS-T angle in type 2 diabetes. Springer-Verlag Italia 2013

  42. Bivariate analysis for normal/abnormal T-wave axis and planar QRS-T angle in patients with type 2 diabetes Factors associated with abnormal T-wave axis and increased QRS-T angle in type 2 diabetes. Springer-Verlag Italia 2013

  43. 10. QRS –T Angle inChronic Dialysis Patients

  44. QRS –T angle in chronic dialysis patients Aims to establish the prognostic value of the spatial QRS-T angle in chronic dialysis patients Subjects 272 dialysis therapy patients (172 male, mean age 56.3±17.0) Miha´ly K. et al. Europace 2013

  45. Abnormal QRS-T angle with a higher risk of death from all causes [HR 2.33; CI 1.46–3.70] Abnormal QRS-T angle with a higher risk of sudden cardiac death (HR 2.99; 95% CI 1.04–8.60). Miha´ly K. et al.Europace 2013

  46. 11. QRS-T angle and CVD inHIV-patients

  47. QRS-T angle and CVD in HIV-patients 4,453 HIV-infected patients (aged 43.5± 9.3 years ) Quartiles of the spatial QRS-T angle was calculated for men and women separately Follow up 28.7 months A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. Farah Z. et al. Am J Cardiol 2013;111:118-124

  48. Conclusion a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. Farah Z. et al. Am J Cardiol 2013;111:118-124

  49. Summary • Routine ECG is a simple noninvasive tool in detecting cardiovascular related diseases. • The QRS-T angles have the most important role in CVD risk-screening, CVD diagnosing and prognosis of diseases. • An increased spatial QRS-T angle is thought to reflect increased heterogeneity in cardiac repolarization. • Widened QRS-T angle has been associated with adverse clinical outcomes. The larger of QRS-T angles indicate the worse of the situation. • The value of spatial QRS-T angle is greater than that of planar QRS-T angle.

  50. Thanks for your attention Thanks for your attention

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