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 Cardiomyopathy Treatment 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 ≤90° and in 72 of 283 patients (25.4%) with a QRS-T angle >90° (hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.05; P =0.002). A QRS-T angle >90° remained a significant predictor of the primary end point ( P =0.039) 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 ≤90° and in 49 of the 283 patients (17.3%) with a QRS-T angle >90° (hazard ratio, 1.79; 95% confidence interval, 1.03 to 3.10; P =0.016). 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 ( P <0.001). Conclusions— A planar QRS-T angle >90° is a significant predictor of a composite end point of death, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest in nonpaced, mild to moderately symptomatic patients with nonischemic cardiomyopathy with frequent or complex ventricular ectopy. QRS-T angles changed predictably with left ventricular ejection fraction and QRS duration.
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In nonischemic cardiomyopathy, a planar QRS-T angle >90° has important prognostic value.
“In nonischemic cardiomyopathy a planar QTS-T angle >90 • was found to have important prognostic value.42”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [42]
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- Authors
- Pavri, B. B., Hillis, M. B., Subačius, H., Brumberg, G. E., Schaechter, A., Levine, J. H., & Kadish, A.
- Affiliations
- Thomas Jefferson University Hospital (US)
- From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pa (B.B.P., M.B.H., G.E.B.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Chicago, Ill (H.S., A.S., A.K.); and Department of Medicine, Division of Cardiology, St Francis Hospital, Roslyn, NY (J.H.L.).
- Corresponding author
- Pavri, Behzad B.
- Venue
- Circulation
- Published
- 2008-06-24
- Volume
- 117
- Issue
- 25
- Pages
- 3181-3186
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2085211243
- Cited by
- 88
- References
- 34
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 8 · 2022: 9 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 3 · 2016: 6 · 2015: 5 · 2014: 6 · 2013: 5 · 2012: 5
- FWCI
- 2.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Keywords
- non-ischemic cardiomyopathy, prognosis, implantable cardioverter-defibrillator, ventricular arrhythmias, mortality, left ventricular ejection fraction, QRS duration, heart failure, non-sustained ventricular tachycardia, ventricular ectopy, ECG biomarkers
- MeSH terms
- Adult, Aged, Aged, 80 and over, Electrocardiography, Follow-Up Studies, Humans, Middle Aged, Cardiomyopathies, Predictive Value of Tests, Prognosis, Risk Factors, Multivariate Analysis, Randomized Controlled Trials as Topic, Treatment Outcome, Defibrillators, Implantable, Kaplan-Meier Estimate
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