Wide QRS-T Angle on the 12-Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction

Kelvin C M Chua, Carmen Teodorescu, Kyndaron Reinier, Audrey Uy-Evanado, Aapo L. Aro, Sandeep G. Nair, Harpriya Chugh, Jonathan Jui, Sumeet S. Chugh

Research output: Contribution to journalArticle

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Abstract

Introduction: Improvements in risk stratification for sudden cardiac arrest (SCA) will require discovery of markers that extend beyond the LV ejection fraction (LVEF). The frontal QRS-T angle has been shown to predict risk of SCA but the value of this marker independent of the LVEF has not been investigated. Methods and Results: Cases of adult SCA with an archived electrocardiogram (12-lead ECG) available before the event, with a computable frontal QRS-T angle, were identified from the Oregon Sudden Unexpected Death Study (Oregon SUDS) ongoing in the Portland, Oregon metro area. A total of 666 SCA cases (mean age 67.2 years; 95% CI, 52.3–82.1 years; 68.6% males) were compared to 863 controls (mean age 66.6 years, 55.2–78.0 years; 68.1% males; 75.0% had CAD) from the same geographical region. The mean frontal QRS-T angle was wider in cases (74o; 95% CI, 17o–131o) compared to controls (51o; 95% CI, 5o–97o; P<0.0001). A frontal QRS-T angle of more than 90o remained associated with increased risk of SCD after adjusting for age, gender, heart rate, prolonged intraventricular conduction, electrocardiographic left ventricular hypertrophy (ECG LVH), baseline comorbidities, and left ventricular ejection fraction (LVEF) (OR 2.2; 95% CI, 1.60–3.09; P<0.0001). Conclusion: A wide QRS-T angle greater than 90o is associated with an increased risk of SCA independent of the left ventricular ejection fraction.

Original languageEnglish (US)
Pages (from-to)833-839
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume27
Issue number7
DOIs
StatePublished - Jul 1 2016

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Sudden Cardiac Death
Sudden Death
Electrocardiography
Stroke Volume
Left Ventricular Hypertrophy
Comorbidity
Heart Rate
Lead

Keywords

  • electrocardiogram
  • QRS-T angle
  • sudden cardiac arrest
  • sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Chua, K. C. M., Teodorescu, C., Reinier, K., Uy-Evanado, A., Aro, A. L., Nair, S. G., ... Chugh, S. S. (2016). Wide QRS-T Angle on the 12-Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction. Journal of Cardiovascular Electrophysiology, 27(7), 833-839. https://doi.org/10.1111/jce.12989

Wide QRS-T Angle on the 12-Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction. / Chua, Kelvin C M; Teodorescu, Carmen; Reinier, Kyndaron; Uy-Evanado, Audrey; Aro, Aapo L.; Nair, Sandeep G.; Chugh, Harpriya; Jui, Jonathan; Chugh, Sumeet S.

In: Journal of Cardiovascular Electrophysiology, Vol. 27, No. 7, 01.07.2016, p. 833-839.

Research output: Contribution to journalArticle

Chua, KCM, Teodorescu, C, Reinier, K, Uy-Evanado, A, Aro, AL, Nair, SG, Chugh, H, Jui, J & Chugh, SS 2016, 'Wide QRS-T Angle on the 12-Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction', Journal of Cardiovascular Electrophysiology, vol. 27, no. 7, pp. 833-839. https://doi.org/10.1111/jce.12989
Chua, Kelvin C M ; Teodorescu, Carmen ; Reinier, Kyndaron ; Uy-Evanado, Audrey ; Aro, Aapo L. ; Nair, Sandeep G. ; Chugh, Harpriya ; Jui, Jonathan ; Chugh, Sumeet S. / Wide QRS-T Angle on the 12-Lead ECG as a Predictor of Sudden Death Beyond the LV Ejection Fraction. In: Journal of Cardiovascular Electrophysiology. 2016 ; Vol. 27, No. 7. pp. 833-839.
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abstract = "Introduction: Improvements in risk stratification for sudden cardiac arrest (SCA) will require discovery of markers that extend beyond the LV ejection fraction (LVEF). The frontal QRS-T angle has been shown to predict risk of SCA but the value of this marker independent of the LVEF has not been investigated. Methods and Results: Cases of adult SCA with an archived electrocardiogram (12-lead ECG) available before the event, with a computable frontal QRS-T angle, were identified from the Oregon Sudden Unexpected Death Study (Oregon SUDS) ongoing in the Portland, Oregon metro area. A total of 666 SCA cases (mean age 67.2 years; 95{\%} CI, 52.3–82.1 years; 68.6{\%} males) were compared to 863 controls (mean age 66.6 years, 55.2–78.0 years; 68.1{\%} males; 75.0{\%} had CAD) from the same geographical region. The mean frontal QRS-T angle was wider in cases (74o; 95{\%} CI, 17o–131o) compared to controls (51o; 95{\%} CI, 5o–97o; P<0.0001). A frontal QRS-T angle of more than 90o remained associated with increased risk of SCD after adjusting for age, gender, heart rate, prolonged intraventricular conduction, electrocardiographic left ventricular hypertrophy (ECG LVH), baseline comorbidities, and left ventricular ejection fraction (LVEF) (OR 2.2; 95{\%} CI, 1.60–3.09; P<0.0001). Conclusion: A wide QRS-T angle greater than 90o is associated with an increased risk of SCA independent of the left ventricular ejection fraction.",
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AU - Aro, Aapo L.

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