Association of the Frontal QRS-T Angle with Adverse Cardiac Remodeling, Impaired Left and Right Ventricular Function, and Worse Outcomes in Heart Failure with Preserved Ejection Fraction

作者：Selvaraj Senthil; Ilkhanoff Leonard; Burke Michael A; Freed Benjamin H; Lang Roberto M; Martinez Eva E; Shah Sanjiv J^*

来源：Journal of the American Society of Echocardiography, 2014, 27(1): 74-+.

DOI：10.1016/j.echo.2013.08.023

• QRS-T angle
• Diastolic heart failure
• Echocardiography
• Outcomes

Background: No prior studies have investigated the association of QRS-T angle with cardiac structure and function and outcomes in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to test the hypothesis that increased frontal QRS-T angle is associated with worse cardiac function and remodeling and adverse outcomes in HFpEF.
Methods: A total of 376 patients with HFpEF (i.e., symptomatic heart failure with left ventricular ejection fraction >50%) were prospectively studied. The frontal QRS-T angle was calculated from the 12-lead electrocardiogram. Patients were divided into tertiles by frontal QRS-T angle (0 degrees-26 degrees, 27 degrees-75 degrees, and 76 degrees-179 degrees), and clinical, laboratory, and echocardiographic data were compared among groups. Cox proportional-hazards analyses were performed to determine the association between QRS-T angle and outcomes.
Results: The mean age of the cohort was 64 +/- 13 years, 65% were women, and the mean QRS-T angle was 61 +/- 51 degrees. Patients with increased QRS-T angles were older; had lower body mass indices; more frequently had coronary artery disease, diabetes, chronic kidney disease, and atrial fibrillation; and had higher B-type natriuretic peptide levels (P < .05 for all comparisons). After multivariate adjustment, patients with increased QRS-T angles had higher B-type natriuretic peptide levels in addition to higher left ventricular mass indices, worse diastolic function parameters, more right ventricular remodeling, and worse right ventricular systolic P < .05 for all associations). QRS-T angle was independently associated with the composite outcome of cardiovascular hospitalization or death on multivariate analysis, even after adjusting for B-type natriuretic peptide (heart rate for the highest QRS-T tertile, 2.0; 95% confidence interval, 1.2-3.4; P = .008).
Conclusions: In HFpEF, increased QRS-T angle is independently associated with worse left and right ventricular function and remodeling and adverse outcomes.

• 出版日期2014-1
• 单位西北大学