QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population

Spatial QRS-T angle measured from a 12-lead electrocardiogram (ECG) has been shown to predict cardiac mortality. However, there is a paucity of studies on the prognostic significance of frontal QRS-T angle, which is more readily available from the standard 12-lead ECG. The purpose of the present stu...

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Bibliographic Details
Published in:Europace (London, England) Vol. 14; no. 6; pp. 872 - 876
Main Authors: Aro, A. L., Huikuri, H. V., Tikkanen, J. T., Junttila, M. J., Rissanen, H. A., Reunanen, A., Anttonen, O.
Format: Journal Article
Language:English
Published: England 01.06.2012
Subjects:
Adult
Arrhythmias, Cardiac - diagnosis
Arrhythmias, Cardiac - mortality
Death, Sudden, Cardiac - epidemiology
Electrocardiography - methods
Female
Finland - epidemiology
Follow-Up Studies
Humans
Hypertrophy, Left Ventricular - diagnosis
Hypertrophy, Left Ventricular - mortality
Kaplan-Meier Estimate
Male
Middle Aged
National Health Programs - statistics & numerical data
Predictive Value of Tests
Risk Factors
Finland
ISSN:1099-5129, 1532-2092, 1532-2092
Online Access:Get full text
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Summary:Spatial QRS-T angle measured from a 12-lead electrocardiogram (ECG) has been shown to predict cardiac mortality. However, there is a paucity of studies on the prognostic significance of frontal QRS-T angle, which is more readily available from the standard 12-lead ECG. The purpose of the present study was to investigate the importance of wide frontal QRS-T angle, QRS-axis, and T-wave axis as cardiac risk predictors in general population. We evaluated the 12-lead ECGs of 10 957 Finnish middle-aged subjects from the general population recorded between 1966 and 1972, and followed them for 30 ± 11 years. QRS-T angle 0 to 90°, QRS-axis -30 to 90°, and T-wave axis 0 to 90° were considered normal. The primary endpoint was death from arrhythmia, and the secondary endpoints were all-cause mortality and non-arrhythmic cardiac mortality. QRS-T angle ≥ 100° was present in 2.0% of the subjects, and it was associated with an increased risk of sudden arrhythmic death [relative risk (RR) 2.26; 95% confidence interval (CI) 1.59-3.21; P< 0.001) and all-cause mortality (RR 1.57; CI 1.34-1.84; P< 0.001), but not with non-arrhythmic cardiac mortality (RR 1.34; CI 0.93-1.92; P= 0.13). The prognostic significance of wide QRS-T angle was mainly due to abnormal T-wave axis, which predicted death from arrhythmia (RR 2.13; CI 1.63-2.79; P< 0.001), all-cause mortality (RR 1.39; 1.24-1.55; P< 0.001), and non-arrhythmic cardiac death (RR 1.87; CI 1.50-2.34; P< 0.001). Frontal QRS-T angle ≥ 100° increases the risk of arrhythmic death, this being mainly the result of an altered T-wave axis.
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ISSN:1099-5129
1532-2092
1532-2092
DOI:10.1093/europace/eur393