QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients
Background: Cardiovascular disease is the commonest cause of death in hemodialysis (HD) patients but accurate risk prediction is lacking. The spatial QRS – T angle is a promising electrophysiological marker for sudden cardiac death risk stratification. The aim of this study was to assess the prognos...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-02-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphys.2019.00145/full |
| _version_ | 1828857965076021248 |
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| author | Sofia Skampardoni Darren Green Katerina Hnatkova Marek Malik Philip A. Kalra Dimitrios Poulikakos |
| author_facet | Sofia Skampardoni Darren Green Katerina Hnatkova Marek Malik Philip A. Kalra Dimitrios Poulikakos |
| author_sort | Sofia Skampardoni |
| collection | DOAJ |
| description | Background: Cardiovascular disease is the commonest cause of death in hemodialysis (HD) patients but accurate risk prediction is lacking. The spatial QRS – T angle is a promising electrophysiological marker for sudden cardiac death risk stratification. The aim of this study was to assess the prognostic value of spatial QRS-T angle derived from standard 12 lead electrocardiograms (ECG) and its association with echocardiographic parameters in HD patients.Methods: This prospective study of 178 prevalent HD patients (aged 67 ± 14 years, 72% men) collected ECG and echocardiographic data on an annual basis. Baseline echocardiograms at study entry were used for cross-sectional comparisons with ECGs. Study endpoints were all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE). The QRS – T angle was calculated from standard 10-s ECG as the total cosine R to T (TCRT) using singular value decomposition and expressed in degrees. TCRT above 100° was defined as abnormal.Results: During a follow-up period of 36 ± 19 months, 74 patients died, including 17 cardiac deaths, and 54 suffered from MACE. In multivariate Cox regression analysis, QRS-T angle by TCRT at baseline was associated with increased cardiovascular mortality both as a continuous value and dichotomized below or above 100° (HR 1.016, p = 0.029, CI: 1.002–1.030 and HR 3.506, CI: 1.118–10.995, p = 0.031 respectively) and with MACE dichotomized at 100° (HR 1.902, CI: 1.046–3.459; p = 0.035). In multivariate regression analysis including baseline parameters, echocardiographic global longitudinal strain (GLS) was significantly correlated with TCRT (F 9.648, r2 = 0.192, standardized β = 0.331, unstandardized β = 3.567, t = 4.4429, CI: 1.976–5.157, p < 0.001).Conclusion: TCRT correlates with GLS and is independently associated with cardiac deaths and MACE in HD patients. |
| first_indexed | 2024-12-13T01:48:52Z |
| format | Article |
| id | doaj.art-5326b09f8a77462a9d6b2d9af0b5e3b5 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-13T01:48:52Z |
| publishDate | 2019-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-5326b09f8a77462a9d6b2d9af0b5e3b52022-12-22T00:03:35ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2019-02-011010.3389/fphys.2019.00145430575QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis PatientsSofia Skampardoni0Darren Green1Katerina Hnatkova2Marek Malik3Philip A. Kalra4Dimitrios Poulikakos5Department of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United KingdomDepartment of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United KingdomNational Heart and Lung Institute, Imperial College London, London, United KingdomNational Heart and Lung Institute, Imperial College London, London, United KingdomDepartment of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United KingdomDepartment of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United KingdomBackground: Cardiovascular disease is the commonest cause of death in hemodialysis (HD) patients but accurate risk prediction is lacking. The spatial QRS – T angle is a promising electrophysiological marker for sudden cardiac death risk stratification. The aim of this study was to assess the prognostic value of spatial QRS-T angle derived from standard 12 lead electrocardiograms (ECG) and its association with echocardiographic parameters in HD patients.Methods: This prospective study of 178 prevalent HD patients (aged 67 ± 14 years, 72% men) collected ECG and echocardiographic data on an annual basis. Baseline echocardiograms at study entry were used for cross-sectional comparisons with ECGs. Study endpoints were all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE). The QRS – T angle was calculated from standard 10-s ECG as the total cosine R to T (TCRT) using singular value decomposition and expressed in degrees. TCRT above 100° was defined as abnormal.Results: During a follow-up period of 36 ± 19 months, 74 patients died, including 17 cardiac deaths, and 54 suffered from MACE. In multivariate Cox regression analysis, QRS-T angle by TCRT at baseline was associated with increased cardiovascular mortality both as a continuous value and dichotomized below or above 100° (HR 1.016, p = 0.029, CI: 1.002–1.030 and HR 3.506, CI: 1.118–10.995, p = 0.031 respectively) and with MACE dichotomized at 100° (HR 1.902, CI: 1.046–3.459; p = 0.035). In multivariate regression analysis including baseline parameters, echocardiographic global longitudinal strain (GLS) was significantly correlated with TCRT (F 9.648, r2 = 0.192, standardized β = 0.331, unstandardized β = 3.567, t = 4.4429, CI: 1.976–5.157, p < 0.001).Conclusion: TCRT correlates with GLS and is independently associated with cardiac deaths and MACE in HD patients.https://www.frontiersin.org/article/10.3389/fphys.2019.00145/fullQRS-T angleTCRTsudden cardiac deathhemodialysiscardiovascularglobal longitudinal strain |
| spellingShingle | Sofia Skampardoni Darren Green Katerina Hnatkova Marek Malik Philip A. Kalra Dimitrios Poulikakos QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients Frontiers in Physiology QRS-T angle TCRT sudden cardiac death hemodialysis cardiovascular global longitudinal strain |
| title | QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients |
| title_full | QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients |
| title_fullStr | QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients |
| title_full_unstemmed | QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients |
| title_short | QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients |
| title_sort | qrs t angle predicts cardiac risk and correlates with global longitudinal strain in prevalent hemodialysis patients |
| topic | QRS-T angle TCRT sudden cardiac death hemodialysis cardiovascular global longitudinal strain |
| url | https://www.frontiersin.org/article/10.3389/fphys.2019.00145/full |
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