title: Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction.
abstract: In light of the low cost, the widespread availability of the electrocardiogram, and the increasing economic burden of the health-related problems, we aimed to analyze the prognostic value of automatic frontal QRS-T angle to predict mortality in patients with left ventricular (LV) systolic dysfunction after acute myocardial infarction (AMI). About 467 consecutive patients discharged with diagnosis of AMI and with LV ejection fraction ≤40% were followed during 3.9 years (2.1 to 5.9). From them, 217 patients (47.5%) died. The frontal QRS-T angle was higher in patients who died (116.6±52.8 vs 77.9±55.1, respectively, p<0.001). The QRS-T angle value of 90° was the most accurate to predict all-cause cardiac death. After multivariate analysis, frontal QRS-T angle remained as an excellent predictor of all-cause and cardiac deaths, increasing the mortality 6% per each 10°. For the global mortality, the hazard ratio for a QRS-T angle>90° was 2.180 (1.558 to 3.050), and for the combined end point of cardiac death and appropriate implantable cardioverter defribrillator therapy, it was 2.385 (1.570 to 3.623). This independent predictive value was maintained even after adjusting by bundle brunch block, ST-elevation AMI, and its localization. In conclusion, a wide automatic frontal QRS-T angle (>90°) is a good discriminator of long-term mortality in patients with LV systolic dysfunction after an AMI. The ability to easily measure it from a standard 12-lead electrocardiogram together with its prognostic value makes the frontal QRS-T angle an attractive tool to help clinicians to improve risk stratification of those patients.
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain. Electronic address: raposeiras26@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras-Roubín
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Virgós-Lamela
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Bouzas-Cruz
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: López-López
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Castiñeira-Busto
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Rita
authors.initials: R
authors.lastname: Fernández-Garda
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Castelo
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: García-Acuña
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.affiliation: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*