title: T wave axis deviation and QRS-T angle - Controversial indicators of incident coronary heart events.
abstract: Abnormal orientation of the T-wave axis and increased angle between the QRS complex (depolarization) and the T-wave (repolarization) have long been assumed to provide a global measure of repolarization abnormality, and have been used to assess ventricular repolarization. The ability of the T wave axis deviation and the QRS-T angle to predict incident coronary heart events was examined in several studies. However, conflicting results have led to significant controversy in the literature concerning their purported ability. Potential explanations involve true variation between study populations, non-standardized cut-off values, different baseline cardiovascular risk levels or different patterns of confounding by other concomitant cardiovascular risk factors. In the present article we will attempt to briefly present the rationale and pathophysiology behind these indices, summarize existing knowledge regarding their prognostic significance and their correlation with established cardiovascular disease risk factors. Further prospective studies are necessary to confirm or refute whether T-wave axis deviation, QRS-T angle and ventricular gradient may in the future serve as indicators of incident coronary heart events and mortality, both in populations with higher prevalence of subclinical advanced atherosclerotic heart disease and in apparently healthy subjects.
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece. Electronic address: hrodil1@yahoo.com.
authors.forename: Polychronis
authors.initials: P
authors.lastname: Dilaveris
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Christos-Konstantinos
authors.initials: CK
authors.lastname: Antoniou
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gatzoulis
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D011237:Predictive Value of Tests; D012307:Risk Factors
keywords: Coronary artery disease; Prediction; QRS-T angle; T wave axis; Ventricular gradient