Relationship between the Spatial QRS-T angle and Syntax and Gensini Scores in patients with non-ST-elevation Acute Coronary Syndrome

Abstract

Background: Frontal and spatial QRS-T angles reflect ventricular repolarization heterogeneity and may be associated with coronary artery disease severity. This study aimed to evaluate their relationship with SYNTAX and Gensini scores in non-ST elevation myocardial infarction (NSTMI) patients. Methods: A total of 1188 patients with NSTMI were retrospectively analyzed. Frontal and spatial QRS-T angles were calculated from 12-lead digital ECGs using the Rautaharju method. Correlation, univariate and multivariate linear regression, ROC, and logistic regression analyses were performed to assess their associations with SYNTAX and Gensini scores. Results: The spatial QRS-T angle was independently associated with SYNTAX and Gensini scores in multivariate linear regression, whereas the frontal QRS-T angle showed no significant association. Patients with SYNTAX score >32 had significantly higher spatial QRS-T angles. ROC analysis demonstrated that spatial QRS-T angle >105.2° predicted high SYNTAX scores with an AUC of 0.80. Logistic regression confirmed the spatial angle as an independent predictor of high SYNTAX score (OR: 1.04, 95% CI: 1.02–1.06; p<0.001). Conclusion: The spatial QRS-T angle, but not the frontal angle, is a significant independent predictor of severe coronary artery disease in NSTMI patients. It may serve as a simple, non-invasive ECG marker for identifying patients with high atherosclerotic burden.

Keywords

• Non-ST elevation myocardial infarction
• Spatial QRS-T angle
• Frontal QRS-T angle
• SYNTAX score
• Gensini score

Non-ST elevasyonlu Akut Koroner Sendromlu hastalarda Spasyal QRS-T açısı ile SYNTAX ve Gensini skorları arasındaki ilişki

Abstract

Giriş: Frontal ve spatial QRS-T açıları ventriküler repolarizasyon heterojenliğini yansıtarak koroner arter hastalığının şiddetiyle ilişkili olabilir. Bu çalışmada non-ST elevasyonlu miyokart enfarktüsü (NSTMI) hastalarında bu açıların SYNTAX ve Gensini skorları ile ilişkisi değerlendirildi. Yöntem: NSTMI tanılı 1188 hasta retrospektif olarak incelendi. Dijital 12 derivasyonlu EKG’lerden Rautaharju yöntemiyle frontal ve spatial QRS-T açıları hesaplandı. Korelasyon, univaryant ve multivaryant lineer regresyon, ROC ve lojistik regresyon analizleri ile SYNTAX ve Gensini skorlarıyla ilişkileri değerlendirildi. Bulgular: Multivaryant lineer regresyon analizinde spatial QRS-T açısı SYNTAX ve Gensini skorları ile bağımsız olarak ilişkilendirilirken, frontal QRS-T açısı anlamlı bulunmadı. SYNTAX skoru >32 olan hastalarda spatial QRS-T açısı anlamlı şekilde yüksekti. ROC analizinde spatial QRS-T açısının >105.2° olması yüksek SYNTAX skorunu AUC 0.80 ile öngördü. Lojistik regresyon spatial açının yüksek SYNTAX skorunun bağımsız belirleyicisi olduğunu doğruladı (OR:1.04, %95 GA:1.02–1.06; p<0.001). Sonuç: NSTMI hastalarında sadece spatial QRS-T açısı, ağır koroner arter hastalığının bağımsız anlamlı belirleyicisidir. Bu açı, yüksek aterosklerotik yük taşıyan hastaların belirlenmesinde pratik, non-invaziv bir EKG göstergesi olabilir.

Keywords

• Non-ST segment elevasyonlu miyokart enfarktüsü
• Spatial QRS-T açısı
• Frontal QRS-T açısı
• SYNTAX skoru
• Gensini skoru

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