FRONTAL QRS-T ANGLE AS A MARKER OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL HYPERTENSION

Year 2018, Volume: 32 Issue: 2, 77 - 87, 27.08.2018

Zülkif Tanrıverdi , Feyzullah Beşli Fatih Güngören İbrahim Halil Altıparmak Asuman Biçer Yeşilay Musluhittin Emre Erkuş Recep Demirbağ

https://doi.org/10.5505/deutfd.2018.98700

Cited By: 2

Abstract

Objective: Previous studies showed that myocardial
repolarization markers are prolonged in hypertensive patients with left
ventricular hypertrophy (LVH) compared to patients with non-LVH. Frontal QRS-T
angle, angle between the QRS and T wave axes, is novel marker of myocardial
repolarization. The aim of our study is to investigate the relationship between
frontal QRS-T angle and LVH in hypertensive patients.

Material and Method: A total 187 hypertensive patients were included our study. Frontal QRS-T angle was obtained from the automatic reports of the ECG machine. LVH was defined as left ventricular mass index (LVMI) > 115 g/m2 in men and 95 g/m2 in women. Results: Patients with LVH had significantly longer QT dispersion (p=0.028), corrected QT dispersion (p=0.010), Tp-e interval (p = 0.045) and wider frontal QRS-T angle (p<0.001) compared to patients with non-LVH. In correlation analysis, LVMI was positively correlated with QT dispersion (r=0.150, p=0.041), corrected QT dispersion (r=0.167, p=0.022), Tp-e interval (r = 0.160, p = 0.046) and frontal QRS-T angle (r=0.360, p<0.001). By a multivariate analysis, frontal QRS-T (OR: 1.04, 95% CI: 1.02-1.06, P < 0.001) angle was found to be the only independent predictor of LVH. ROC curve analysis showed that the best cut-off value of frontal QRS-T angle for predicting LVH was ≥ 28o. This cut-off value predicted LVH with a sensitivity of 70.5% and a specificity of 54.5%. Conclusion: Frontal QRS-T angle is a simple, inexpensive and easily obtainable parameter from surface electrocardiography. It can be used as a simple marker of LVH in hypertensive subjects.

Keywords

hypertension, left ventricular hypertrophy, electrocardiography, frontal QRS-T angle

Esansiyel Hipertansiyonlu Hastalarda Sol Ventrikül Hipertrofisinin Bir Göstergesi Olarak Frontal QRS-T Açısı

Abstract

Amaç: Önceki çalışmalarda sol ventrikül
hipertrofisi (SVH) bulunan hipertansif hastalarda, SVH bulunmayan hastalara
göre miyokardiyal repolarizasyon belirteçlerinin uzamış olduğu gösterilmiştir.
Ortalama QRS ve T dalgası eksenleri arasındaki açı olarak tanımlanan frontal
QRS-T açısı da miyokard repolarizasyonunun yeni bir göstergesidir. Çalışmamızın
amacı, hipertansif hastalarda frontal QRS-T açısı ile SVH arasındaki ilişkiyi
incelemektir.

Gereç ve Yöntem: Çalışmamıza toplam
187 hipertansif hasta dâhil edildi. Frontal QRS-T açısı, EKG cihazının otomatik
raporlarından elde edildi. Sol ventrikül kitle indeksinin (SVKİ) erkeklerde
> 115 g/m², kadınlarda > 95 g/m² olması SVH olarak
tanımlandı.

Bulgular: SVH bulunan
hastalarda, SVH bulunmayan hastalara göre QT dispersiyonu (p = 0,028),
düzeltilmiş QT dispersiyonu  (p = 0,010)
ve Tp-e aralığı (p = 0,045) daha uzun, frontal QRS-T açısı (p < 0,001) ise
daha genişti. Korelasyon analizinde, SVKİ QT dispersiyonu (r= 0,150, p= 0,041),
düzeltilmiş QT dispersiyonu (r= 0,167, p= 0,022), Tp-e aralığı (r= 0,160, p= 0,046)  ve frontal QRS-T açısı (r= 0,360, p < 0,001)
ile pozitif bir şekilde korele idi. Çok değişkenli analizle, frontal QRS-T
açısı SVH'nin tek bağımsız prediktörü olarak bulundu (OR: 1,04, 95% CI: 1,02-1,06,
p < 0,001). ROC curve analizinde frontal QRS-T açısının SVH'yi göstermedeki
en iyi kesme değeri 28^o idi. Bu kesme değer, SVH'yi %70,5
sensitivite ve %54,5 spesifite ile öngördü.

Sonuç: Frontal QRS-T açısı, basit, ucuz ve
12 derivasyonlu yüzey elektrokardiyografiden kolaylıkla elde edilebilen bir
parametredir. Bu açı, hipertansif hastalarda SVH'nin basit bir göstergesi
olarak kullanılabilir.

Keywords

Hipertansiyon, sol ventrikül hipertrofisi, elektrokardiyografi, frontal QRS-T açısı

References

• Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159-2219.
• Messerli FH, Williams B, Ritz E. Essential hypertension. Lancet 2007;370:591-603.
• Tin LL, Beevers DG, Lip GY. Hypertension, left ventricular hypertrophy, and sudden death. Curr Cardiol Rep 2002;4:449-457.
• Casale PN, Devereux RB, Milner M, et al. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 1986;105:173-178.
• Rossi MA. Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hypertension in humans. J Hypertens 1998;16:1031–1041.
• Berk BC, Fujiwara K, Lehoux S. ECM remodeling in hypertensive heart disease. J Clin Invest 2007;117:568–575.
• Perkiömäki JS, Ikäheimo MJ, Pikkujämsä SM, et al. Dispersion of the QT interval and autonomic modulation of heart rate in hypertensive men with and without left ventricular hypertrophy. Hypertension 1996;28:16-21.
• Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550-553.
• Clarkson PB, Naas AA, McMahon A, MacLeod C, Struthers AD, MacDonald TM. QT dispersion in essential hypertension. QJM 1995;88:327–332.
• Mayet J, Shahi M, McGrath K, et al. Left ventricular hypertrophy and QT dispersion in hypertension. Hypertension 1996;28:791-796.
• Zhao Z, Yuan Z, Ji Y, Wu Y, Qi Y. Left ventricular hypertrophy amplifies the QT, and Tp-e intervals and the Tp-e/ QT ratio of left chest ECG. J Biomed Res. 2010;24:69-72.
• Ale OK, Ajuluchukwu JN, Oke DA, Mbakwem AC. QT dispersion in hypertensive Nigerians with and without left ventricular hypertrophy. West Afr J Med 2013;32:57-61.
• Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014;19:534-542.
• Ishizawa K. Mean QRS, ventricular gradient and left ventricular mass in patients with eccentric left ventricular hypertrophy. J Electrocardiol 1975;8:227–232.
• Ishizawa K, Ishizawa K, Motomura M, Konishi T, Wakabayashi A. High reliability rates of spatial pattern analysis by vectorcardiogram in assessing the severity of eccentric left ventricular hypertrophy. Am Heart J 1976;91:50–57.
• Okin PM. Electrocardiography in women: taking the initiative. Circulation 2006; 113:464–466.
• Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM; ARIC Research Group. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol 2007;100:844–849.
• Perkiömäki J, Koistinen MJ, Yli-Mäyry S, Huikuri H. Dispersion of the QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 1995;26:174-179.
• Bazett HC. An analysis of the time relations of electrocardiograms. Heart 1920;7:353–370.
• Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006;47:1828-1834.
• Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011;4:441-447.
• Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-367.
• Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol 1986;57:450-458.
• Aro AL, Huikuri HV, Tikkanen JT, et al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace 2012;14:872–876
• Katholi RE, Couri DM. Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypertens 2011;2011:495349.
• Pye MP, Cobbe SM. Mechanisms of ventricular arrhythmias in cardiac failure and hypertrophy. Cardiovasc Res 1992;26:740-750.
• Raposeiras-Roubín S, Virgós-Lamela A, Bouzas-Cruz N, et al. Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction. Am J Cardiol 2014;113:1312-1319.
• Macfarlane PW. The frontal plane QRS-T angle. Europace. 2012;14:773-775.