Diagnostic and prognostic values of the QRS-T angle in patients with suspected acute decompensated heart failure.

Sweda, Romy; Sabti, Zaid; Strebel, Ivo; Kozhuharov, Nikola; Wussler, Desiree; Shrestha, Samyut; Flores, Dayana; Badertscher, Patrick; Lopez-Ayala, Pedro; Zimmermann, Tobias; Michou, Eleni; Gualandro, Danielle M.; Häberlin, Andreas; Tanner, Hildegard; Keller, Dagmar I.; Nowak, Albina; Pfister, Otmar; Breidthardt, Tobias; Mueller, Christian and Reichlin, Tobias (2020). Diagnostic and prognostic values of the QRS-T angle in patients with suspected acute decompensated heart failure. ESC Heart Failure, 7(4), pp. 1817-1829. Wiley 10.1002/ehf2.12746

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AIMS

The aim of this study was to investigate the diagnostic and prognostic utility of the QRS-T angle, an electrocardiogram (ECG) marker quantifying depolarization-repolarization heterogeneity, in patients with suspected acute decompensated heart failure (ADHF).

METHODS AND RESULTS

We prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of ADHF. The QRS-T angle was automatically derived from a standard 12-lead ECG recorded at presentation. The primary diagnostic endpoint was a final adjudicated diagnosis of ADHF. The primary prognostic endpoint was all-cause mortality during 2 years of follow-up. Among the 1915 patients enrolled, those with higher QRS-T angles were older, were more commonly male, and had a higher rate of co-morbidities such as arterial hypertension, coronary artery disease, or chronic kidney disease. ADHF was the final adjudicated diagnosis in 1140 (60%) patients. The QRS-T angle in patients with ADHF was significantly larger than in patients with non-cardiac causes of dyspnoea {median 110° [inter-quartile range (IQR) 46-156°] vs. median 33° [IQR 15-57°], P < 0.001}. The diagnostic accuracy of the QRS-T angle as quantified by the area under the receiver operating characteristic curve (AUC) was 0.75 [95% confidence interval (CI) 0.73-0.77, P < 0.001], which was inferior to N-terminal pro-B-type natriuretic peptide (AUC 0.93, 95% CI 0.92-0.94, P < 0.001), but similar to that of high-sensitivity troponin T (AUC 0.78, 95% CI 0.76-0.80, P = 0.09). The AUC of the QRS-T angle for discrimination between ADHF and non-cardiac dyspnoea remained similarly high in subgroups of patients known to be diagnostically challenging, including patients older than 75 years [0.71 (95% CI 0.67-0.74)], renal failure [0.79 (95% CI 0.71-0.87)], and atrial fibrillation at presentation [0.68 (95% CI 0.60-0.76)]. Mortality rates according to QRS-T angle tertiles were 4%, 6%, and 10% after 30 days (P < 0.001) and 24%, 31%, and 43% after 2 years (P < 0.001). After adjustment for clinical, laboratory, and ECG parameters, the QRS-T angle remained an independent predictor for 2 year mortality with a 4% increase in mortality for every 20° increase in QRS-T angle (P = 0.02).

CONCLUSIONS

The QRS-T angle is a readily available and inexpensive marker that can assist in the discrimination between ADHF and non-cardiac causes of acute dyspnoea and may aid in the risk stratification of these patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Sweda, Romy; Häberlin, Andreas David Heinrich; Tanner, Hildegard and Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2055-5822

Publisher:

Wiley

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

07 Oct 2020 17:16

Last Modified:

07 Oct 2020 17:16

Publisher DOI:

10.1002/ehf2.12746

PubMed ID:

32452635

Uncontrolled Keywords:

Acute dyspnoea Acute heart failure ECG Heart failure QRS-T angle

BORIS DOI:

10.7892/boris.146893

URI:

https://boris.unibe.ch/id/eprint/146893

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