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(Circulation. 2008;117:3181-3186.)
© 2008 American Heart Association, Inc.

Heart Failure

Prognostic Value and Temporal Behavior of the Planar QRS-T Angle in Patients With Nonischemic Cardiomyopathy

Behzad B. Pavri, MD; Matthew B. Hillis, MD; Haris Subaius, MA; Genevieve E. Brumberg, MD; Andi Schaechter, BSN, RN; Joseph H. Levine, MD; Alan Kadish, MD, for the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators

From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pa (B.B.P., M.B.H., G.E.B.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Chicago, Ill (H.S., A.S., A.K.); and Department of Medicine, Division of Cardiology, St Francis Hospital, Roslyn, NY (J.H.L.).

Correspondence to Behzad B. Pavri, MD, Thomas Jefferson University Hospital, 925 Chestnut St, Philadelphia, PA 19107. E-mail behzad.pavri{at}jefferson.edu

Received September 4, 2007; accepted April 14, 2008.

Background— The planar QRS-T angle can be easily obtained from standard 12-lead ECGs, but its predictive ability is not established. We sought to determine the predictive ability of the planar QRS-T angle in patients with nonischemic cardiomyopathy and to assess QRS-T angle behavior over time.

Methods and Results— Baseline QRS-T angles from 455 patients in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial were measured. All patients had nonischemic cardiomyopathy, New York Heart Association class I to III heart failure, and nonsustained ventricular tachycardia or frequent ventricular ectopy. The primary end point (a composite of total mortality, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest) occurred in 25 of 172 patients (14.5%) with a QRS-T angle 90° and in 72 of 283 patients (25.4%) with a QRS-T angle >90° (hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.05; P=0.002). A QRS-T angle >90° remained a significant predictor of the primary end point (P=0.039) after adjustment for treatment group, age, gender, QRS duration, left bundle-branch block, left ventricular ejection fraction, New York Heart Association class III, atrial fibrillation, and diabetes mellitus. The secondary end point (total mortality) occurred in 17 of the 172 patients (9.9%) with a QRS-T angle 90° and in 49 of the 283 patients (17.3%) with a QRS-T angle >90° (hazard ratio, 1.79; 95% confidence interval, 1.03 to 3.10; P=0.016). A sample of 152 patients with multiple follow-up ECGs was analyzed to assess temporal QRS-T angle behavior. Changes in the QRS-T angle correlated with changes in left ventricular ejection fraction and QRS duration over time (P<0.001).

Conclusions— A planar QRS-T angle >90° is a significant predictor of a composite end point of death, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest in nonpaced, mild to moderately symptomatic patients with nonischemic cardiomyopathy with frequent or complex ventricular ectopy. QRS-T angles changed predictably with left ventricular ejection fraction and QRS duration.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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