Abstract 14559: Association of the Frontal QRS-T Angle with Adverse Cardiac Remodeling, Impaired Biventricular Function, and Worse Outcomes in Heart Failure with Preserved Ejection Fraction
Background: No prior studies have investigated the association of QRS-T angle with cardiac structure/function and outcomes in heart failure with preserved ejection fraction (HFpEF). We hypothesized that increased frontal QRS-T angle is associated with worse cardiac function and remodeling and also adverse outcomes in HFpEF.
Methods: After excluding 44 patients with ventricular paced rhythms, we prospectively studied 376 patients with HFpEF, defined as symptomatic HF with left ventricular (LV) ejection fraction >50%. The frontal QRS-T angle was calculated from each 12-lead ECG. Patients were divided into tertiles by frontal QRS-T angle (0-26°, 27-75°, and 76-179°), and clinical, laboratory, and echocardiographic data were compared among groups. Cox proportional hazards analyses were performed to determine the association between QRS-T angle and outcomes.
Results: The mean age of the cohort was 64±13 years with 65% women, and the mean QRS-T angle was 61±51°. Patients with increased QRS-T angle were older, had a lower body-mass index, more frequently had coronary artery disease, diabetes, chronic kidney disease, and atrial fibrillation, and had higher BNP levels (P<0.05 for all comparisons). On echocardiography, patients with increased QRS-T angle had higher LV mass index, worse diastolic function parameters, more right ventricular (RV) remodeling, and worse RV systolic function (p<0.05 after multivariable adjustment). QRS-T angle was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted HR for the highest QRS-T tertile 2.3, 95% CI 1.4-3.9; P=0.001) (see Figure).
Conclusions: In HFpEF, increased QRS-T angle is independently associated with worse biventricular function, greater biventricular remodeling, and adverse outcomes. .
- © 2012 by American Heart Association, Inc.