Diagnostic utility of the spatial versus individual planar QRS-T angles in cardiac disease detection

Abstract

Introduction We compared the diagnostic utility of various planar QRS-T angles to that of the spatial QRS-T angle in detecting various cardiac diseases. Materials and Methods Electrocardiographic (ECG) and derived vectorcardiographic (VCG) data were analyzed from 370 patients with imaging-proven cardiac disease (coronary artery disease, hypertrophic cardiomyopathy, or left ventricular systolic dysfunction) and 210 apparently healthy controls. The areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) for distinguishing cardiac health from disease for each disease condition were statistically compared for the spatial mean QRS-T angle versus the ECG-derived frontal and VCG-derived frontal, left sagittal and horizontal planar QRS-T angles. Results The AUC ROC of the spatial mean QRS-T angle, which ranged from 0.801 ± 0.035 to 0.987 ± 0.007 depending on the specific comparison, was always significantly greater than that of the ECG frontal planar QRS-T angle (range from 0.680 ± 0.043 to 0.796 ± 0.045) and usually significantly greater than that of all other QRS-T angles for the diseases studied. Discussion The spatial mean QRS-T angle is statistically significantly more diagnostically powerful than the ECG-derived frontal planar QRS-T angle and also generally more diagnostically powerful than all VCG-derived planar QRS-T angles in detecting cardiac disease. The ECG frontal planar QRS-T angle should not be considered an adequate diagnostic substitute for the spatial QRS-T angle.