Frontal QRS-T Research Articles

A new electrocardiographic parameter terminal D1S + D3R predicts right ventricular dilatation in acute pulmonary embolism

Objective Right ventricular (RV) overload findings affect the risk classification and treatment approach in acute pulmonary embolism (APE). Recently, it was reported that a new electrocardiography (ECG) parameter, terminal D1S + D3R (T-D1S + D3R) pattern, supported the diagnosis of APE. We aim to search the relationship between T-D1S + D3R pattern and right ventricular dilatation (RVD) in APE. Methods This single-centre, retrospective study was designed with patients aged > 18 years. We screened 267 patients who underwent transthoracic echocardiography (TTE) because of confirmed APE in our emergency department. This study included 72 patients with RVD and 139 patients without RVD [male 41.7%, median age 73,0 (20.8) years; 49.6% male, median age 64,0 (24.0) years]. We compared T-D1S + D3R between RVD (+) and RVD (-) groups. Results We determined that RVD (+) group had more patients with the T-D1S + D3R parameter than RVD (-) group [51 (70.8%) vs. 25 (18.0%), p < 0.001]. In the univariate logistic regression analyses S1Q3T3, (in)complete right bundle branch block (RBBB), T-D1S + D3R, D3-V1 T wave inversion (TWI), V1-3/4 TWI, V1-3/4 ST-segment elevation, and frontal QRS-T [f(QRS-T)] angle predicted RVD, while T-D1S + D3R, V1-3/4 ST-segment elevation, and f(QRS-T) angle remained independent predictors of RVD in patients with APE. Conclusions T-D1S + D3R, a new ECG parameter, was an independent predictor of RVD in patients with APE.

Evaluation of electrocardiogram findings and inflammatory parameters in patients with benign paroxysmal positional vertigo.

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of intense vertigo, often accompanied by nausea and nystagmus. The frontal QRS-T (fQRS-T) angle, a novel indicator of ventricular depolarization and repolarization heterogeneity, has garnered attention due to its potential to reveal insights into cardiac function. This study aimed to investigate the potential relationship between the fQRS-T angle and inflammation markers in individuals with BPPV. The study encompassed 49 BPPV patients and 51 healthy individuals as a control group. Laboratory assessments were conducted to measure inflammation parameters. Electrocardiogram (ECG) data was analyzed, focusing on conduction parameters including fQRS-T angle, QRS duration, QT interval, and corrected QT interval. The study revealed that the fQRS-T angle was significantly higher in BPPV patients compared to the control group (p<.001). Moreover, inflammation markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and C-reactive protein-to-albumin ratio (CAR) were notably elevated in BPPV patients (p<.001, for all). The findings of the correlation analysis demonstrated a strong association between NLR and the fQRS-T angle (r=.718, p<.001). Additionally, the results of the linear regression analysis indicated that NLR positively predicted the fQRS-T angle (p<.001). The study's outcomes have underscored a significant increase in the fQRS-T angle among BPPV patients, suggesting altered ventricular repolarization dynamics. The strong correlation between NLR and the fQRS-T angle raises intriguing possibilities of inflammation's potential role in influencing cardiac electrophysiology. The study contributes to the growing body of evidence suggesting that BPPV might have implications beyond its immediate vestibular manifestations.

Correlation of QRS/T angle with clinical, echocardiographic, and hemodynamic variables in chronic thromboembolic pulmonary hypertension patients

Objectives: In this study, we aimed to examine the relationships between frontal QRS-T (fQRS-T) angle prognostic risk factors outlined in the current pulmonary hypertension (PH) guidelines and to demonstrate whether the fQRS-T could detect patients with unfavorable echocardiographic and hemodynamic data. Patients and methods: Between July 2009 and February 2023, a total of 33 patients (8 males, 25 females; median age: 61 years; range, 55 to 70 years) with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent electrocardiographic (ECG) examination were retrospectively analyzed. The fQRS-T angle was calculated from surface ECGs. Functional class, 6-min walk distance, and brain natriuretic peptide values were recorded. Two-dimensional echocardiographic data including comprehensive right ventricular (RV) functions, right atrial area (RAA), tricuspid annular systolic plane excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and TAPSE/sPAP ratio were noted. Among invasive hemodynamic variables, sPAP, mean PAP (mPAP), pulmonary vascular resistance (PVR), and cardiac index (CI) were obtained. The correlations between clinical, echocardiographic, and hemodynamic variables were analyzed. Results: There was no significant correlation between clinical variables and fQRS-T angle. The TAPSE and TAPSE/sPAP ratio were negatively correlated with fQRS/T angle (r=-0.37, p=0.02, r=-0.35, and p=0.03, respectively), whereas RV Tei index and RAA were positively correlated with the fQRS-T angle (r=0.53, p=0.014, r=0.47, and p=0.007, respectively). The hemodynamic data including sPAP, mPAP, and PVR were positively correlated with the fQRS-T angle (r=0.32, p=0.048, r=0.34, p=0.034, r=0.35, and p=0.02, respectively) and CI was negatively correlated with the fQRS-T angle (r=-0.30, p=0.048). Conclusion: Our study results suggest that the fQRS/T angle is correlated with poor prognostic echocardiographic and hemodynamic variables in CTEPH patients.

Yaygın Anksiyete Bozukluğu Olan Hastaların Trombosit Parametreleri ve Elektrokardiyogram Verilerinin Sağlıklı Kontrol Grubu ile Karşılaştırılması

Aim: Generalized anxiety disorder (GAD) refers to the intense stress and tension felt in the face of various life events. Various studies have shown that cardiovascular diseases are more common in patients with anxiety. Frontal QRS-T (fQRS-T) has been shown to be elevated in cardiovascular diseases. In this study, the fQRS-T, hemogram, and biochemistry values of patients with GAD were compared with healthy controls (HC) and the cardiovascular risk status of GAD patients was evaluated. Material and Methods: Seventy patients with a diagnosis of GAD and no comorbidity followed in the district state hospital's psychiatry outpatient clinic were included in this study. Sociodemographic data, disease severity, hemogram, biochemistry values, electrocardiogram (ECG) data of these patients were recorded. Disease severity was evaluated with The Generalized Anxiety Disorder Test-7 (GAD-7). These values were compared with 80 HCs without any psychiatric or organic disease. The correlation of fQRS-T value with platelet parameters and age was investigated in GAD patients. Results: According to the statistical analysis, fQRS-T was wider in patients with GAD than in HC (p&amp;lt;.001). Accordingly, basophil count was statistically lower in patients with GAD (p&amp;lt;.001). Eosinophil count and mean platelet volume (MPV) were significantly elevated in patients with GAD (p=.019 and p=.003 respectively). Accordingly, fQRS-T and MPV are highly correlated (p&amp;lt;.001). The GAD-7 score and fQRS-T were positively correlated (p=.001). According to the linear regression analysis for fQRS-T, MPV and GAD-7 scores positively and significantly predict fQRS-T (p&amp;lt;.001 and p=.036 respectively). Conclusion: This study is the first in the literature to examine fQRS-T in patients with GAD. In this study, we discovered that MPV predicts fQRS-T in GAD. Future studies are essential in predicting cardiovascular risk using methods demonstrating platelet dysfunction in anxiety disorders.

Evaluation of frontal QRS-T angle values in electrocardiography in patients with chronic rhinosinusitis

BackgroundChronic Rhinosinusitis (CRS) refers to inflammation of the paranasal sinuses and nasal mucosa. Electrocardiographic indicators of ventricular repolarization have been shown to correlate with systemic inflammation parameters. Recently, the frontal QRS-T (fQRS-T) angle has been accepted as a new indicator of ventricular depolarization and repolarization heterogeneity. The (fQRS-T) angle is recommended in predicting the risk of malignant ventricular arrhythmia. In this study, we aimed to evaluate the ventricular arrhythmia potential in patients with chronic rhinosinusitis by examining the relationship between fQRS-T angle on ECG and inflammation markers.MethodsInflammatory markers as well as electrocardiographc (ECG) f(QRS-T) angle, QRS duration, QT interval and corrected QT interval were examined in 54 patients with CRS versus 56 healthy control subjects.ResultsThe f(QRS-T) angle was significantly higher in CRS patients than in healthy controls (p < .001). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) were significantly higher in CRS patients compared to healthy controls (p < .001, for all). Based on correlation analysis, NLR and f(QRS-T) angles were highly correlated (r = .845, p < .001), and according to the results of linear regression analysis, NLR was independently associated with the f(QRS-T) angle (t = 5.149, Beta = 0.595, p = < 0.001).ConclusionBoth f(QRS-T) angle and NLR are significantly increased in CRS patients compared to healthy controls, with increases in NLR also independently associating with increases in f(QRS-T) angle. While the increases in f(QRS-T) angle did not result in clinically alarming absolute values for f(QRS-T), CRS patients might nonetheless be at relatively higher risk for malignant cardiac arrhythmias.

Investigation of Electrocardiogram and Inflammation Parameters in Patients with First Episode Mania

Aim: This study examined inflammation markers and electrocardiogram data in patients with first-episode mania (FEM). It aimed to examine the inflammation processes in the early stages of the disease and the frontal QRS-T (fQRS-T) angle in bipolar disorder (BD). Materials and Methods: After exclusion criteria, 53 FEM patients and 59 healthy controls (HC) were included in the study. Sociodemographic, electrocardiogram (ECG) and lab data of the participants were evaluated. Results: Mean of age and gender distribution did not differ between the groups (p=.743, p=.294, respectively). The heart rate of the FEM group was significantly higher than the HC group (p&lt;.001). fQRS-T was significantly wider in the FEM group than in healthy controls (p=.20). Albumin was significantly lower in the FEM group than in the HC group (p&lt;.001). CRP and CAR values were significantly higher in the FEM group than in HC (p=.009 and p=.011, respectively). In the FEM group, HDL value was significantly lower than HC, while LDL value was significantly higher than HC (p=&lt;.001 and p=.001, accordingly). MHR and AIP values were significantly greater in the FEM group than in HC (p=&lt;.001 and p=.006, respectively). The fQRS-T angle in FEM patients was associated with MHR (r=.37). Conclusion: This study is unique in evaluating inflammatory markers, fQRS-T angle, and heart rate in FEM patients. In this study, we found significantly higher inflammatory markers of MHR, CRP, and CAR in FEM patients in the control group. We found that these findings were consistent with the literature. Since the fQRS-T angle was wider in the FEM group, the cardiovascular risk may be increased in the early stages of BD disease.

Relationship between frontal QRS-T duration and the severity of coronary artery disease in who were non-diabetic and had stable angina pectoris.

There is a known relationship between frontal-QRS-T (F-QRS-T) angle and coronary artery disease (CAD). This study examined the relationship between F-QRS-T angle changes and CAD severity in patients with stable CAD. A total of 202 patients were included in the study after the implementation of exclusion criteria among 894 patients, who were admitted to the outpatient clinic with stable angina pectoris between September 2018 and September 2019. The F-QRS-T angle calculated on the 12-lead electrocardiograms (ECGs) of the patients (taken in the outpatient clinic), and the CAD severity calculated using the Gensini score in patients undergoing coronary angiography were compared. Of the patients included in the study, 38.6% were female and 61.4% were male. The mean age was calculated as 60.16±11.27 years, and 52% of the patients had hypertension. There was no difference between the groups in terms of demographic and clinical values. In a comparison of CAD severity and F-QRS-T angles, the F-QRS-T angle was seen to be statistically significantly higher in the severe CAD group [91°° (102/79)] compared to the group with mild CAD [53°° (64/38)]. In the multivariate logistic regression analysis, there was a significant association between the F-QRS-T angle (odds ratio=1.09, 95% confidence interval=1.06-1.11, p<0.001) and CAD severity. It seems that CAD severity in patients who were non-diabetic and had stable angina pectoris is associated with the F-QRS-T angle.

Relationship between morning blood pressure surge and the frontal plane QRS-T angle in newly diagnosed hypertensive patients

ABSTRACT Background Morning blood pressure surge (MBPS) plays an important role in target organ damage and major adverse cardiac events. The frontal QRS-T [f(QRS-T)] angle is the electrocardiographic marker and index of ventricular arrhythmogenic events. We aimed to investigate the relationship between MBPS and the f(QRS-T) angle, which is an indicator of ventricular repolarization disorder, in patients with newly diagnosed HT. Methods Between June 2020 and March 2021, 263 patients with newly diagnosed HT who were admitted to our outpatient clinic were prospectively included in the study. According to ambulatory blood pressure monitoring (ABPM), the patients were categorized into two groups: Group-I: low-value MBPS (<37 mm Hg), and group-II: high-value MBPS (≥37 mm Hg). The f(QRS-T) angle calculated from the 12-lead electrocardiogram and all other data were compared between the groups. Results A total of 186 newly diagnosed HT patients who met the inclusion criteria were included in the study. The average f(QRS-T) angle in Groups I and 2 was 21° ± 16° and 51° ± 30°, respectively (P < .001). According to multivariate regression analysis, T peak-end and MBPS were found to be independent predictors of the f(QRS-T) angle. Conclusions As a result of our study, we found that the f(QRS-T) angle was widened in patients with exaggerated MBPS. The cause of increased cardiovascular outcomes in patients with exaggerated MBPS may be explained by widened in the f(QRS-T) angle that is a ventricular repolarization parameter.

The frontal plane QRS-T angle may affect our perspective on prehypertension: A prospective study

ABSTRACT Backround The frontal plane QRS-T [f(QRS-T)] angle is an easy marker of myocardial repolarization and was associated with adverse cardiovascular outcomes like prehypertension (PHT). This study was aimed to investigate to evaluate the f(QRS-T) angle in patients with PHT. Methods We measured f(QRS-T) angle of 70 subjects with PHT, 109 patients with hypertension (HT), and 102 normotensive healthy volunteers. The f(QRS-T) angle was calculated from 12-lead electrocardiography. Results The f(QRS-T) angle was significantly higher in the HT and PHT groups as compared to the control group, but there was no significant difference in the f(QRS-T) angle between the HT and PHT groups. The f(QRS-T) angle was significantly and positively correlated with age, systolic blood pressure (BP) in 24 hours, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, TpE distance while was negatively correlated with left ventricular ejection fraction. In multivariable analysis, we showed that systolic BP, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, Tpe distance were independent predictors of higher f(QRS-T) angle. Conclusions The f(QRS-T) angle, a noninvasive measurement analyzing the dysfunction in cardiac conduction system, was increased in subjects with PHT as compared to normotensives, and the subjects with PHT had f(QRS-T) angle as higher as patients with HT did. Our findings are supportive for the hypothesis that disturbances in ventricular repolarization is present in an early stage of essential hypertension.

Is there association between QRS-T angle, and hormonal and sonographic features in polycystic ovarian syndrome?

Polycystic ovary syndrome (PCOS) is a complex disorder comprising ovulatory dysfunction, hyperandrogenism, and polycystic ovaries (PCO). Several studies have used electrocardiography (ECG) to assess PCOS patients. We aimed to analyze the associations among QRS-T angle, hormonal parameters, and ovarian and thyroid sonography in PCOS. Adult females with PCOS, but without comorbid illness, were included in our study. Demographic and clinical features (body mass index, Ferriman-Gallwey score, phenotype) were analyzed, as well as laboratory test results. Based on standard 12-lead ECGs, frontal plane QRS-T angles were calculated, defined as the angle between the mean QRS and the mean T vector, and verified with automatic instrument measurements. Values within the range -46 to +59° were classified as "normal", and those out of this range as "abnormal". Patients were divided into groups according to the presence of thyroid nodules, echogenicity (normal/decreased), and vascularity (normal/increased) based on thyroid sonography, and by mean ovarian volume (MOV ≥ 10/< 10 mL) or apparent PCO based on ovarian sonography. The mean age of the 92 patients was 22.68 ± 4.58 years; 11 patients (11.9%) had abnormal QRS-T angles. Demographic, clinical, electrocardiographic, and laboratory parameters were similar between the normal and abnormal QRS-T angle groups, with the exception of MOV, which was higher in the latter group (p=0.032). Among all clinical and laboratory parameters, only MOV was a strong predictor of abnormal QRS-T angle (p=0.016). Our study is the first to analyze the association between the QRS-T angle and hormonal and sonographic features of patients with PCOS. A small percentage of patients had abnormal QRS-T angles, and a large MOV was a strong predictor of this abnormality.

The relation of frontal QRS-T angle with syntax score in patients with ST segment elevation myocardial infarction

Aim: Current data regarding the relation between the Frontal QRS-T (FQRST) angle and the atherosclerotic burden is limited. This study purposed to investigate the relation between FQRST angle and the Syntax (SX) score in subjects presenting with STEMI. Material and Methods: Forty-nine patients who were admitted to the coronary care unit of a tertiary-care hospital for acute STEMI and underwent successful revascularization of the infarct related artery were included in this retrospective analysis. FQRST angle, QTc, and T peak- T end (TpTe) intervals were obtained from the presenting electrocardiogram (ECG). ECG was repeated 30 minutes after revascularization. The SX score was calculated using dedicated software. The study population was then divided into 3 tertiles based on the SYNTAX trial results as follows: SX score ≤ 22 (Low SX score, n=34), SX score ≥ 23 and 33 (Intermediate SX score, n=8), and those with an SX score ≥ 33(High SX score, n=7).Results: Median FQRST angle of the subjects with an SX score ≥ 33 was significantly wider than those with an SX score 22 had a longer TpTe interval than those with an SX score ≤ 22 points. SX score was significantly correlated with the FQRST angle (r=0.691, p 0.001) and TpTe interval (r=0.579, p 0.001).Conclusion: FQRST angle obtained from the admission surface ECG of the subjects with acute STEMI might reflect the extent and severity of the CAD, as demonstrated by the SX score. Moreover, FQRST angle may be useful in determination of the success of the revascularization in STEMI subjects.

P5535The role of both baseline frontal plane qrs-t angle and post-revascularization frontal plane QRS-T angle in cardiac risk asssessment in patients with acute ST elevated myocardial infarction

P5535The role of both baseline frontal plane qrs-t angle and post-revascularization frontal plane QRS-T angle in cardiac risk asssessment in patients with acute ST elevated myocardial infarction