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QRS-T angle predicts cardiac risk and correlates with global longitudinal strain in prevalent hemodialysis patients

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Front Physiol 2019 10-145 10.3389-fphys.2019.00145.pdfPublished version3 MBAdobe PDFView/Open
Title: QRS-T angle predicts cardiac risk and correlates with global longitudinal strain in prevalent hemodialysis patients
Authors: Skampardoni, S
Green, D
Hnatkova, K
Malik, M
Kalra, PA
Poulikakos, D
Item Type: Journal Article
Abstract: Background: Cardiovascular disease is the commonest cause of death in hemodialysis (HD) patients but accurate risk prediction is lacking. The spatial QRS – T angle is a promising electrophysiological marker for sudden cardiac death risk stratification. The aim of this study was to assess the prognostic value of spatial QRS-T angle derived from standard 12 lead electrocardiograms (ECG) and its association with echocardiographic parameters in HD patients. Methods: This prospective study of 178 prevalent HD patients (aged 67 ± 14 years, 72% men) collected ECG and echocardiographic data on an annual basis. Baseline echocardiograms at study entry were used for cross-sectional comparisons with ECGs. Study endpoints were all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE). The QRS – T angle was calculated from standard 10-s ECG as the total cosine R to T (TCRT) using singular value decomposition and expressed in degrees. TCRT above 100∘ was defined as abnormal. Results: During a follow-up period of 36 ± 19 months, 74 patients died, including 17 cardiac deaths, and 54 suffered from MACE. In multivariate Cox regression analysis, QRS-T angle by TCRT at baseline was associated with increased cardiovascular mortality both as a continuous value and dichotomized below or above 100∘ (HR 1.016, p = 0.029, CI: 1.002–1.030 and HR 3.506, CI: 1.118–10.995, p = 0.031 respectively) and with MACE dichotomized at 100∘ (HR 1.902, CI: 1.046–3.459; p = 0.035). In multivariate regression analysis including baseline parameters, echocardiographic global longitudinal strain (GLS) was significantly correlated with TCRT (F 9.648, r2 = 0.192, standardized β = 0.331, unstandardized β = 3.567, t = 4.4429, CI: 1.976–5.157, p < 0.001). Conclusion: TCRT correlates with GLS and is independently associated with cardiac deaths and MACE in HD patients.
Issue Date: 25-Feb-2019
Date of Acceptance: 7-Feb-2019
URI: http://hdl.handle.net/10044/1/69279
DOI: https://doi.org/10.3389/fphys.2019.00145
ISSN: 1664-042X
Publisher: Frontiers Media
Journal / Book Title: Frontiers in Physiology
Volume: 10
Copyright Statement: © 2019 Skampardoni, Green, Hnatkova, Malik, Kalra and Poulikakos. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Sponsor/Funder: Kidney research UK
British Heart Foundation
Funder's Grant Number: KBA 1632500
NH/16/2/32499
Keywords: Science & Technology
Life Sciences & Biomedicine
Physiology
ORS-T angle
TCRT
sudden cardiac death
hemodialysis
cardiovascular
global longitudinal strain
WAVE MORPHOLOGY
ECHOCARDIOGRAPHY
MORTALITY
DEATH
QRS-T angle
Publication Status: Published
Article Number: 145
Online Publication Date: 2019-02-25
Appears in Collections:National Heart and Lung Institute