Frontal Planar QRS/T Angle Can Be a Prognostic Factor in the Early Postoperative Period of Patients Undergoing Coronary Bypass Surgery
DOI:
https://doi.org/10.1532/HSF98.2014440Abstract
Background: Wide QRS/T angle reflects the ventricular repolarization heterogeneity and has been found in association with cardiac morbidity and mortality in various study populations. However, literature data about the availability of QRS/T angle in patients undergoing cardiac surgery has not yet been available.
Methods: A total of 157 patients who underwent isolated coronary artery bypass surgery were included in this study. A preoperative 12-lead ECG was obtained one day before surgical procedure. The absolute difference between the frontal QRS wave axes and T-wave axes was defined as frontal planar QRS/T angle. Afterwards, patients were divided into two groups according to their frontal planar QRS/T angle (the cut-off value as 90°).
Results: Group 1 consisted of 109 patients with frontal planar QRS/T angle of <90, and the remaining 48 patients with frontal planar QRS/T angle 90 were placed into group 2. Mean EuroSCORE was much higher in group 2. There were significant differences for positive inotropic agent usage (27.5% for group 1 versus 58.3% for group 2, P < .001) and the prevalence of postoperative atrial fibrillation (11.9% for group 1 versus 31.2% for group 2, P = .004) between the two groups. In multivariate logistic regression analysis, used to determine the independent predictors of positive inotropic usage in the early postoperative period, only frontal planar QRS/T angle (OR: 0.989, 95% CI: 0.981-0.997, P = .008) and EuroSCORE (OR: 0.792, 95% CI: 0.646-0.971, P = .025) were found to be statistically significant.
Conclusion: We found that frontal planar QRS/T angle might be an important preoperative parameter in predicting the need for inotropic drugs in the early postoperative period following coronary artery bypass surgery.
References
Argenziano M, Spotnitz HM, Whang W, et al. 1999. Risk stratification for coronary bypass surgery in patients with left ventricular dysfunction. Circulation 100(Suppl II):119-24.nAro AL, Huikuri HV, Tikkanen JT, et al. 2012. QRS/T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace 14:872-6.nde Bruyne MC, Hoes AW, Kors JA, et al. 1999. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study. Eur Heart J 20:278-84.nHingra R, Ho Nam B, Benjamin EJ, et al. 2005. Cross 2 sectional relations of electrocardiographic QRS duration to left ventricular dimensions: the Framingham Heart Study. J Am Coll Cardiol 45:685.nKannel WB, Anderson K, McGee DL, et al. 1987. Nonspecific electrocardiographic abnormality as a predictor of coronary heart disease: the Framingham Study. Am Heart J 113:370-6.nKardys I, Kors JA, van der Meer IM, et al. 2003. Spatial QRS/T angle predicts cardiac death in a general population. European Heart Journal 24:1357-64.nKors JA, Kardys I, van der Meer IM, et al. 2003. Spatial QRS/T angle as a risk indicator of cardiac death in an elderly population. J Electrocardiol 36 Suppl:113-14.nMacfarlane PW. 2012. The frontal plane QRS/T angle. Europace. 14:773-5.nMalik M, Hnatkova K, Batchvarov VN. 2004. Post infarction risk stratification using the 3-D angle between QRS complex and T-wave vectors. J Electrocardiol 37 Suppl:201-8.nMyers WO, Blackstone EH, Davis K, et al. 1999. CASS Registry long term surgical survival. Coronary Artery Surgery Study. J Am Coll Cardiol 33:488-98.nNilsson J, Algotsson L, Hoglund P, et al. 2004. Early mortality in coronary bypass surgery: the EuroSCORE versus The Society of Thoracic Surgeons risk algorithm. Ann Thorac Surg 77:1235-9.nPavri BB, Hillis MB, Subacius H, et al. 2008. Prognostic value and temporal behavior of the planar QRS/T angle in patients with nonischemic cardiomyopathy. Circulation 117:3181-6.nRady MY, Ryan T. 1999. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Critical Care Med 27:340-7.nRaposeiras-Roubín S, Virgós-Lamela A, Bouzas-Cruz N, et al. 2014. Usefulness of the QRS/T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction. Am J Cardiol 113:1312-9.nRautaharju PM, Kooperberg C, Larson JC, LaCroix A. 2006. Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in postmenopausal women: the Women's Health Initiative. Circulation 113:481-9.nScherptong RW, Henkens IR, Man SC, et al. 2008. Normal limits of the spatial QRS/T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate. J Electrocardiol 41:648-55.nVoulgari C, Tentolouris N. 2009. Assessment of the spatial QRS-T angle by vectorcardiography: current data and perspectives. Curr Cardiol Rev 5:251-62.nWagner GS. 2001. Marriott's Practical Electrocardiography. 10th edition. Baltimore, Md: Lippincott Williams & Wilkins, p. 60.nYamazaki T, Froelicher VF, Myers J, et al. 2005. Spatial QRS-T angle predicts cardiac death in a clinical population. Heart Rhythm 2:73-8.nYan-Hong Li, Xue-Jun Ren, Zhi-Hong Han, et al. 2013. Value of the frontal planar QRS/T angle on cardiac dysfunction in patients with old myocardial infarction. Int J Clin Exp Med 6:688-92.n
