Lazzeroni Davide, Bini Matteo, Camaiora Umberto, Castiglioni Paolo, Moderato Luca, Ugolotti Pietro Tito, Brambilla Lorenzo, Brambilla Valerio, Coruzzi Paolo
IRCCS Fondazione Don Carlo Gnocchi, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Italy.
J Electrocardiol. 2018 Nov-Dec;51(6):967-972. doi: 10.1016/j.jelectrocard.2018.08.028. Epub 2018 Aug 23.
An abnormal frontal QRS-T angle (fQRSTa) is associated with increased risk of death in primary and secondary cardiovascular prevention. The aim of this study was to evaluate the fQRSTa prognostic role in patients undergoing myocardial revascularization and/or cardiac valve surgery.
We enrolled and prospectively followed for 48 ± 26 months 939 subjects with available QRS and T axis data; mean age was 68 ± 12 years, 449 patients (48%) underwent myocardial revascularization, 333 (35%) cardiac valve surgery, 94 (10%) valve plus bypass graft surgery and 63 (7%) cardiac surgery for other cardiovascular (CV) diseases. The ECG variables were collected at the end of the cardiac rehabilitation program and fQRSTa was considered normal if <60°, abnormal if >120°, borderline otherwise. Endpoints were overall and CV mortality.
The fQRSTa was normal in 333 patients (36%), borderline in 285 (30%) and abnormal in 321 (34%). Overall (p = 0.012) and cardiovascular (p = 0.007) mortality were significantly higher in patients with abnormal fQRSTa even after adjusting separately for gender, PR-, QTc- intervals, presence of right or left bundle branch block and left atrial volume index. The predictive value was confirmed in patients with stable coronary artery disease (SCAD), not in patients with acute coronary syndrome or valve disease. SCAD patients with abnormal both fQRSTa and QRS axis had higher risk of overall (hazard ratio = 2.9, p < 0.0001) and CV (hazard ratio = 4.4, p < 0.0001) mortality compared with SCAD patients with normal fQRSTa, even after multivariate adjustment for age, gender, ECG intervals, left-ventricle ejection fraction and mass index.
In SCAD patients undergoing myocardial revascularization, abnormal fQRSTa is independent predictor of overall and CV mortality.
异常的额面QRS-T角（fQRSTa）与一级和二级心血管预防中死亡风险增加相关。本研究的目的是评估fQRSTa在接受心肌血运重建和/或心脏瓣膜手术患者中的预后作用。
我们纳入了939例有可用QRS和T轴数据的受试者，并进行了48±26个月的前瞻性随访；平均年龄为68±12岁，449例患者（48%）接受了心肌血运重建，333例（35%）接受了心脏瓣膜手术，94例（10%）接受了瓣膜加旁路移植手术，63例（7%）因其他心血管疾病接受了心脏手术。在心脏康复计划结束时收集心电图变量，fQRSTa<60°被认为正常，>120°为异常，否则为临界值。终点为全因死亡率和心血管死亡率。
333例患者（36%）的fQRSTa正常，285例（30%）为临界值，321例（34%）异常。即使在分别对性别、PR间期、QTc间期、右或左束支传导阻滞的存在以及左心房容积指数进行调整后，fQRSTa异常的患者全因死亡率（p=0.012）和心血管死亡率（p=0.007）仍显著更高。在稳定型冠状动脉疾病（SCAD）患者中证实了其预测价值，而在急性冠状动脉综合征或瓣膜疾病患者中未得到证实。与fQRSTa正常的SCAD患者相比，fQRSTa和QRS轴均异常的SCAD患者全因死亡风险（风险比=2.9，p<0.0001）和心血管死亡风险（风险比=4.4，p<0.0001）更高，即使在对年龄、性别、心电图间期、左心室射血分数和体重指数进行多变量调整后也是如此。
在接受心肌血运重建的SCAD患者中，异常的fQRSTa是全因死亡率和心血管死亡率的独立预测因素。
