Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
Ann Nucl Med. 2021 Jun;35(6):662-668. doi: 10.1007/s12149-021-01596-6. Epub 2021 Apr 18.
The frontal QRS-T angle is one of markers of ventricular repolarization. We investigated whether or not the frontal QRS-T angle could predict left ventricular (LV) volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease (CKD).
Two hundred and twelve patients with advanced CKD defined as estimated glomerular filtration rate of < 45 ml min/1.73 m were enrolled. Wide QRS-T angle was defined as its angle of > 90°, and was considered abnormal. Enlarged LV end-diastolic volume (LVEDV) was defined as LVEDV index of > 76 ml m in men and > 57 ml m in women. Reduced LV ejection fraction (LVEF) was defined as LVEF of < 40%.
Fifty-one patients (24%) had wide QRS-T angle, and 161 patients (76%) had normal QRS-T angle. Patients with wide QRS-T angle had larger SSS [9 (5-16) vs 4 (1-9), p < 0.001], larger LVEDV index (69 ± 29 vs 50 ± 18 ml m, p < 0.001) and lower LVEF (47 ± 13 vs 59 ± 12%, p < 0.001) than those with normal QRS-T angle. Multivariate analysis showed that wide QRS-T angle (odds ratio 5.93; 95% CI 2.55-14.33; p < 0.001) was significantly associated with enlarged LVEDV, whereas SSS severity was not. Severely abnormal SSS (odds ratio 3.80; 95% CI 1.16-14.05; p < 0.03) and wide QRS-T angle (odds ratio 5.67; 95% CI 2.10-16.22; p < 0.001) were significantly associated with reduced LVEF.
Our results suggest that wide QRS-T angle is associated with LV remodeling such as enlarged LVEDV or reduced LVEF in patients with advanced CKD.
额面 QRS-T 角是心室复极的标志之一。我们研究了额面 QRS-T 角是否可以预测晚期慢性肾脏病（CKD）患者心电图门控 SPECT 得出的左心室（LV）容积和功能。
我们纳入了 212 名晚期 CKD 患者，定义为估计肾小球滤过率<45ml/min/1.73m。宽 QRS-T 角定义为其角度>90°，并认为异常。LV 舒张末期容积（LVEDV）增大定义为男性 LVEDV 指数>76ml/m，女性>57ml/m。LV 射血分数（LVEF）降低定义为 LVEF<40%。
51 名患者（24%）有宽 QRS-T 角，161 名患者（76%）有正常 QRS-T 角。宽 QRS-T 角患者的 SSS 更大[9（5-16）比 4（1-9），p<0.001]，LVEDV 指数更大（69±29 比 50±18ml/m，p<0.001），LVEF 更低（47±13 比 59±12%，p<0.001）。多变量分析显示，宽 QRS-T 角（比值比 5.93；95%置信区间 2.55-14.33；p<0.001）与 LVEDV 增大显著相关，而 SSS 严重程度无此关联。严重异常 SSS（比值比 3.80；95%置信区间 1.16-14.05；p<0.03）和宽 QRS-T 角（比值比 5.67；95%置信区间 2.10-16.22；p<0.001）与 LVEF 降低显著相关。
我们的结果表明，宽 QRS-T 角与晚期 CKD 患者的 LV 重构有关，如 LVEDV 增大或 LVEF 降低。
