Association of the frontal QRS-T angle with adverse cardiac remodeling, impaired left and right ventricular function, and worse outcomes in heart failure with preserved ejection fraction

Abstract

Background: No prior studies have investigated the association of QRS-T angle with cardiac structure and function and outcomes in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to test the hypothesis that increased frontal QRS-T angle is associated with worse cardiac function and remodeling and adverse outcomes in HFpEF.

Methods: A total of 376 patients with HFpEF (i.e., symptomatic heart failure with left ventricular ejection fraction > 50%) were prospectively studied. The frontal QRS-T angle was calculated from the 12-lead electrocardiogram. Patients were divided into tertiles by frontal QRS-T angle (0°-26°, 27°-75°, and 76°-179°), and clinical, laboratory, and echocardiographic data were compared among groups. Cox proportional-hazards analyses were performed to determine the association between QRS-T angle and outcomes.

Results: The mean age of the cohort was 64 ± 13 years, 65% were women, and the mean QRS-T angle was 61 ± 51°. Patients with increased QRS-T angles were older; had lower body mass indices; more frequently had coronary artery disease, diabetes, chronic kidney disease, and atrial fibrillation; and had higher B-type natriuretic peptide levels (P < .05 for all comparisons). After multivariate adjustment, patients with increased QRS-T angles had higher B-type natriuretic peptide levels in addition to higher left ventricular mass indices, worse diastolic function parameters, more right ventricular remodeling, and worse right ventricular systolic function (P < .05 for all associations). QRS-T angle was independently associated with the composite outcome of cardiovascular hospitalization or death on multivariate analysis, even after adjusting for B-type natriuretic peptide (heart rate for the highest QRS-T tertile, 2.0; 95% confidence interval, 1.2-3.4; P = .008).

Conclusions: In HFpEF, increased QRS-T angle is independently associated with worse left and right ventricular function and remodeling and adverse outcomes.

Keywords: B-type natriuretic peptide; BNP; Corrected QT; Diastolic heart failure; Echocardiography; HF; HFpEF; Heart failure; Heart failure with preserved ejection fraction; LV; LVEF; Left ventricular; Left ventricular ejection fraction; Outcomes; QRS-T angle; QTc; RV; Right ventricular; TAPSE; Tricuspid annular plane systolic excursion.