Frontal Plane QRS – T Angle Is a Predictor of Ventricular Arrhythmia in Heart Failure With Preserved Ejection Fraction

Abstract

Introduction: Various ventricular repolarization parameters are known to predict ventricular arrhythmias and mortality in various diseases. Although mortality in patients with heart failure with preserved ejection fraction (HFpEF) is similar to that in heart failure with reduced ejection fraction patients, studies on this subject are more limited. Therefore, it is important to evaluate the relationship between ventricular arrhythmias and mortality and ventricular repolarization parameters, especially the frontal plane QRS–T angle, in patients with HFpEF. Methods: Electrocardiographic, echocardiographic, and laboratory data of 811 patients were evaluated, and the fQRST angle was calculated on ECG. The occurrence of ventricular tachycardia, ventricular fibrillation, or sudden death within a mean of 48 ± 12 months was recorded. Statistical significance was determined as p < 0.05. Results: A total of 811 patients were evaluated, 180 patients in the cardiac event group and 631 patients in the no cardiac event group. NT-proBNP, La size, La volume index, Tp-e time, Tp-e/QTc ratio, and fQRS-T angle were statistically significantly higher in the cardiac event group. NT-proBNP level and fQRS-T angle were found to be independent predictors of mortality in multivariate cox analysis. According to ROC analysis, when QRS-T angle has a cut-off value of 58.63, its sensitivity is 81.2, and its specificity is 79.3. Kaplan-Meier analysis also found that when the fQRS-T angle was > 58.63, mortality was higher than at narrower angles. Conclusions: According to our study, the fQRS-T angle, which can be easily and inexpensively calculated on ECG, predicts long-term ventricular arrhythmias in patients with HFpEF.