Frontal QRS-T angle and mortality in ischemic stroke patients: a multicenter study

Abstract

Background: Acute ischemic stroke (AIS) is a leading cause of mortality and morbidity worldwide. Cardiac electrical abnormalities, such as changes in the frontal QRS-T angle (fQRS-TA), are linked to adverse outcomes in various cardiovascular disorders. However, the prognostic significance of fQRS-TA in patients with AIS was not clearly established. This study aimed to evaluate the association between fQRS-TA and 30-day mortality in patients with AIS. Methods: This prospective, two-center observational study was conducted at Bilkent City Hospital and Etlik City Hospital between 01 June and 31 July, 2023. Patients aged ≥18 years diagnosed with AIS were enrolled, whereas individuals with hemorrhagic stroke, congenital heart disease, history of cerebrovascular events or significant electrocardiographic abnormalities were excluded. Baseline demographic data, clinical parameters, and electrocardiogram (ECG) findings were collected. fQRS-TA was defined as the absolute difference between the frontal plane QRS and T-wave axes. Patients were classified into survivors or deceased based on 30-day outcomes. Statistical analysis was performed using SPSS version 25. Results: The data of 85 AIS patients were assessed (mean age: 67.29 ± 12.88 years; 51.8% female), and the results demonstrated that fQRS-TA was significantly elevated in patients with hypertension and congestive heart failure (p < 0.05). A weak positive correlation was observed between age and fQRS-TA (p = 0.017), with the deceased group demonstrating significantly higher fQRS-TA values than the survivors (p = 0.045). The NIHSS (National Institutes of Health Stroke Scale) scores were also found to be significantly higher in the deceased group (p = 0.014). Conclusions: fQRS-TA is an easily obtainable ECG parameter that may serve as a predictor of short-term mortality in AIS patients. When combined with NIHSS scores, fQRS-TA may improve risk stratification and inform early clinical decision-making. Further large-scale, randomized studies are needed to confirm these findings.