Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction
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Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction. / Strebel, Ivo; Twerenbold, Raphael; Wussler, Desiree; Boeddinghaus, Jasper; Nestelberger, Thomas; du Fay de Lavallaz, Jeanne; Abächerli, Roger; Maechler, Patrick; Mannhart, Diego; Kozhuharov, Nikola; Rubini Giménez, Maria; Wildi, Karin; Sazgary, Lorraine; Sabti, Zaid; Puelacher, Christian; Badertscher, Patrick; Keller, Dagmar I; Miró, Òscar; Fuenzalida, Carolina; Calderón, Sofia; Martin-Sanchez, F Javier; Iglesias, Sergio Lopez; Osswald, Stefan; Mueller, Christian; Reichlin, Tobias.
in: INT J CARDIOL, Jahrgang 277, 15.02.2019, S. 8-15.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction
AU - Strebel, Ivo
AU - Twerenbold, Raphael
AU - Wussler, Desiree
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - du Fay de Lavallaz, Jeanne
AU - Abächerli, Roger
AU - Maechler, Patrick
AU - Mannhart, Diego
AU - Kozhuharov, Nikola
AU - Rubini Giménez, Maria
AU - Wildi, Karin
AU - Sazgary, Lorraine
AU - Sabti, Zaid
AU - Puelacher, Christian
AU - Badertscher, Patrick
AU - Keller, Dagmar I
AU - Miró, Òscar
AU - Fuenzalida, Carolina
AU - Calderón, Sofia
AU - Martin-Sanchez, F Javier
AU - Iglesias, Sergio Lopez
AU - Osswald, Stefan
AU - Mueller, Christian
AU - Reichlin, Tobias
N1 - Copyright © 2018 Elsevier B.V. All rights reserved.
PY - 2019/2/15
Y1 - 2019/2/15
N2 - BACKGROUND: The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard ECG criteria. The QRS-T angle reflects depolarization-repolarization heterogeneity and might assist in detecting patients with a NSTEMI (diagnosis) as well as predicting patients with an increased mortality risk (prognosis).METHODS: We prospectively enrolled 2705 consecutive patients with symptoms suggestive of NSTEMI. The QRS-T angle was automatically derived from the standard 10 s 12-lead ECG recorded at presentation to the ED. Patients were followed up for all-cause mortality for 2 years.RESULTS: NSTEMI was the final diagnosis in 15% (n = 412) of patients. QRS-T angles were significantly greater in patients with NSTEMI compared to those without (p < 0.001). The use of the QRS-T angle in addition to standard ECG criteria indicative of ischemia improved the diagnostic accuracy for NSTEMI as quantified by the area under the ROC curve from 0.68 to 0.72 (p < 0.001). An algorithm for the combined use of standard ECG criteria and the QRS-T angle improved the sensitivity of the ECG for NSTEMI from 45% to 78% and the specificity from 86% to 91% (p < 0.001 for both comparisons). The 2-year survival rates were 98%, 97% and 87% according to QRS-T angle tertiles (p < 0.001).CONCLUSION: In patients with suspected NSTEMI, the QRS-T angle derived from the standard 12-lead ECG provides incremental diagnostic accuracy on top of standard ECG criteria indicative of ischemia, and independently predicts all-cause mortality during 2 years of follow-up.
AB - BACKGROUND: The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard ECG criteria. The QRS-T angle reflects depolarization-repolarization heterogeneity and might assist in detecting patients with a NSTEMI (diagnosis) as well as predicting patients with an increased mortality risk (prognosis).METHODS: We prospectively enrolled 2705 consecutive patients with symptoms suggestive of NSTEMI. The QRS-T angle was automatically derived from the standard 10 s 12-lead ECG recorded at presentation to the ED. Patients were followed up for all-cause mortality for 2 years.RESULTS: NSTEMI was the final diagnosis in 15% (n = 412) of patients. QRS-T angles were significantly greater in patients with NSTEMI compared to those without (p < 0.001). The use of the QRS-T angle in addition to standard ECG criteria indicative of ischemia improved the diagnostic accuracy for NSTEMI as quantified by the area under the ROC curve from 0.68 to 0.72 (p < 0.001). An algorithm for the combined use of standard ECG criteria and the QRS-T angle improved the sensitivity of the ECG for NSTEMI from 45% to 78% and the specificity from 86% to 91% (p < 0.001 for both comparisons). The 2-year survival rates were 98%, 97% and 87% according to QRS-T angle tertiles (p < 0.001).CONCLUSION: In patients with suspected NSTEMI, the QRS-T angle derived from the standard 12-lead ECG provides incremental diagnostic accuracy on top of standard ECG criteria indicative of ischemia, and independently predicts all-cause mortality during 2 years of follow-up.
KW - Adult
KW - Aged
KW - Cohort Studies
KW - Electrocardiography/instrumentation
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Internationality
KW - Male
KW - Middle Aged
KW - Mortality/trends
KW - Non-ST Elevated Myocardial Infarction/diagnosis
KW - Prognosis
KW - Prospective Studies
U2 - 10.1016/j.ijcard.2018.09.040
DO - 10.1016/j.ijcard.2018.09.040
M3 - SCORING: Journal article
C2 - 30274750
VL - 277
SP - 8
EP - 15
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
