PMID- 32452635 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20210621 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 7 IP - 4 DP - 2020 Aug TI - Diagnostic and prognostic values of the QRS-T angle in patients with suspected acute decompensated heart failure. PG - 1817-1829 LID - 10.1002/ehf2.12746 [doi] AB - AIMS: The aim of this study was to investigate the diagnostic and prognostic utility of the QRS-T angle, an electrocardiogram (ECG) marker quantifying depolarization-repolarization heterogeneity, in patients with suspected acute decompensated heart failure (ADHF). METHODS AND RESULTS: We prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of ADHF. The QRS-T angle was automatically derived from a standard 12-lead ECG recorded at presentation. The primary diagnostic endpoint was a final adjudicated diagnosis of ADHF. The primary prognostic endpoint was all-cause mortality during 2 years of follow-up. Among the 1915 patients enrolled, those with higher QRS-T angles were older, were more commonly male, and had a higher rate of co-morbidities such as arterial hypertension, coronary artery disease, or chronic kidney disease. ADHF was the final adjudicated diagnosis in 1140 (60%) patients. The QRS-T angle in patients with ADHF was significantly larger than in patients with non-cardiac causes of dyspnoea median 110 degrees [inter-quartile range (IQR) 46-156 degrees ] vs. median 33 degrees [IQR 15-57 degrees ], P < 0.001. The diagnostic accuracy of the QRS-T angle as quantified by the area under the receiver operating characteristic curve (AUC) was 0.75 [95% confidence interval (CI) 0.73-0.77, P < 0.001], which was inferior to N-terminal pro-B-type natriuretic peptide (AUC 0.93, 95% CI 0.92-0.94, P < 0.001), but similar to that of high-sensitivity troponin T (AUC 0.78, 95% CI 0.76-0.80, P = 0.09). The AUC of the QRS-T angle for discrimination between ADHF and non-cardiac dyspnoea remained similarly high in subgroups of patients known to be diagnostically challenging, including patients older than 75 years [0.71 (95% CI 0.67-0.74)], renal failure [0.79 (95% CI 0.71-0.87)], and atrial fibrillation at presentation [0.68 (95% CI 0.60-0.76)]. Mortality rates according to QRS-T angle tertiles were 4%, 6%, and 10% after 30 days (P < 0.001) and 24%, 31%, and 43% after 2 years (P < 0.001). After adjustment for clinical, laboratory, and ECG parameters, the QRS-T angle remained an independent predictor for 2 year mortality with a 4% increase in mortality for every 20 degrees increase in QRS-T angle (P = 0.02). CONCLUSIONS: The QRS-T angle is a readily available and inexpensive marker that can assist in the discrimination between ADHF and non-cardiac causes of acute dyspnoea and may aid in the risk stratification of these patients. CI - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. FAU - Sweda, Romy AU - Sweda R AD - Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. AD - sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland. FAU - Sabti, Zaid AU - Sabti Z AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Strebel, Ivo AU - Strebel I AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Kozhuharov, Nikola AU - Kozhuharov N AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Wussler, Desiree AU - Wussler D AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Shrestha, Samyut AU - Shrestha S AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Flores, Dayana AU - Flores D AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Badertscher, Patrick AU - Badertscher P AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Lopez-Ayala, Pedro AU - Lopez-Ayala P AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Zimmermann, Tobias AU - Zimmermann T AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Michou, Eleni AU - Michou E AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Gualandro, Danielle M AU - Gualandro DM AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Haberlin, Andreas AU - Haberlin A AD - Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. AD - sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland. FAU - Tanner, Hildegard AU - Tanner H AD - Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. FAU - Keller, Dagmar I AU - Keller DI AD - Emergency Department, University Hospital Zurich, Zurich, Switzerland. FAU - Nowak, Albina AU - Nowak A AD - Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland. FAU - Pfister, Otmar AU - Pfister O AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Breidthardt, Tobias AU - Breidthardt T AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Mueller, Christian AU - Mueller C AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. FAU - Reichlin, Tobias AU - Reichlin T AD - Department of Cardiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland. AD - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. LA - eng GR - Singulex/International GR - Roche/International GR - BRAHMS/International GR - Alere/International GR - Abbott/International GR - Critical Diagnostics/International GR - University Hospital Basel/International GR - University of Basel/International GR - Cardiovascular Research Foundation Basel/International GR - Swiss Heart Foundation/International PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200526 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM MH - Arrhythmias, Cardiac MH - Dyspnea MH - Electrocardiography MH - *Heart Failure/diagnosis MH - Humans MH - Male MH - Prognosis PMC - PMC7373892 OTO - NOTNLM OT - Acute dyspnoea OT - Acute heart failure OT - ECG OT - Heart failure OT - QRS-T angle COIS- T.B. has received research grants from the Swiss National Science Foundation (PASMP3-134362), the Department of Internal Medicine, University Hospital Basel, Abbott, and Roche as well as speaker honoraria from Roche. C.M. has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the Cardiovascular Research Foundation Basel, the KTI, the University of Basel, Abbott, Alere, AstraZeneca, Beckman Coulter, BG Medicine, Biomerieux, BRAHMS, Critical Diagnostics, Roche, Siemens, Singulex, Sphingotec, and 8sense as well as speaker/consulting honoraria from Abbott, Alere, AstraZeneca, Biomerieux, BMS, Boehringer Ingelheim, BRAHMS, Cardiorentis, Eli Lilly, Novartis, Roche, Sanofi, Siemens, and Singulex. T.R. has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union (Eurostars 9799-ALVALE), the Professor Max Cloetta Foundation, the Cardiovascular Research Foundation Basel, the University of Basel, and the University Hospital Basel, all for work outside the submitted study. He has received speaker/consulting honoraria or travel support from Abbott/SJM, Astra Zeneca, Brahms, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi Sankyo, Medtronic, Pfizer-BMS, and Roche, all for work outside the submitted study. He has received support for his institution's fellowship programme from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic for work outside the submitted study. All other authors declare no conflict of interest. EDAT- 2020/05/27 06:00 MHDA- 2021/06/22 06:00 PMCR- 2020/05/26 CRDT- 2020/05/27 06:00 PHST- 2019/12/06 00:00 [received] PHST- 2020/04/08 00:00 [revised] PHST- 2020/04/20 00:00 [accepted] PHST- 2020/05/27 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/05/27 06:00 [entrez] PHST- 2020/05/26 00:00 [pmc-release] AID - EHF212746 [pii] AID - 10.1002/ehf2.12746 [doi] PST - ppublish SO - ESC Heart Fail. 2020 Aug;7(4):1817-1829. doi: 10.1002/ehf2.12746. Epub 2020 May 26.