A Novel Electrocardiographic Marker for Predicting Total Mortality in Ischemic Stroke: Frontal QRS-T Angle

OBJECTIVE
This study aimed to investigate the relationship between mortality and the frontal QRS-T angle (FQRS-TA), obtained by calculating the absolute difference between the QRS and T waves electrocardiographically (ECG), in patients diagnosed with ischemic stroke (IS).


METHODS
This research is a retrospective and cross-sectional study. The diagnosis of IS was confirmed through brain imaging and physical examination. Patients with sinus rhythm were included in the study. The FQRS-TA was measured by calculating the absolute difference between the QRS-axis and the T-axis, as automatically measured on the ECG. Patients were divided into two groups: those who died within five years and those who survived, and the groups were compared.


RESULTS
A total of 322 patients with IS were included in the study, of whom 290 survived, and 32 died. Age, creatinine level, PR interval, QRS duration, corrected QT (cQT) value, and FQRS-TA value were found to be higher in the deceased group. Cox regression analyses were performed to examine the association between predictors of stroke-related mortality. Age [hazard ratio (HR): 1.091, 95% (1.045-1.140), P < 0.001], high-density lipoprotein (HDL) [HR: 0.914, 95% (0.875-0.955), P < 0.001], and FQRS-TA [odds ratio (OR): 1.011, 95% (1.003-1.019), P = 0.007] were associated with mortality. A FQRS-TA of 68 degrees or higher was associated with cumulative mortality in the Kaplan-Meier survival analysis (log rank [Mantel-Cox] test: P = 0.001).


CONCLUSION
In this study, increased FQRS-TA was found to be associated with mortality in patients with IS. ECG parameters are simple and time-efficient measurements that can provide important prognostic information. To the best of our knowledge, this research is the first study to examine the relationship between FQRS-TA and mortality in patients with IS.