Frontal QRS-T Angle as a Prognostic Marker of Long-Term Mortality in Hemodialysis Patients

Objective: The electrocardiogram is a crucial, cost-effective, and noninvasive tool for assessing the risk of cardiac morbidity and mortality. The frontal QRS-T angle is a marker of ventricular repolarization. This study investigated whether the frontal QRS-T angle could predict mortality in hemodialysis patients over a seven-year follow-up period.

Method: The study included 110 patients undergoing regular hemodialysis. Frontal QRS-T angles greater than 90 degrees were classified as wide. Patients were categorized based on the width of the QRS-T angle and the presence or absence of mortality. Electrocardiogram (ECG) parameters measured included the QRS, T axis, TP/QT ratio, fragmented QRS, TPe/QTc ratio, and the frontal QRS-T angle, defined as the absolute difference between the frontal QRS and T axes.

Results: A total of 37 patients (34%) had a wide frontal QRS-T angle. The mean age was significantly higher in both the wide frontal QRS-T angle group and the deceased group. Ejection fraction was lower and the frontal QRS-T angle was wider in the mortality group (94 [31-113] vs. 33 [16-80], P < 0.001). In univariate and multivariate logistic regression analyses, having a wide QRS-T angle was associated with increased mortality (odds ratio [OR]: 8.08, confidence interval [CI]: 2.75-23.74, P < 0.001). Additionally, the presence of fragmented QRS also increased mortality risk (OR: 11.25, CI: 2.98-42.49, P < 0.001).

Conclusion: Our findings demonstrate the independent prognostic value of the frontal QRS-T angle in patients undergoing hemodialysis, irrespective of ejection fraction status. This suggests that it may serve as a valuable tool in routine cardiovascular risk assessments, contributing to improved management strategies for this high-risk population.

Keywords: Frontal QRS-T angle, hemodialysis, long-term mortality