Johannes Riis Jensen1, Kristian Kragholm2, Karoline Willum Bødker3, Rikke Mortensen3, Claus Graff4, Adrian Pietersen5, Jonas Bille Nielsen6, Christoffer Polcwiartek2, Bhupendar Tayal7, Christian Torp-Pedersen3, Peter Søgaard8, Steen Møller Hansen3. 1. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark. Electronic address: Johannes.j@rn.dk. 2. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 3. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark. 4. Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. 5. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA. 6. Department of Medicine, Nordjylland Regional Hospital, Hjorring, Denmark. 7. Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark. 8. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Abstract
BACKGROUND: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.
BACKGROUND: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.
Authors: Steven J Mould; Elsayed Z Soliman; Alain G Bertoni; Prashant D Bhave; Joseph Yeboah; Matthew J Singleton Journal: Diabetologia Date: 2021-01-08 Impact factor: 10.122
Authors: Marc Meller Søndergaard; Johannes Riis; Karoline Willum Bodker; Steen Møller Hansen; Jesper Nielsen; Claus Graff; Adrian Holger Pietersen; Jonas Bille Nielsen; Bhupendar Tayal; Christoffer Polcwiartek; Christian Torp-Pedersen; Peter Soegaard; Kristian Hay Kragholm Journal: Open Heart Date: 2021-02