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 one of the markers of the repolarization of the ventricles. This research investigated whether the frontal QRS-T angle could predict mortality in hemodialysis patients with a 7-year follow-up.

METHOD
This study was conducted with 110 patients undergoing regular hemodialysis. Frontal QRS-T angles exceeding 90 degrees were classified as wide. Two different groupings were evaluated according to the width of the QRS-T angle and the occurrence of mortality. Measurable ECG parameters included the QRS, T axis, TP/QT ratio, fragmented QRS, TPe/QTc ratio, and frontal QRS-T angle, which is defined as the absolute difference between the frontal QRS axis and the T axis.

RESULTS
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 mortality-present group. Ejection fraction was found to be lower in the mortality-present group. It was also found that the Frontal QRS_T angle was wider in the mortality-present (94 (31-113), 33(16-80) p<0,001). In univariate-multivariate logistic regression analyses, being on the broader group increased mortality (OR: 8.08, CI: 2.75- 23.74,p<0.001). Fragmented QRS also increased mortality (OR: 11,25, CI: 2,98-42,49,p<0.001).


CONCLUSION
Our findings demonstrate the independent risk-stratifying value of the frontal QRS-T angle in hemodialysis patients, regardless of ejection fraction status. This suggests its potential to play a crucial role in routine cardiovascular assessments, enhancing risk management strategies for this vulnerable group.