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Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction

Strebel, Ivo and Twerenbold, Raphael and Wussler, Desiree and Boeddinghaus, Jasper and Nestelberger, Thomas and du Fay de Lavallaz, Jeanne and Abächerli, Roger and Maechler, Patrick and Mannhart, Diego and Kozhuharov, Nikola and Rubini Giménez, Maria and Wildi, Karin and Sazgary, Lorraine and Sabti, Zaid and Puelacher, Christian and Badertscher, Patrick and Keller, Dagmar I. and Miró, Òscar and Fuenzalida, Carolina and Calderón, Sofia and Martin-Sanchez, F. Javier and Iglesias, Sergio Lopez and Osswald, Stefan and Mueller, Christian and Reichlin, Tobias. (2019) Incremental diagnostic and prognostic value of the QRS-T angle, a 12-lead ECG marker quantifying heterogeneity of depolarization and repolarization, in patients with suspected non-ST-elevation myocardial infarction. International journal of cardiology, 277. pp. 8-15.

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Official URL: https://edoc.unibas.ch/77020/

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Abstract

The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard ECG criteria. The QRS-T angle reflects depolarization-repolarization heterogeneity and might assist in detecting patients with a NSTEMI (diagnosis) as well as predicting patients with an increased mortality risk (prognosis).; We prospectively enrolled 2705 consecutive patients with symptoms suggestive of NSTEMI. The QRS-T angle was automatically derived from the standard 10 s 12-lead ECG recorded at presentation to the ED. Patients were followed up for all-cause mortality for 2 years.; NSTEMI was the final diagnosis in 15% (n = 412) of patients. QRS-T angles were significantly greater in patients with NSTEMI compared to those without (p < 0.001). The use of the QRS-T angle in addition to standard ECG criteria indicative of ischemia improved the diagnostic accuracy for NSTEMI as quantified by the area under the ROC curve from 0.68 to 0.72 (p < 0.001). An algorithm for the combined use of standard ECG criteria and the QRS-T angle improved the sensitivity of the ECG for NSTEMI from 45% to 78% and the specificity from 86% to 91% (p < 0.001 for both comparisons). The 2-year survival rates were 98%, 97% and 87% according to QRS-T angle tertiles (p < 0.001).; In patients with suspected NSTEMI, the QRS-T angle derived from the standard 12-lead ECG provides incremental diagnostic accuracy on top of standard ECG criteria indicative of ischemia, and independently predicts all-cause mortality during 2 years of follow-up.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Strebel, Ivo and Reichlin, Tobias
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1874-1754
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:19 Aug 2020 07:08
Deposited On:19 Aug 2020 07:08

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