Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study

Abstract

Background: Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown.

Methods: We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54years, 57% women, and 20% African-American), who were free of cardiovascular disease at baseline (visit 1, 1987-1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996-1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal).

Results: A total of 317 (3.3%) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95% CI 1.58-3.29) and spatial (HR 2.10, 95% CI 1.44-3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex.

Conclusions: Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.

Keywords: Electrocardiography; QRS/T angle; Silent myocardial infarction.

Fig. 1

Risk of incident myocardial infarction by QRS/T angle category and gender. CI = confidence interval. Cutpoints listed in Table 2: normal, QRS/T angle ≤ 75th percentile; borderline, >75th percentile and ≤95th percentile; wide, >95th percentile. Model adjusted for age, sex, race, study site, body mass index, education, smoking status, systolic blood pressure, blood pressure lowering medications, diabetes mellitus, ratio of total cholesterol to high density lipoprotein, use of cholesterol-lowering medications, use of aspirin, family history of coronary heart disease, ECG-LVH by Cornell voltage, and serum creatinine at baseline.