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. 2025 Aug;194(4):1471-1476.
doi: 10.1007/s11845-025-03988-3. Epub 2025 Jun 21.

A new electrocardiographic evaluation in hyperkalemia: frontal QRS-T angle

Mustafa Yedigoz  1 , Akkan Avci  2 , Kemal Sener  3 , Begum S Avci  4 , Onder Yesiloglu  5 , Ahmet B Urfalioglu  1 , Erdem Aksay  1 , Yeliz Simsek  1
Affiliations

A new electrocardiographic evaluation in hyperkalemia: frontal QRS-T angle

Mustafa Yedigoz et al. Ir J Med Sci. 2025 Aug.

Abstract

Introduction: ECG is a frequently used and easily accessible diagnostic tool used to evaluate cardiac involvement in hyperkalemia patients.

Objective: The present study aimed to investigate the mortality prediction potential of the frontal QRS-T angle in hyperkalemia patients and the effects of the treatment process on this angle.

Method: The study was planned as a prospective study. A total of 121 hyperkalemia patients were included in the study. Conditions that caused high potassium were identified and the PR, QRS, QT, QTc, and frontal QRS-T angle were calculated and recorded from the 12-lead ECG recordings of the patients at the time of admission to the emergency room.

Results: The mean age of the patients was 58.5 ± 9.2 years (median: 59), 63 (% 52.1) were female and 58 (% 47.9) were male. The second measurements of the ECG parameters PR, QTc, QRS, T-amplitude, T duration, and frontal QRS-T values were lower than the first measurements (p < 0.001; p = 0.007; p < 0.001; p < 0.001; p < 0.001; p = 0.006, respectively). The ability of the patient's ECG parameters PR, QT, QTc, QRS, T-amplitude, frontal QRS-T angle, and frontal QRS-T (absolute value) to predict the development of mortality In the ROC Curve analysis, it was found that these parameters did not have a statistically significant effect in predicting mortality.

Conclusion: As well as known ECG findings, in cases of hyperkalemia, widening of the frontal QRS-T angle and correction of this widened angle in patients with normokalemia detected with treatment can be used as an important follow-up parameter.

Keywords: Electrocardiography; Emergency department; Frontal QRS-T angle; Hyperkalemia.

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Conflict of interest statement

Declarations. Ethics approval: The ethics committee of the Adana City Training and Research Hospital approved the study. Human rights: This manuscript was carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Informed consent: Written informed consent was obtained from all patients who accepted including this study. Conflict of interest: The authors declare no competing interests.

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