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Frontal QRS-T angle and ventricular mechanics in congenital heart disease

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Abstract

Background

The QRS-T angle has been associated with adverse cardiovascular events and sudden cardiac deaths. We determined frontal QRS-T angle in patients with complete transposition of the great arteries (TGA) after atrial switch operation and repaired tetralogy of Fallot (TOF) and explored its relationships with ventricular mechanics.

Methods

Thirty TGA patients aged 32.3 ± 4.4 years after atrial switch operation and 47 repaired TOF patients aged 28.7 ± 6.0 years were studied. The frontal planar QRS-T angle and QRS duration were measured from 12-lead electrocardiograms. Right (RV) and left ventricular (LV) strain parameters were determined using speckle tracking echocardiography.

Results

Compared with TOF patients, TGA patients after atrial switch operation had significantly greater frontal QRS-T angle (136.3° ± 43.5° vs 74.5° ± 59.6°, p < 0.001), greater prevalence of QRS-T angle ≥ 100° (83.3% vs 29.8%, p < 0.001), and showed progressive increase in QRS-T angle over a duration of 3.3 ± 1.0 years (p = 0.035). The QRS-T angle correlated positively with QRS duration in both the TGA (r = 0.61, p < 0.001) and TOF (r = 0.30, p < 0.043) groups. Among TGA patients, QRS-T angle was found to correlate negatively with systemic RV global longitudinal strain (r = − 0.49, p = 0.007), early diastolic strain rate (r = − 0.41, p = 0.026), and fractional area change (r = − 0.38, p = 0.045), but not subpulmonary LV strain indices. By contrast, among repaired TOF patients, there were no significant correlations between QRS-T angle and systemic and subpulmonary ventricular strain indices (all p > 0.05).

Conclusion

Increased frontal QRS-T angle is prevalent in TGA patients after atrial switch operation and is related to worse systemic RV mechanics.

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Authors and Affiliations

  1. Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China

    Lok-yee Lau, Edwina Kam-fung So, Pak-cheong Chow & Yiu-fai Cheung

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  1. Lok-yee Lau
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  2. Edwina Kam-fung So
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  3. Pak-cheong Chow
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  4. Yiu-fai Cheung
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Contributions

L-YL designed the study, collected and interpreted the data and drafted the manuscript. EK-F So analyzed the imaging data and performed statistical analysis. Y-Fc and P-CC contributed to the conception of the study, data interpretation and final revision of the manuscript.

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Correspondence to Yiu-fai Cheung.

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Lau, Ly., So, E.Kf., Chow, Pc. et al. Frontal QRS-T angle and ventricular mechanics in congenital heart disease. Heart Vessels 35, 1299–1306 (2020). https://doi.org/10.1007/s00380-020-01601-4

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  • DOI: https://doi.org/10.1007/s00380-020-01601-4

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