Heart Failure - Circulation.pdfVIP

Heart Failure Prognostic Value and Temporal Behavior of the Planar QRS-T Angle in Patients With Nonischemic Cardiomyopathy Behzad B. Pavri, MD; Matthew B. Hillis, MD; Haris Subaius, MA; Genevieve E. Brumberg, MD; Andi Schaechter, BSN, RN; Joseph H. Levine, MD; Alan Kadish, MD; for the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators Background—The planar QRS-T angle can be easily obtained from standard 12-lead ECGs, but its predictive ability is not established. We sought to determine the predictive ability of the planar QRS-T angle in patients with nonischemic cardiomyopathy and to assess QRS-T angle behavior over time. Methods and Results—Baseline QRS-T angles from 455 patients in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial were measured. All patients had nonischemic cardiomyopathy, New York Heart Association class I to III heart failure, and nonsustained ventricular tachycardia or frequent ventricular ectopy. The primary end point (a composite of total mortality, appropriate implantable cardioverter-defibrillator shock, or resuscitated cardiac arrest) occurred in 25 of 172 patients (14.5%) with a QRS-T angle 90° and in 72 of 283 patients (25.4%) with a QRS-T angle 90° (hazard ratio, 1.93; 95% confidence interval, 1.23 to 3.05; P 0.002). A QRS-T angle 90° remained a significant predictor of the primary end point (P 0.039) after adjustment for treatment group, age, gender, QRS duration, left bundle-branch block, left ventricular ejection fraction, New York Heart Association class III, atrial fibrillation, and diabetes mellitus. The secondary end point (total mortality) occurred in 17 of the 172 patients (9.9%) with a QRS-T angle 90° and in 49 of the 283 patients (17.3%) with a QRS-T angle 90° (hazard ratio, 1.79; 95% c