The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients.
Journal
Blood pressure monitoring
ISSN: 1473-5725
Titre abrégé: Blood Press Monit
Pays: England
ID NLM: 9606438
Informations de publication
Date de publication:
01 Apr 2023
01 Apr 2023
Historique:
entrez:
14
3
2023
pubmed:
15
3
2023
medline:
16
3
2023
Statut:
ppublish
Résumé
The frontal QRS-T angle (fQRS-T angle) in ECG is a new measure of myocardial repolarization, in which a higher fQRS-T angle is linked with worse cardiac outcomes. Reverse dipper hypertension is also linked to poor cardiac outcomes. The purpose of this study was to investigate the association between the fQRS-T angle and reverse dipper status in individuals newly diagnosed with hypertension who did not have left ventricular hypertrophy (LVH). The investigation recruited 171 hypertensive individuals without LVH who underwent 24-h ambulatory blood pressure monitoring (ABPM). On the basis of the findings of 24-h ABPM, the study population was categorized into the following three groups: patients with dipper hypertension, non-dipper hypertension, and reverse dipper hypertension. LVH was defined by echocardiography. The fQRS-T angle was measured using the 12-lead ECG. The fQRS-T angle in individuals with reverse dipper hypertension was substantially greater than in patients with and without dipper hypertension (51° ± 28° vs. 28° ± 22° vs. 39° ± 25°, respectively, P < 0.001). The fQRS-T angle (odds ratio: 1.040, 95% confidence interval: 1.016-1.066; P = 0.001) was independently associated with reverse dipper hypertension according to multivariate analysis. In receiver operating characteristic curve analysis, the fQRS-T angle to predict reverse dipper hypertension was 33.5° with 76% sensitivity and 71% specificity. This study showed that an increased fQRS-T angle was associated with reverse dipper hypertension in newly diagnosed hypertensive patients without LVH.
Identifiants
pubmed: 36916470
doi: 10.1097/MBP.0000000000000637
pii: 00126097-202304000-00004
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
96-102Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1659–1724.
Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML, et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension 2008; 51:55–61.
Hermida RC, Hermida RC. Ambulatory blood pressure monitoring in the prediction of cardiovascular events and effects of chronotherapy: rationale and design of the MAPEC study. Chronobiol Int 2007; 24:749–775.
Izzedine H, Launay-Vacher V, Deray G. Fanconi syndrome associated with didanosine therapy. AIDS 2005; 19:844–845.
Pickering TG. The clinical significance of diurnal blood pressure variations. Dippers and nondippers. Circulation 1990; 81:700–702.
Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001; 38:852–857.
Wang C, Zhang J, Liu X, Li C, Ye Z, Peng H, et al. Reversed dipper blood-pressure pattern is closely related to severe renal and cardiovascular damage in patients with chronic kidney disease. PLoS One 2013; 8:e55419.
Kim BK, Kim YM, Lee Y, Lim YH, Shin J. A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort. J Korean Med Sci 2013; 28:1468–1473.
Yokota H, Imai Y, Tsuboko Y, Tokumaru AM, Fujimoto H, Harada K. Nocturnal blood pressure pattern affects left ventricular remodeling and late gadolinium enhancement in patients with hypertension and left ventricular hypertrophy. PLoS One 2013; 8:e67825.
Antzelevitch C, Shimizu W, Yan GX, Sicouri S. Cellular basis for QT dispersion. J Electrocardiol 1998; 30:168–175.
Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015; 3:705.
Altunova M, Püşüroğlu H, Karakayali M, Şahin AA, Demir AR, Yilmaz E, et al. Relationship between fragmented QRS complex and long-term cardiovascular outcome in patients with essential hypertension. Anatol J Cardiol 2022; 26:442.
Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014; 19:534–542.
Kardys I, Kors JA, van der Meer IM, Hofman A, van der Kuip DA, Witteman JC. Spatial QRS-T angle predicts cardiac death in a general population. Eur Heart J 2003; 24:1357–1364.
Yamazaki T, Froelicher VF, Myers J, Chun S, Wang P. Spatial QRS-T angle predicts cardiac death in a clinical population. Heart Rhythm 2005; 2:73–78.
Havranek EP, Emsermann CD, Froshaug DN, Masoudi FA, Krantz MJ, Hanratty R, et al. Thresholds in the relationship between mortality and left ventricular hypertrophy defined by electrocardiography. J Electrocardiol 2008; 41:342–350.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018; 39:3021–3104.
Fagard RH. Dipping pattern of nocturnal blood pressure in patients with hypertension. Expert Rev Cardiovasc Ther 2009; 7:599–605.
Brown RA, Schlegel TT. Diagnostic utility of the spatial versus individual planar QRS-T angles in cardiac disease detection. J Electrocardiol 2011; 44:404–409.
Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM; ARIC Research Group. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol 2007; 100:844–849.
Das MK, Khan B, Jacob S, Kumar A, Mahenthiran J. Significance of a fragmented QRS complex versus a Q wave in patients with coronary artery disease. Circulation 2006; 113:2495–2501.
Antzelevitch C. Tpeak–Tend interval as an index of transmural dispersion of repolarization. Eur J Clin Invest 2001; 31:555–557.
Çağdaş M, Karakoyun S, Rencüzoğullari I, Karabağ Y, Yesin M, Velibey Y, et al. Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention. Anatol J Cardiol 2018; 19:50.
Henry MP, Cotella JI, Slivnick JA, Yamat M, Hipke K, Johnson R, et al. Three-dimensional echocardiographic deconstruction: feasibility of clinical evaluation from two-dimensional views derived from a three-dimensional data set. J Am Soc Echocardiogr 2022; 35:1009–1017.e2.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159–2219.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7:79–108.
de Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG, et al.; Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. Am J Hypertens 2005; 18:191–196.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17:1321–1360.
Grassi G, Seravalle G, Quarti-Trevano F, Dell’Oro R, Bombelli M, Cuspidi C, et al. Adrenergic, metabolic, and reflex abnormalities in reverse and extreme dipper hypertensives. Hypertension 2008; 52:925–931.
Kohara K, Nishida W, Maguchi M, Hiwada K. Autonomic nervous function in non-dipper essential hypertensive subjects. Evaluation by power spectral analysis of heart rate variability. Hypertension 1995; 26:808–814.
Ino-Oka E, Yumita S, Sekino H, Ohtaki Y, Takahashi T, Inooka H, et al. The effects of physical activity and autonomic nerve tone on the daily fluctuation of blood pressure. Clin Exp Hypertens 2004; 26:129–136.
Sun L, Yan B, Gao Y, Su D, Peng L, Jiao Y, et al. Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients. Sci Rep 2016; 6:25053.
Tanriverdi Z, Unal B, Eyuboglu M, Tanriverdi TB, Nurdag A, Demirbag R. The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens 2018; 40:318–323.
Strand A, Gudmundsdottir H, Høieggen A, Fossum E, Bjørnerheim R, Os I, et al. Increased hematocrit before blood pressure in men who develop hypertension over 20 years. J Am Soc Hypertens 2007; 1:400–406.
Smith WC, Lowe GD, Lee AJ, Tunstall-Pedoe H. Rheological determinants of blood pressure in a scottish adult population. J Hypertens 1992; 10:467–472.
Nadar S, Blann A, Lip G. Platelet morphology and plasma indices of platelet activation in essential hypertension: effects of amlodipine-based antihypertensive therapy. Ann Med 2004; 36:552–557.
Yan B, Peng L, Han D, Sun L, Dong Q, Yang P, et al. Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients. Medicine (Baltim) 2015; 94:e604.
Berk BC, Fujiwara K, Lehoux S. ECM remodeling in hypertensive heart disease. J Clin Invest 2007; 117:568–575.
Akin H, Bilge O, Altintaş B, Yildiz G. The relationship of frontal QRS-T angle between patients with newly diagnosed true and white coat hypertension. Blood Press Monit 2022; 10:1097.
Eyuboglu M, Karabag Y, Karakoyun S, Akdeniz B. The effect of circadian blood pressure pattern on presence of fragmented QRS complexes in hypertensive subjectss. J Am Soc Hypertens 2017; 11:513–518.
Demir M, Uyan U. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with non-dipper hypertension. Clin Exp Hypertens 2014; 36:285–288.
Jogu HR, O’Neal WT, Broughton ST, Shah AJ, Zhang ZM, Soliman EZ. Frontal QRS-T angle and the risk of atrial fibrillation in the elderly. Ann Noninvasive Electrocardiol 2017; 22:e12388.
Dogan A, Serkan K. ‘Frontal QRS-T angle predicts coronary atherosclerotic burden in patients with ST segment elevation myocardial infarction’. J Electrocardiol 2020; 58:155–159.
Erdogan G, Yontar OC, Yenercag M, Gul S, Arslan U. Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction. J Electrocardiol 2020; 61:86–91.
Shi B, Ferrier KA, Sasse A, Harding SA, Larsen PD. Correlation between vector cardiographic measures and cardiac magnetic resonance imaging of the left ventricle in an implantable cardioverter defibrillator population. J Electrocardiol 2014; 47:52–58.
Jensen CJ, Lambers M, Zadeh B, Wambach JM, Nassenstein K, Bruder O. QRS-T angle in patients with hypertrophic cardiomyopathy – a comparison with cardiac magnetic resonance imaging. Int J Med Sci 2021; 18:821–825.
Passino C, Magagna A, Conforti F, Buralli S, Kozáková M, Palombo C, et al. Ventricular repolarization is prolonged in nondipper hypertensive patients: role of left ventricular hypertrophy and autonomic dysfunction. J Hypertens 2003; 21:445–451.