Prognostic significance of inverse spatial QRS-T angle circadian pattern in myocardial infarction survivors

Background

We investigated the predictive value of the spatial QRS-T angle (QRSTA) circadian variation in myocardial infarction (MI) patients.

Methods

Analyzing 24-hour recordings (SEER MC, GE Marquette) from 151 MI patients (age 63 ± 12.7), the QRSTA was computed in derived XYZ leads. QRS-T angle values were compared between daytime and night time. The end point was cardiac death or life-threatening ventricular arrhythmia in 1 year.

Results

Overall, QRSTA was slightly higher during the day vs. the night (91° vs. 87°, P = .005). However, 33.8% of the patients showed an inverse diurnal QRSTA variation (higher values at night), which was correlated to the outcome (P = .001, odds ratio 6.7). In multivariate analysis, after entering all factors exhibiting univariate trend towards significance, inverse QRSTA circadian pattern remained significant (P = .036).

Conclusion

Inverse QRSTA circadian pattern was found to be associated with adverse outcome (22.4%) in MI patients, whereas a normal pattern was associated (96%) with a favorable outcome.