Key result
A QRS-T angle greater than 90 degrees on surface ECG was significantly associated with the presence of late gadolinium enhancement on cardiovascular magnetic resonance imaging (OR 7.18).
Why the study?
Diagnosis and risk stratification in suspected myocarditis is challenging, and it was unknown whether the simple surface ECG QRS-T angle associates with prognostically meaningful late gadolinium enhancement on CMR.
Is a wide QRS-T angle on surface ECG associated with late gadolinium enhancement on CMR in patients with suspected myocarditis?
Cross-Sectional (n=97)
Single-blind
No
Is a wide QRS-T angle on surface ECG associated with late gadolinium enhancement on CMR in patients with suspected myocarditis?
Odds Ratio: 7.18
Absolute Event Rate: 100% vs 76.5%
p-value: p=0.037
A wide QRS-T angle (≥90 degrees) on a standard 12-lead ECG is highly specific for the presence of myocardial fibrosis or necrosis (LGE) on CMR in patients with suspected myocarditis.
May support ECG triage for CMR in suspected myocarditis; hypothesis-generating and requires prospective validation.
Objective: To investigate the association of a wide QRS-T angle on the surface ECG and late gadolinium enhancement on contrast-enhanced cardiovascular magnetic (CMR) imaging in patients with clinically suspected myocarditis. Background: Diagnosis and risk stratification in patients with suspected myocarditis is particularly challenging due to a great spectrum of clinical presentations. Late gadolinium enhancement (LGE) visualizes myocardial necrosis and fibrosis in patients with biopsy-proven myocarditis. The presence or absence of late gadolinium enhancements in these patients is prognostically meaningful. The QRS-T angle from the surface ECG, on the other hand, may serve as a simple and easily available risk marker in suspected myocarditis. Methods: We enrolled 97 consecutive patients that were referred to CMR imaging for a clinical suspicion of myocarditis. All patients obtained a standardized digital 12-lead ECG for the calculation of the QRS-T angle and underwent contrast-enhanced CMR imaging. Patients were divided into two groups according to the absence or presence of LGE on CMR. Results: 78 of 97 patients with suspected myocarditis had LGE on CMR. Patients with LGE had wider QRS-T angles as compared to the patient group without p<0.001). The sensivity, specificity, negative predictive value and positive predictive value for a QRS-T angle above 90 degrees for LGE positive myocarditis were 16.5%, 100%, 24.7%, and 100%, respectively. Conclusion: A wide QRS-T angle of 90 degrees or more is linked to myocardial fibrosis or necrosis (late gadolinium enhancement) in patients with suspected myocarditis.
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Jensen et al. (2021) conducted a cross-sectional in Clinically suspected myocarditis (n=97). QRS-T angle > 90 degrees vs. QRS-T angle ≤ 90 degrees was evaluated on Presence of late gadolinium enhancement (LGE) on CMR (OR 7.18, p=0.037). A QRS-T angle greater than 90 degrees on surface ECG was significantly associated with the presence of late gadolinium enhancement on cardiovascular magnetic resonance imaging (OR 7.18).
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