Key result
Preoperative frontal QRS/T angle ≥90° linked to more than doubled inotrope use after CABG.
Why the study?
The prognostic value of frontal planar QRS/T angle in patients undergoing coronary artery bypass surgery had not been previously established.
Does a preoperative frontal planar QRS/T angle ≥90° predict the need for inotropic drugs and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery?
Cohort (n=157)
Does a preoperative frontal planar QRS/T angle ≥90° predict the need for inotropic drugs and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery?
Odds Ratio: 0.989 (95% CI 0.981–0.997)
Absolute Event Rate: 58.3% vs 27.5%
p-value: p=.008
A preoperative frontal planar QRS/T angle ≥90° is an independent predictor of the need for inotropic support and postoperative atrial fibrillation following isolated coronary artery bypass surgery.
Preoperative QRS/T angle ≥90° may flag higher inotrope risk after CABG; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Wide QRS/T angle reflects the ventricular repolarization heterogeneity and has been found in association with cardiac morbidity and mortality in various study populations. However, literature data about the availability of QRS/T angle in patients undergoing cardiac surgery has not yet been available. METHODS: A total of 157 patients who underwent isolated coronary artery bypass surgery were included in this study. A preoperative 12-lead ECG was obtained one day before surgical procedure. The absolute difference between the frontal QRS wave axes and T-wave axes was defined as frontal planar QRS/T angle. Afterwards, patients were divided into two groups according to their frontal planar QRS/T angle (the cut-off value as 90°). RESULTS: Group 1 consisted of 109 patients with frontal planar QRS/T angle of <90, and the remaining 48 patients with frontal planar QRS/T angle 90 were placed into group 2. Mean EuroSCORE was much higher in group 2. There were significant differences for positive inotropic agent usage (27.5% for group 1 versus 58.3% for group 2, P < .001) and the prevalence of postoperative atrial fibrillation (11.9% for group 1 versus 31.2% for group 2, P = .004) between the two groups. In multivariate logistic regression analysis, used to determine the independent predictors of positive inotropic usage in the early postoperative period, only frontal planar QRS/T angle (OR: 0.989, 95% CI: 0.981-0.997, P = .008) and EuroSCORE (OR: 0.792, 95% CI: 0.646-0.971, P = .025) were found to be statistically significant. CONCLUSION: We found that frontal planar QRS/T angle might be an important preoperative parameter in predicting the need for inotropic drugs in the early postoperative period following coronary artery bypass surgery.
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Karabacak et al. (2015) conducted a cohort in Coronary artery bypass surgery (n=157). Frontal planar QRS/T angle ≥90° vs. Frontal planar QRS/T angle <90° was evaluated on Positive inotropic agent usage (OR 0.989, 95% CI 0.981-0.997, p=.008). A preoperative frontal planar QRS/T angle ≥90° was associated with significantly higher positive inotropic agent usage (58.3% vs 27.5%, P<.001) in the early postoperative period following CABG.
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