Soliman EZ, Shah AJ, Boerkircher A, Li Y, Rautaharju PM. The QT interval and risk of incident atrial fibrillation. Mandyam MC, Soliman EZ, Alonso A, Dewland TA, Heckbert SR, Vittinghoff E, Cummings SR, Ellinor PT, Chaitman BR, Stocke K, Applegate WB, Arking DE, Butler J, Loehr LR, Magnani JW, Murphy RA, Satterfield S, Newman AB, Marcus GM. Usefulness of electrocardiographic frontal QRS‐T angle to predict increased morbidity and mortality in patients with chronic heart failure. Gotsman I, Keren A, Hellman Y, Banker J, Lotan C, Zwas DR. Published on behalf of the American Heart Association, Inc., by Wiley. QRS transition zone cardiovascular outcomes electrocardiography epidemiology mortality.
Counterclockwise and clockwise how to#
These results have implications on how to interpret QRS transition zone rotation when ECG was recorded. On the contrary, counterclockwise rotation was significantly related to lower risk of composite CVD (hazard ratio, 0.93 95% CI, 0.87-0.99]), CVD mortality (hazard ratio, 0.76 95% CI, 0.65-0.88), and non-CVD deaths (hazard ratio, 0.92 95% CI, 0.85-0.99 ).Ĭounterclockwise rotation, the most prevalent QRS transition zone pattern, demonstrated the lowest risk of CVD and mortality, whereas clockwise rotation was associated with the highest risk of heart failure and non-CVD mortality. Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20 95% confidence interval, 1.02-1.41) and non-CVD death (hazard ratio, 1.28 95% CI, 1.12-1.46) after adjusting for potential confounders including other ECG parameters.
Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow-up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. However, their prospective correlates and associations with individual cardiovascular disease (CVD) outcomes are yet to be investigated.Īmong 13 567 ARIC (Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite CVD (4124 events), 898 CVD deaths, and 3469 non-CVD deaths over 23 years of follow-up. A few studies have recently reported clockwise and counterclockwise rotations of QRS transition zone as predictors of mortality.
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