Correlation of frontal QRS-T angle with mortality in ischemic stroke patients: a multicenter study

Background: Acute ischemic stroke (AIS) is a leading cause of mortality and morbidity worldwide. Cardiac electrical abnormalities, such as changes in the frontal QRS-T angle (fQRS-TA), have been linked to adverse outcomes in various cardiovascular disorders. However, the prognostic significance of fQRS-TA in patients with AIS has not been clearly established. This study aimed to evaluate the association between fQRS-TA and 30-day mortality in patients with AIS. Methods: This prospective, two-center observational study was conducted at Bilkent City Hospital and Etlik City Hospital between 01 June and 31 July, 2023. Patients aged ≥18 years diagnosed with AIS were enrolled, whereas individuals with hemorrhagic stroke, congenital heart disease, a history of cerebrovascular events or significant electrocardiographic abnormalities were excluded. Baseline demographic data, clinical parameters, and electrocardiogram (ECG) findings were collected. fQRS-TA was defined as the absolute difference between the frontal plane QRS and T-wave axes. Patients were classified into survivor and deceased groups based on 30-day outcomes. Statistical analysis was performed using SPSS version 25. Results: The data of 85 AIS patients were assessed (mean age: 67.29 ± 12.88 years; 51.8% female), and the results demonstrated that fQRS-TA was significantly elevated in patients with hypertension and congestive heart failure (p < 0.05). A weak positive correlation was observed between age and fQRS-TA (p = 0.017), with the deceased group demonstrating significantly higher fQRS-TA values than the survivors (p = 0.045). The NIHSS (National Institutes of Health Stroke Scale) scores were also found to be significantly higher in the deceased group (p = 0.014). Conclusions: fQRS-TA is an easily obtainable ECG parameter that may serve as a predictor of short-term mortality in AIS patients. When combined with NIHSS scores, fQRS-TA may improve risk stratification and inform early clinical decision-making. Further large-scale, randomized studies are needed to confirm these findings.

Ischemic stroke; Frontal QRS-T angle; Electrocardiography; Mortality prediction; NIHSS

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