Elevated frontal QRS-T angle as a predictor of cardiovascular risk in graves' disease: A comparative study

Backgrounds

Graves' disease (GD) is linked to cardiovascular complications, but reliable non-invasive predictors are limited. This study aimed to assess whether the frontal QRS-T (fQRS-T) angle could predict mortality and cardiovascular outcomes in GD patients.

Methods

Initially, we conducted a retrospective analysis of electrocardiogram (ECG) parameters from 291 GD patients compared with 96 healthy controls. GD patients were then categorized based on the presence of hyperthyroid heart disease. Using logistic regression, we identified predictors of cardiovascular outcomes. Subsequently, a retrospective cohort study followed 41 patients with an fQRS-T angle ≥90° and 162 controls over five years, assessing all-cause mortality, ventricular fibrillation (VF) and first hospitalization for heart failure (HF).

Results

Initial analysis showed that a significantly higher proportion of GD patients had an fQRS-T angle ≥90° compared to healthy controls (p < 0.001). Among GD patients, those with hyperthyroid heart disease were more likely to have an fQRS-T angle ≥90° (p < 0.001). Multivariate logistic regression analysis revealed that age, fQRS-T angle, thyroxine (T4), and platelet were independent predictors of hyperthyroid heart disease. In the cohort study, Kaplan-Meier analysis showed significant differences in all-cause mortality or VF (p < 0.001) and first hospitalization for HF (p < 0.001) between the groups. Multivariate Cox regression analyses shown QRS-T angle ≥90° significantly increased the risk of hospitalization for HF (HR 5.04, 95 % CI 2.59–9.81, p < 0.001).

Conclusions

An increased fQRS-T angle may be associated with elevated cardiovascular risk in patients with GD. These preliminary findings suggest that fQRS-T angle could serve as a hypothesis-generating marker for further prospective research.