Title:The Spatial QRS-T Angle: Implications in Clinical Practice
Volume: 9
Issue: 3
Author(s): Christina Voulgari, Stamatina Pagoni, Solomon Tesfaye and Nicholas Tentolouris
Affiliation:
Keywords:
Vectorcardiography, spatial ventricular gradient, spatial QRS-T angle, arrythmogeneity
Abstract: The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information
that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand
and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined
as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization
abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary
electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial
QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas
in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent
population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular
events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified
primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This
review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment
of dispersion of repolarization, a key factor in arrythmogeneity.
