The Frontal QRS-T Angle and Cardiovascular Disease: A Narrative Review of Electrophysiological Basis, Measurement, and Clinical Utility
Bratislava Medical Journal, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s44411-026-00839-0
- Dergi Adı: Bratislava Medical Journal
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Ultimate (EBSCO)
- Anahtar Kelimeler: Electrocardiography, Frontal QRS-T angle, Risk stratification, Spatial QRS-T angle, Sudden cardiac death, Ventricular repolarization
- Çanakkale Onsekiz Mart Üniversitesi Adresli: Evet
Özet
Background: The QRS-T angle quantifies the divergence between the vectors of ventricular depolarization and repolarization and is regarded as a surrogate for global heterogeneity of ventricular repolarization. Its frontal-plane variant, calculated as the absolute difference between the automatically reported QRS and T-wave axes on a standard 12-lead electrocardiogram, has attracted intense clinical interest because it requires no additional equipment, no additional cost, and no additional patient contact. Objective: To synthesize the evidence relating the frontal QRS-T angle to cardiovascular disease, with emphasis on its electrophysiological rationale, its measurement properties relative to the spatial angle, its prognostic performance across populations, and the methodological limitations that currently constrain its translation into practice. Methods: A narrative review of the peer-reviewed literature of the last two decades, prioritizing meta-analyses, large prospective cohorts, and randomized or otherwise controlled datasets over small single-centre series. Results: A wide frontal QRS-T angle is consistently associated with all-cause and cardiac mortality in general populations, with sudden and arrhythmic death, with incident coronary heart disease and heart failure, and with adverse outcomes across an expanding range of cardiac and non-cardiac conditions. Pooled estimates from meta-analysis confirm an increase in mortality risk of similar magnitude to that of the spatial angle for all-cause death, although the spatial angle retains superior diagnostic discrimination for structural heart disease. The evidence base is nevertheless dominated by retrospective single-centre studies with heterogeneous, non-standardized abnormality thresholds; reported upper limits of normal vary from below 40 degrees to above 130 degrees depending on cohort, sex, and derivation method. Reproducibility is further affected by the vectorcardiographic reconstruction matrix, by peak-versus-mean vector definitions, and by the automated algorithm of the recording device. Conclusions: The frontal QRS-T angle is a reproducible, universally available, and prognostically informative electrocardiographic marker whose principal weakness is not biological but methodological. Standardization of measurement, age- and sex-stratified reference ranges, prospective validation with formal reclassification metrics, and evaluation of serial rather than single measurements are the priorities that would convert a promising research variable into a clinically actionable one.