Kocatepe Tıp Dergisi · Jul 20, 2026
FRONTAL QRS-T ANGLE AND MULTISYSTEM STRESS: A NONINVASIVE MARKER ?
By Yılmaz ÖF, Siner H, Korucu C et al.
OBJECTIVE: The frontal QRS-T angle is a noninvasive electrocardiographic marker of ventricular electrical heterogeneity, previously linked to arrhythmogenic risk and systemic disease burden. However, its role in multidimensional outpatient risk stratification remains underexplored.MATERIAL AND METHODS: In this retrospective study of 290 cardiology outpatients (mean age: 65.9 ± 11.9 years; 57.8% male), patients were grouped based on frontal QRS-T angle (<90° vs. ≥90°). Clinical, laboratory, and electrocardiographic data were compared, along with 12-month all-cause mortality.RESULTS: Patients with a QRS-T angle ≥90° had significantly higher rates of diabetes (53.3% vs. 37.6%, p=0.013), coronary artery disease (89.1% vs. 79.5%, p=0.045), heart failure (46.7% vs. 29.2%, p=0.004), elevated BMI (30.54 ± 5.89 vs. 28.90 ± 5.96 kg/m², p=0.027), and prolonged QTc (430.4 ± 31.5 vs. 416.2 ± 28.4 ms, p=0.001). Although patients with a QRS-T angle ≥90° had a worse clinical profile, their 12-month all-cause mortality rate was not significantly different from those with an angle <90° (5.4% vs. 7.2%, p=0.580).Among non-survivors, older age, lower BMI, increased hospitalization, heart failure, atrial fibrillation, chronic kidney disease, malignancy, and elevated SII and SIRI were more common. Subgroup analysis in patients with coronary artery disease showed consistent trends.CONCLUSIONS: While a widened frontal QRS-T angle reflects greater cardiometabolic and repolarization stress, it lacks independent prognostic value for short-term mortality. Its clinical utility improves when interpreted with systemic inflammation and frailty. As a simple and cost-effective ECG marker, it may support outpatient triage, personalized follow-up, and treatment optimization, especially in resource-limited settings.