Int J Med Sci 2021; 18(3):821-825. doi:10.7150/ijms.52415 This issue

Research Paper

QRS-T angle in patients with Hypertrophic Cardiomyopathy - A comparison with Cardiac Magnetic Resonance Imaging

Christoph Julian Jensen1,2*, Moritz Lambers1,2*, Behnam Zadeh1,2, Jan Martin Wambach1,2, Kai Nassenstein3, Oliver Bruder1,2✉

1. Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Essen, Germany.
2. Ruhr University Bochum, Bochum, Germany.
3. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
*Co-first authors with equal contributions to this work.

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Jensen CJ, Lambers M, Zadeh B, Wambach JM, Nassenstein K, Bruder O. QRS-T angle in patients with Hypertrophic Cardiomyopathy - A comparison with Cardiac Magnetic Resonance Imaging. Int J Med Sci 2021; 18(3):821-825. doi:10.7150/ijms.52415. Available from

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Objective: We sought to investigate the possible association of a wide QRS-T angle on the surface EKG and myocardial fibrosis on contrast-enhanced cardiovascular magnetic (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM).

Background: Risk stratification in HCM patients is challenging. Late gadolinium enhancement (LGE) visualizes myocardial fibrosis with unique spatial resolution and is a strong and independent prognosticator in these patients. The QRS-T angle from the surface EKG is a promising prognostic marker in various cardiac pathologies.

Methods: 70 patients with HCM obtained a standardized digital 12-lead EKG for the calculation of the QRS-T angle and underwent comprehensive CMR imaging for visualization of fibrosis by LGE. Patients were divided into groups according to the absence or presence of fibrosis on CMR.

Results: 43 of 70 patients with HCM showed LGE on CMR following contrast administration. HCM patients with LGE (fibrosis) had wider QRS-T angles as compared to the patient group without LGE (100±54 vs. 46±31; <0.001). A QRS-T angle of 90 degrees or more was a strong predictor (OR 32.84, CI 4.08-264.47; p <0.001) of HCM with LGE.

Conclusion: There is a strong association of a wide QRS-T angle and myocardial fibrosis in patients with HCM.

Keywords: QRS-T angle, cardiovascular magnetic resonance, late gadolinium enhancement, fibrosis, hypertrophic cardiomyopathy