Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in hiv-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] Study)

Farah Z Dawood, Faraaz Khan, Mollie Roediger, Zhu-Ming Zhang, Shobha Swaminathan, Hartwig Klinker, Jennifer F Hoy, Jens D Lundgren, James D Neaton, Elsayed Z Soliman

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)

Abstract

Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ? 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men and women separately, and values in the upper quartile were considered as a widened angle (values >74? for women and >93? for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11,965 person-years of follow-up, 152 CVD events occurred at a rate of 1.27 events/100 person-years. The rate of CVD events in those with a widened spatial QRS-T angle was almost double the rate in those with a normal spatial QRS-T angle (rate ratio 1.94, 95 confidence interval 1.40 to 2.69; p 50 increased risk of CVD events compared to a normal spatial QRS-T angle (hazard ratio 1.53, 95 confidence interval 1.07 to 2.17; p = 0.02). No interaction was seen by SMART trial arm (p value for interaction = 0.37) or gender (p value for interaction = 0.84). In conclusion, a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients. ? 2013 Elsevier Inc. All rights reserved.
Original languageEnglish
Pages (from-to)118 - 124
Number of pages7
JournalAmerican Journal of Cardiology
Volume111
Issue number1
DOIs
Publication statusPublished - 2013

Cite this

Dawood, Farah Z ; Khan, Faraaz ; Roediger, Mollie ; Zhang, Zhu-Ming ; Swaminathan, Shobha ; Klinker, Hartwig ; Hoy, Jennifer F ; Lundgren, Jens D ; Neaton, James D ; Soliman, Elsayed Z. / Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in hiv-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] Study). In: American Journal of Cardiology. 2013 ; Vol. 111, No. 1. pp. 118 - 124.
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title = "Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in hiv-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] Study)",
abstract = "Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ? 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men and women separately, and values in the upper quartile were considered as a widened angle (values >74? for women and >93? for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11,965 person-years of follow-up, 152 CVD events occurred at a rate of 1.27 events/100 person-years. The rate of CVD events in those with a widened spatial QRS-T angle was almost double the rate in those with a normal spatial QRS-T angle (rate ratio 1.94, 95 confidence interval 1.40 to 2.69; p 50 increased risk of CVD events compared to a normal spatial QRS-T angle (hazard ratio 1.53, 95 confidence interval 1.07 to 2.17; p = 0.02). No interaction was seen by SMART trial arm (p value for interaction = 0.37) or gender (p value for interaction = 0.84). In conclusion, a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients. ? 2013 Elsevier Inc. All rights reserved.",
author = "Dawood, {Farah Z} and Faraaz Khan and Mollie Roediger and Zhu-Ming Zhang and Shobha Swaminathan and Hartwig Klinker and Hoy, {Jennifer F} and Lundgren, {Jens D} and Neaton, {James D} and Soliman, {Elsayed Z}",
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Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in hiv-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] Study). / Dawood, Farah Z; Khan, Faraaz; Roediger, Mollie; Zhang, Zhu-Ming; Swaminathan, Shobha; Klinker, Hartwig; Hoy, Jennifer F; Lundgren, Jens D; Neaton, James D; Soliman, Elsayed Z.

In: American Journal of Cardiology, Vol. 111, No. 1, 2013, p. 118 - 124.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in hiv-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] Study)

AU - Dawood, Farah Z

AU - Khan, Faraaz

AU - Roediger, Mollie

AU - Zhang, Zhu-Ming

AU - Swaminathan, Shobha

AU - Klinker, Hartwig

AU - Hoy, Jennifer F

AU - Lundgren, Jens D

AU - Neaton, James D

AU - Soliman, Elsayed Z

PY - 2013

Y1 - 2013

N2 - Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ? 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men and women separately, and values in the upper quartile were considered as a widened angle (values >74? for women and >93? for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11,965 person-years of follow-up, 152 CVD events occurred at a rate of 1.27 events/100 person-years. The rate of CVD events in those with a widened spatial QRS-T angle was almost double the rate in those with a normal spatial QRS-T angle (rate ratio 1.94, 95 confidence interval 1.40 to 2.69; p 50 increased risk of CVD events compared to a normal spatial QRS-T angle (hazard ratio 1.53, 95 confidence interval 1.07 to 2.17; p = 0.02). No interaction was seen by SMART trial arm (p value for interaction = 0.37) or gender (p value for interaction = 0.84). In conclusion, a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients. ? 2013 Elsevier Inc. All rights reserved.

AB - Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ? 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men and women separately, and values in the upper quartile were considered as a widened angle (values >74? for women and >93? for men). A multivariate Cox proportional hazards analysis was used to examine the association between a widened baseline spatial QRS-T angle and incident CVD events. During 11,965 person-years of follow-up, 152 CVD events occurred at a rate of 1.27 events/100 person-years. The rate of CVD events in those with a widened spatial QRS-T angle was almost double the rate in those with a normal spatial QRS-T angle (rate ratio 1.94, 95 confidence interval 1.40 to 2.69; p 50 increased risk of CVD events compared to a normal spatial QRS-T angle (hazard ratio 1.53, 95 confidence interval 1.07 to 2.17; p = 0.02). No interaction was seen by SMART trial arm (p value for interaction = 0.37) or gender (p value for interaction = 0.84). In conclusion, a widened spatial QRS-T angle was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients. ? 2013 Elsevier Inc. All rights reserved.

UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525800/pdf/nihms-407048.pdf

U2 - 10.1016/j.amjcard.2012.08.054

DO - 10.1016/j.amjcard.2012.08.054

M3 - Article

VL - 111

SP - 118

EP - 124

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

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