Can frontal QRS-T angle predict mortality in patients with severe Crimean-Congo Hemorrhagic Fever?

Year 2023, Volume: 7 Issue: 3, 181 - 186, 30.09.2023

Anıl Şahin , Oğuz Gündoğdu , Onur Avcı

https://doi.org/10.30621/jbachs.1298337

Abstract

Purpose: This study aims to determine whether frontal QRS-T (fQRS-T) angle measurements assist in predicting prognosis in severe CCHF (Crimean-Congo Hemorrhagic Fever) patients.
Material and Method: The study was conducted with 140 intensive care patients diagnosed with CCHF between 01.01.2012 and 2022. Demographic data and length of stay were recorded. In addition, laboratory data were recorded, including hemoglobin, troponin T, C-reactive protein, lymphocyte numbers, neutrophil, and platelet. fQRS-T angles were measured on electrocardiographic (ECG) data of the patients.
Results: The mean fQRS-T angle was 53.9°±29.3° in non-survivors and 34.2°±17.3° in the survivors (p<0.001). Regarding non-survivors, they were older, and their hemoglobin, platelet and lymphocyte levels were lower (p<0.001), and their QRS durations were broader (p=0.021) than survivors. The fQRS-T angle cutoff value in predicting mortality was determined as 41.5°. For fQRS-T ≥41.5°, specificity was 61.1%, and sensitivity was 80.9% (area under the curve: 0.711, 95% CI: 0.624–0.798, p<0.001).
Conclusion: Current study's results showed the usability of the fQRS-T angle as an inexpensive, convenient, strong, and repeatable predictor to determine the prognosis of CCHF patients. A detailed electrocardiographic evaluation in the routine follow-up of high-risk CCHF patients may indicate the prognosis of the disease.

Keywords

QRS-T angle, Crimean-Congo Hemorrhagic Fever, mortality, prognosis

References

• Whitehouse CA. Crimean-Congo hemorrhagic fever. Antiviral Res 2004; 64(3): 145-160.
• Ergonul O. Crimean-Congo haemorrhagic fever. Lancet Infect Dis 2006; 6: 203-14.
• Fillâtre P, Revest M, Tattevin P. Crimean-Congo hemorrhagic fever: An update. Med Mal Infect 2019; 49(8): 574-585.
• Sunbul M, Esen S, Fletcher TE, et al. Fatal case of healthcare associated Crimean-Congo haemorrhagic fever with severe disease and multi-organ failure. J Infect 2016; 72(2): 253-255.
• Engin A, Yilmaz MB, Elaldi N, et al. Crimean-Congo hemorrhagic fever: does it involve the heart? Int J Infect Dis 2009; 13(3): 369-373.
• Yilmaz MB, Engin A, Bektasoglu G, et al. Does electrocardiography at admission predict outcome in Crimean -Congo hemorrhagic fever? J Vector Borne Dis 2011; 48(3): 150-154.
• Whang W, Shimbo D, Levitan EB, et al. Relations between QRS|T angle, cardiac risk factors, and mortality in the third National Health and Nutrition Examination Survey (NHANES III). Am J Cardiol 2012; 109(7): 981-987.
• Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol 2014; 19(6): 534-542.
• Walsh JA, Soliman EZ, Ilkhanoff L, et al. Prognostic value of frontal QRS-T angle in patients without clinical evidence of cardiovascular disease (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2013; 112(12): 1880-1884.
• Ocak M, Tascanov MB, Yurt NŞ, Yurt YC. A new predictor for indicating clinical severity and prognosis in COVID-19 patients: Frontal QRS-T angle. Am J Emerg Med 2021; 50: 631-635.
• Bakır M, Gözel MG, Köksal I, et al. Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF). Eur J Clin Microbiol Infect Dis 2015; 34(2): 325–330.
• Bozkurt I, Esen S. Association Between Severity Grading Score And Acute Phase Reactants In Patients With Crimean Congo Hemorrhagic Fever. Pathog Glob Health 2021; 115(7-8): 496-498.
• Yilmaz H, Yilmaz G, Kostakoğlu U, Yaman H, Örem A, Köksal İ. The prognostic significance of serum troponin T levels in Crimean-Congo hemorrhagic fever patients. J Med Virol 2017; 89(3): 408-412.
• Büyüktuna SA, Doğan HO, Unlusavuran M, Bakir M. An evaluation of the different biomarkers to discriminate bleeding in Crimean-Congo Hemorrhagic Fever. Ticks Tick Borne Dis 2019; 10(5): 997-1002.
• Bastug A, Kayaaslan B, Kazancioglu S, et al. Crimean-Congo Hemorrhagic Fever: Prognostic Factors and the Association of Leukocyte Counts with Mortality. Jpn J Infect Dis 2016; 69(1): 51-55.
• Oflaz MB, Kucukdurmaz Z, Guven AS, et al. Bradycardia seen in children with Crimean-Congo hemorrhagic fever. Vector Borne Zoonotic Dis 2013; 13(11): 807-811.
• Gul I, Kaya A, Güven AS, et al. Cardiac findings in children with Crimean-Congo hemorrhagic fever. Med Sci Monit 2011; 17(8): 457-460.
• Ozturk B, Tutuncu E, Kuscu F, Gurbuz Y, Sencan I, Tuzun H. Evaluation of factors predictive of the prognosis in Crimean-Congo hemorrhagic fever: new suggestions. Int J Infect Dis 2012; 16(2): e89-e93.
• Ünver Ulusoy T, Hekimoğlu CH, Kayhan S, Altın N, Şencan İ. Prognostic nutritional index: Is it associated with the prognosis of Crimean congo hemorrhagic fever J Med Virol 2022; 94: 4910- 4917.
• Gundogdu O, Avci O. Relationship between Systemic Immune-inflammation Index and Mortality in Intensive Care Patients Diagnosed with Crimean-Congo Hemorrhagic Fever. J Coll Physicians Surg Pak. 2022 Dec;32(12):1538-1543.
• Avcı O, Gündoğdu O. The Relationship between Platelet/Lymphocyte and Neutrophil/Lymphocyte Ratios and Mortality in Intensive Care Patients with Crimean-congo Hemorrhagic Fever. Erciyes Med J 2020; 42(4): 425–30.
• Okin PM. Electrocardiography in women: taking the initiative. Circulation 2006; 113: 464–6.
• Zhang ZM, Prineas RJ, Case D, Soliman EZ, Rautaharju PM. Comparison of the prognostic significance of the electrocardiographic QRS/T angles in predicting incident coronary heart disease and total mortality (from the atherosclerosis risk in communities study). Am J Cardiol 2007; 100: 844–9.
• Scacciavillani R, Galli M. Potential use of frontal QRS-T angle for sudden death risk stratification in athletes. Minerva Cardiol Angiol 2021; 69(3): 241-243.
• Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2013; 9: 197–210.
• Zampa HB, Moreira DA, Ferreira Filho CA, et al. Value of the Qrs-T angle in predicting the induction of ventricular tachyarrhythmias in patients with Chagas disease. Arq Bras Cardiol 2014; 103(6): 460-467.
• Kearney MT, Cotton JM, Richardson PJ, Shah AM. Viral myocarditis and dilated cardiomyopathy: mechanisms, manifestations, and management. Postgrad Med J 2001; 77: 4-10.
• Huber SA. Viral Myocarditis and Dilated Cardiomyopathy: Etiology and Pathogenesis. Curr Pharm Des 2016; 22(4): 408-426.
• Saggioro FP, Rossi MA, Duarte MI, et al. Hantavirus infection induces a typical myocarditis that may be responsible for myocardial depression and shock in hantavirus pulmonary syndrome. J Infect Dis 2007; 195: 1541-9.
• Gülhan B, Kanık-Yüksek S, Çetin İ, Özkaya-Parlakay A, Tezer H. Myocarditis in a Child with Crimean-Congo Hemorrhagic Fever. Vector Borne Zoonotic Dis 2015; 15(9): 565-567.