Since ischemic stroke may be associated with autonomic imbalance which may affect cardiac repolarization, we investigated the prevalence of an abnormal planar QRS-T angle measured from a 12-lead electrocardiogram (ECG) in patients seen in the emergency department with an ischemic stroke versus a transient ischemic attack (TIA).
we investigated the prevalence of an abnormal planar QRS-T angle measured from a 12-lead ECG in 249 consecutive patients seen in the emergency department with focal neurological symptoms and signs in whom cerebral hemorrhage was excluded by a computer tomography brain scan. TIA was diagnosed if the focal neurological deficit lasted less than 24 hours. Ischemic stroke was confirmed by the computer tomography brain scan.The planar QRS-T angle was calculated by the difference between the QRS axis and the T wave axis on the 12-lead ECG. A QRS-T angle of > 90 degrees was considered abnormal.
Of 249 patients, 175 (70%) had an ischemic stroke, and 74 (30%) had a TIA. The mean age was 68 years in patients with an ischemic stroke versus 61 years in patients with a TIA (p = 0.003). The prevalence of gender, race, hypertension, smoking, diabetes, dyslipidemia, obesity, and prior coronary artery disease was not significantly different between patients with an ischemic stroke versus a TIA. An abnormal planar QRS-T angle was present in 48 of 175 patients (27%) with an ischemic stroke versus in 8 of 74 patients (11%) with a TIA (p = 0.004).
Patients with an ischemic stroke have a higher prevalence of an abnormal planar QRS-T angle on a 12-lead ECG than patients with a TIA.
In patients being evaluated for ischemic stroke, a planar QRS-T angle should be measured from the 12-lead ECG obtained to rule out myocardial infarction.
Kaushang Gandhi, No Financial Disclosure Information; No Product/Research Disclosure Information