{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T03:29:43Z","timestamp":1768534183884,"version":"3.49.0"},"reference-count":38,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T00:00:00Z","timestamp":1669248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical University of Warsaw","award":["2M6\/1\/M\/MB\/N\/20"],"award-info":[{"award-number":["2M6\/1\/M\/MB\/N\/20"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cardiomyopathies have a low prevalence in children and thus may lead to malignant ventricular arrhythmias or the progression of heart failure, resulting in death. In adults, the QRS-T angle derived from ECG has been associated with adverse outcomes in patients with hypertrophic and dilated cardiomyopathies. We aimed to assess the electrocardiographic parameters, including QRS-T angle, associated with adverse cardiac events in children with cardiomyopathies. Forty-two children with cardiomyopathies were included in this study: 19 with dilated cardiomyopathy, 17 with hypertrophic cardiomyopathy, and 6 with left ventricular non-compaction. Additionally, 19 control subjects were recruited. In terms of ECG parameters, the QRS-T angle was significantly greater among patients with adverse outcomes compared to patients without the end points of the study (133\u00b0 vs. 65\u00b0, p &lt; 0.001). On Kaplan\u2013Meier survival curves, QRS-T angle &gt; 120\u00b0, increased serum concentrations of NT-proBNP and troponin I levels as well as greater NYHA or Ross scale were associated with the greatest risk of unfavorable outcome. The QRS-T angle appears to be a valuable component of 12-lead ECG interpretation, and might be helpful in outlining patients with the greatest cardiovascular risk. Additionally, serum biomarkers such as NT-proBNP (p = 0.003) and troponin (p &lt; 0.001) are useful in outlining patients with the worst survival.<\/jats:p>","DOI":"10.3390\/jcm11236930","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T05:35:08Z","timestamp":1669268108000},"page":"6930","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Electrocardiographic Parameters Associated with Adverse Outcomes in Children with Cardiomyopathies"],"prefix":"10.3390","volume":"11","author":[{"given":"Katarzyna","family":"Luczak-Wozniak","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaudia","family":"Obsznajczyk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Jozef Polikarp Brudzinski Public Pediatric Hospital, 02-091 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8981-6377","authenticated-orcid":false,"given":"Cezary","family":"Niszczota","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Jozef Polikarp Brudzinski Public Pediatric Hospital, 02-091 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6416-4106","authenticated-orcid":false,"given":"Bo\u017cena","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1111\/anec.12206","article-title":"QRS-T angle: A review","volume":"19","author":"Oehler","year":"2014","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1159\/000509766","article-title":"Vectorcardiography Findings Are Associated with Recurrent Ventricular Arrhythmias and Mortality in Patients with Heart Failure Treated with Implantable Cardioverter-Defibrillator Device","volume":"145","author":"Chaudhry","year":"2020","journal-title":"Cardiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3181","DOI":"10.1161\/CIRCULATIONAHA.107.733451","article-title":"Prognostic value and temporal behavior of the planar QRS-T angle in patients with nonischemic cardiomyopathy","volume":"117","author":"Pavri","year":"2008","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.4103\/0366-6999.187844","article-title":"Prognostic Significance of Frontal QRS-T Angle in Patients with Idiopathic Dilated Cardiomyopathy","volume":"129","author":"Li","year":"2016","journal-title":"Chin. Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jelectrocard.2020.10.009","article-title":"Impaired repolarization parameters may predict fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy (from the CILICIA Registry)","volume":"63","author":"Guner","year":"2020","journal-title":"J. Electrocardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/clc.22549","article-title":"In Hypertrophic Cardiomyopathy, the Spatial Peaks QRS-T Angle Identifies Those with Sustained Ventricular Arrhythmias","volume":"39","author":"Cortez","year":"2016","journal-title":"Clin. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1161\/CIRCULATIONAHA.119.044794","article-title":"Intronic CRISPR Repair in a Preclinical Model of Noonan Syndrome-Associated Cardiomyopathy","volume":"142","author":"Hanses","year":"2020","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sedaghat-Hamedani, F., Rebs, S., El-Battrawy, I., Chasan, S., Krause, T., Haas, J., Zhong, R., Liao, Z., Xu, Q., and Zhou, X. (2021). Identification of SCN5a p.C335R Variant in a Large Family with Dilated Cardiomyopathy and Conduction Disease. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222312990"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e001893","DOI":"10.1161\/CIRCGEN.117.001893","article-title":"Ion Channel Dysfunctions in Dilated Cardiomyopathy in Limb-Girdle Muscular Dystrophy","volume":"11","author":"Zhao","year":"2018","journal-title":"Circ. Genom. Precis. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1093\/europace\/euab214","article-title":"Preclinical short QT syndrome models: Studying the phenotype and drug-screening","volume":"24","author":"Fan","year":"2022","journal-title":"Europace"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e646","DOI":"10.1002\/ctm2.646","article-title":"Deciphering the pathogenic role of a variant with uncertain significance for short QT and Brugada syndromes using gene-edited human-induced pluripotent stem cell-derived cardiomyocytes and preclinical drug screening","volume":"11","author":"Lan","year":"2021","journal-title":"Clin. Transl. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1093\/eurheartj\/ehab070","article-title":"Different genotypes of Brugada syndrome may present different clinical phenotypes: Electrophysiology from bench to bedside","volume":"42","author":"Lang","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"L105","DOI":"10.1093\/eurheartj\/suaa146","article-title":"The omics of channelopathies and cardiomyopathies: What we know and how they are useful","volume":"22","author":"Pappone","year":"2020","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1017\/S1047951116000640","article-title":"Lower spatial QRS-T angle rules out sustained ventricular arrhythmias in children with hypertrophic cardiomyopathy","volume":"27","author":"Cortez","year":"2017","journal-title":"Cardiol. Young"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e12588","DOI":"10.1111\/anec.12588","article-title":"Pediatric noncompaction patients with high spatial QRS-T angles are at increased risk for ventricular tachycardia","volume":"24","author":"Cortez","year":"2019","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1161\/CIR.0000000000000682","article-title":"Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement from the American Heart Association","volume":"140","author":"Lipshultz","year":"2019","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1093\/eurheartj\/ehu284","article-title":"ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)","volume":"35","author":"Perry","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1136\/heart.86.6.666","article-title":"Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: A step towards classification as a distinct cardiomyopathy","volume":"86","author":"Jenni","year":"2001","journal-title":"Heart"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/0002-9149(87)91118-0","article-title":"Plasma norepinephrine levels in infants and children with congestive heart failure","volume":"59","author":"Ross","year":"1987","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1093\/oxfordjournals.eurheartj.a059647","article-title":"Reconstruction of the Frank vectorcardiogram from standard electrocardiographic leads: Diagnostic comparison of different methods","volume":"11","author":"Kors","year":"1990","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jelectrocard.2013.09.003","article-title":"Visual transform applications for estimating the spatial QRS-T angle from the conventional 12-lead ECG: Kors is still most Frank","volume":"47","author":"Cortez","year":"2014","journal-title":"J. Electrocardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.echo.2010.03.019","article-title":"Recommendations for quantification methods during the performance of a pediatric echocardiogram: A report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council","volume":"23","author":"Lopez","year":"2010","journal-title":"J. Am. Soc. Echocardiogr. Off. Publ. Am. Soc. Echocardiogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1016\/j.hrthm.2016.02.014","article-title":"Electrocardiographic repolarization abnormalities and increased risk of life-threatening arrhythmias in children with dilated cardiomyopathy","volume":"13","author":"Chen","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00431-020-03569-9","article-title":"The relationship between electrocardiographic data and mortality in children diagnosed with dilated cardiomyopathy","volume":"179","author":"Ture","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1002\/ehf2.13233","article-title":"Predicting outcome in children with dilated cardiomyopathy: The use of repeated measurements of risk factors for outcome","volume":"8","author":"Meulen","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.hrtlng.2014.03.001","article-title":"The prognostic use of serum concentrations of cardiac troponin-I, CK-MB and myoglobin in patients with idiopathic dilated cardiomyopathy","volume":"43","author":"Li","year":"2014","journal-title":"Heart Lung"},{"key":"ref_27","first-page":"656","article-title":"Prognostic role of high-sensitivity cardiac troponin T in patients with nonischemic dilated cardiomyopathy","volume":"75","author":"Kawahara","year":"2011","journal-title":"Circ. J. Off. J. Jpn. Circ. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.pcad.2019.05.002","article-title":"Sudden cardiac death in nonischemic cardiomyopathy","volume":"62","author":"Kadakia","year":"2019","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chmielewski, P., Michalak, E., Kowalik, I., Franaszczyk, M., Sobieszczanska-Malek, M., Truszkowska, G., Stepien-Wojno, M., Biernacka, E.K., Foss-Nieradko, B., and Lewandowski, M. (2020). Can Circulating Cardiac Biomarkers Be Helpful in the Assessment of LMNA Mutation Carriers?. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051443"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2302","DOI":"10.1016\/j.jacc.2015.03.552","article-title":"Sudden death in childhood cardiomyopathy: Results from a long-term national population-based study","volume":"65","author":"Bharucha","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1093\/eurjpc\/zwab046","article-title":"The role of the electrocardiographic phenotype in risk stratification for sudden cardiac death in childhood hypertrophic cardiomyopathy","volume":"29","author":"Norrish","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jelectrocard.2016.10.001","article-title":"ECG-derived spatial QRS-T angle is strongly associated with hypertrophic cardiomyopathy","volume":"50","author":"Cortez","year":"2017","journal-title":"J. Electrocardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1136\/hrt.2007.126748","article-title":"B-type natriuretic peptide predicts disease severity in children with hypertrophic cardiomyopathy","volume":"94","author":"Kaski","year":"2008","journal-title":"Heart"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1093\/eurheartj\/eht070","article-title":"Relation between serum N-terminal pro-brain natriuretic peptide and prognosis in patients with hypertrophic cardiomyopathy","volume":"34","author":"Coats","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Aquaro, G.D., Corsi, E., Todiere, G., Grigoratos, C., Barison, A., Barra, V., Di Bella, G., Emdin, M., Ricci, F., and Pingitore, A. (2022). Magnetic Resonance for Differential Diagnosis of Left Ventricular Hypertrophy: Diagnostic and Prognostic Implications. J. Clin. Med., 11.","DOI":"10.20944\/preprints202201.0042.v1"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1016\/j.jacc.2013.03.055","article-title":"Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy","volume":"62","author":"Kubo","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.amjcard.2021.04.040","article-title":"Usefulness of High-Sensitivity Cardiac Troponin T to Predict Long-Term Outcome in Patients with Hypertrophic Cardiomyopathy","volume":"152","author":"Gommans","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"821","DOI":"10.7150\/ijms.52415","article-title":"QRS-T angle in patients with Hypertrophic Cardiomyopathy\u2014A comparison with Cardiac Magnetic Resonance Imaging","volume":"18","author":"Jensen","year":"2021","journal-title":"Int. J. Med. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/6930\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:25:56Z","timestamp":1760145956000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/6930"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,24]]},"references-count":38,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11236930"],"URL":"https:\/\/doi.org\/10.3390\/jcm11236930","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,24]]}}}