{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T18:00:08Z","timestamp":1779904808858,"version":"3.53.1"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Recep Tayyip Erdo\u011fan University Development Foundation","award":["02025012016882"],"award-info":[{"award-number":["02025012016882"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ischemic heart disease is the primary contributor to global mortality. The QRS-T angle at the anterior aspect of the heart serves as a significant biomarker of the heterogeneity in myocardial repolarization and the electrophysiological instability of the cardiac myocytes. A wide frontal QRS-T angle is associated with proximal vascular disease, coexistence of three-vessel disease, and increased mortality. Hereby, we aimed to examine the relationship between collateral circulation and frontal QRS-T angle in patients with chronic total occlusion (CTO). Methods: A cohort comprising 120 patients (17 females, 14.1%) who received a diagnosis of chronic total occlusion (CTO) subsequent to the administration of coronary angiography conducted for the evaluation of stable angina pectoris was incorporated into the investigation. The electrocardiographs of the patients were evaluated in detail, and the frontal QRS-T angle was calculated. The patients were categorized into two groups: subjects exhibiting an increased frontal QRS-T angle (&gt;110\u00b0 for men, &gt;90\u00b0 for women) and those presenting with a normative frontal QRS-T angle. Coronary angiographies of the patients were analyzed, and coronary collateral circulation was classified according to Rentrop classification. Results: Serum albumin level (OR = 0.711, 95% CI 0.564\u20130.896; p = 0.004) and poor collateral flow (OR = 17.7, 95% CI 12.2\u201385.3; p &lt; 0.001) were significant predictors of raised frontal QRS-T angle. Conclusions: The frontal QRS-T angle is a novel parameter that is more reliable, consistent, and less sensitive to miscalculation and misidentification than other conventional electrocardiographic myocardial repolarization parameters. Revealing the bad collateral relationship with the frontal QRS-T angle may enable physicians to take more stringent precautions and change the risk factors related to the increased QRS-T angle in advance.<\/jats:p>","DOI":"10.3390\/jcm15010148","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T16:41:19Z","timestamp":1766594479000},"page":"148","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Relationship Between Collateral Circulation and Electrocardiographic Frontal QRS-T Angle in Patients with Coronary Artery Chronic Total Occlusion"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0995-4658","authenticated-orcid":false,"given":"Muhammet","family":"\u00d6zt\u00fcrk","sequence":"first","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0791-1248","authenticated-orcid":false,"given":"Nadir","family":"Emlek","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0679-9434","authenticated-orcid":false,"given":"Ali G\u00f6khan","family":"\u00d6zy\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3192-4719","authenticated-orcid":false,"given":"Elif","family":"Erg\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-5966","authenticated-orcid":false,"given":"H\u00fcseyin","family":"Durak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2514-5516","authenticated-orcid":false,"given":"Afag","family":"\u00d6zy\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Training and Research Hospital, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6342-436X","authenticated-orcid":false,"given":"Mustafa","family":"\u00c7etin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1038\/nrcardio.2014.74","article-title":"Contemporary overview and clinical perspectives of chronic total occlusions","volume":"11","author":"Hoebers","year":"2014","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/0002-8703(78)90372-1","article-title":"The functional value of coronary collaterals in myocardial ischemia and therapeutic approach to enhance collateral flow","volume":"95","author":"Cohen","year":"1978","journal-title":"Am. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/0002-8703(89)90771-0","article-title":"Coronary collateral circulation: Clinical significance and influence on survival in patients with coronary artery occlusion","volume":"117","author":"Hansen","year":"1989","journal-title":"Am. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1161\/01.CIR.27.1.12","article-title":"Intercoronary anastomotic channels and sudden unexpected death from advanced coronary atherosclerosis","volume":"27","author":"Spain","year":"1963","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/0002-9149(76)90282-4","article-title":"Functional significance of coronary collateral vessels in patients with acute myocardial infarction: Relation to pump performance, cardiogenic shock, and survival","volume":"37","author":"Williams","year":"1976","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/0002-9149(74)90274-4","article-title":"Natural history of severe proximal coronary artery disease as documented by coronary cineangiography","volume":"33","author":"Webster","year":"1974","journal-title":"Am. J. Cardiol."},{"key":"ref_7","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_8","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.jelectrocard.2008.01.001","article-title":"Elevated blood pressure and electrocardiographic frontal T axis and spatial QRS-T angle changes in postmenopausal women","volume":"41","author":"Atsma","year":"2008","journal-title":"J. Electrocardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1016\/j.amjcard.2013.01.294","article-title":"Usefulness of electrocardiographic frontal QRS-T angle to predict increased morbidity and mortality in patients with chronic heart failure","volume":"111","author":"Gotsman","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_10","first-page":"31","article-title":"A planar QRS-T angle >90 degrees is associated with multivessel coronary artery disease in patients undergoing coronary angiography","volume":"15","author":"Palaniswamy","year":"2009","journal-title":"Med. Sci. Monit."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.23736\/S2724-5683.20.05105-1","article-title":"Effect of anemia on the frontal QRS-T angle","volume":"69","author":"Gungoren","year":"2021","journal-title":"Minerva Cardiol. Angiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jelectrocard.2021.03.003","article-title":"The relationship between coronary slow flow and frontal QRS-T angle","volume":"66","author":"Aslan","year":"2021","journal-title":"J. Electrocardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1007\/s12149-021-01596-6","article-title":"Associations of frontal QRS-T angle with left ventricular volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease","volume":"35","author":"Kurisu","year":"2021","journal-title":"Ann. Nucl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.amjcard.2007.03.104","article-title":"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)","volume":"100","author":"Zhang","year":"2007","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/j.amjcard.2007.06.036","article-title":"Electrocardiographic predictors of new-onset heart failure in men and in women free of coronary heart disease (from the Atherosclerosis in Communities [ARIC] Study)","volume":"100","author":"Rautaharju","year":"2007","journal-title":"Am. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography","volume":"23","author":"Rudski","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1161\/CIRCULATIONAHA.104.481283","article-title":"Percutaneous recanalization of chronically occluded coronary arteries: A consensus document: Part I","volume":"112","author":"Stone","year":"2005","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/0002-9149(88)91048-X","article-title":"Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model","volume":"61","author":"Rentrop","year":"1988","journal-title":"Am. J. Cardiol."},{"key":"ref_19","first-page":"e28506","article-title":"The Relationship Between In-Hospital Mortality and Frontal QRS-T Angle in Patients With COVID-19","volume":"14","author":"Tastan","year":"2022","journal-title":"Cureus"},{"key":"ref_20","first-page":"194","article-title":"The frontal QRS-T angle is related with hemodynamic significance of coronary artery stenosis in patients with single-vessel disease","volume":"22","author":"Kahraman","year":"2019","journal-title":"Anatol. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jelectrocard.2020.06.008","article-title":"Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction","volume":"61","author":"Erdogan","year":"2020","journal-title":"J. Electrocardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1097\/MCA.0000000000000935","article-title":"Improvement of the frontal QRS-T angle after successful percutaneous coronary revascularization in patients with chronic total occlusion","volume":"31","author":"Uzun","year":"2020","journal-title":"Coron. Artery Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1054\/jelc.2001.28819","article-title":"The grades of ischemia on the presenting electrocardiogram of patients with ST elevation acute myocardial infarction","volume":"34","author":"Birnbaum","year":"2001","journal-title":"J. Electrocardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/anec.12173","article-title":"Effects of the coronary collateral circulation on the Tp-e interval and Tp-e\/QT ratio in patients with stable coronary artery disease","volume":"20","author":"Otlu","year":"2015","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jelectrocard.2017.05.001","article-title":"Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study","volume":"50","author":"Zhang","year":"2017","journal-title":"J. Electrocardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.jelectrocard.2017.02.008","article-title":"T wave axis deviation and QRS-T angle\u2014Controversial indicators of incident coronary heart events","volume":"50","author":"Dilaveris","year":"2017","journal-title":"J. Electrocardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1002\/ehf2.12746","article-title":"Diagnostic and prognostic values of the QRS-T angle in patients with suspected acute decompensated heart failure","volume":"7","author":"Sweda","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Giovanardi, P., Vernia, C., Tincani, E., Giberti, C., Silipo, F., and Fabbo, A. (2022). Combined Effects of Age and Comorbidities on Electrocardiographic Parameters in a Large Non-Selected Population. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133737"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"22","DOI":"10.18087\/cardio.2021.12.n1896","article-title":"Factors associated with an increase in spatial and frontal QRS-T angles in patients with anterior myocardial infarction","volume":"61","author":"Sakhnova","year":"2021","journal-title":"Kardiologiia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.ijbiomac.2021.06.140","article-title":"Serum albumin levels and inflammation","volume":"184","author":"Sheinenzon","year":"2021","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejim.2018.04.014","article-title":"Human serum albumin in cardiovascular diseases","volume":"52","author":"Arques","year":"2018","journal-title":"Eur. J. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Chen, X., Lin, Y., Tian, L., and Wang, Z. (2020). Correlation between ischemia-modified albumin level and coronary collateral circulation. BMC Cardiovasc. Disord., 20.","DOI":"10.1186\/s12872-020-01543-9"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1111\/imj.13796","article-title":"Serum albumin level and abnormal corrected QT interval in patients with coronary artery disease and chronic kidney disease","volume":"48","author":"Wu","year":"2018","journal-title":"Intern. Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Abus, S., Koparal, M., Kaya, H., Kap\u0131c\u0131, O.B., Tasolar, M.H., and Tibilli, H. (2023). Evaluation of frontal QRS-T angle values in electrocardiography in patients with chronic rhinosinusitis. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03175-1"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/148\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T16:52:04Z","timestamp":1766595124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010148"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010148","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,24]]}}}