Frontal QRS-T angle in patients with Graves’ disease: association with thyroid function and cardiovascular parameters
5 affiliations
- 1Department of Normal and Clinical Anatomy, Faculty of Medicine, Medical College, University of Rzeszów
- 2Clinical Department of Cardiology with the Acute Coronary Syndromes Subdivision, St. Queen Jadwiga Clinical Hospital in Rzeszow
- 3Department of Internal Medicine, Nephrology and Endocrinology, St. Queen Jadwiga Clinical Hospital in Rzeszow
- 4Department of Nephrology and Endocrinology, Faculty of Medicine, Medical College, University of Rzeszów
- 5Department of Nephrology and Dialysis Unit, Fryderyk Chopin University Clinical Hospital in Rzeszów
Abstract
Introduction: Thyroid hormone excess may alter ventricular electrophysiology, affecting both depolarization and repolarization. The frontal QRS-T (fQRS-T) angle reflects the directional relationship between these processes and may provide information on ventricular electrical heterogeneity. However, data on the fQRS-T angle in overt hyperthyroidism (OHT) remain limited. We evaluated the fQRS-T angle in patients with Graves’ disease presenting with OHT compared with euthyroid controls.
Materials and methods: This retrospective single-center study included 55 patients with Graves’ disease and biochemically confirmed OHT and 42 euthyroid controls. Frontal QRS and T axes were calculated from ECG measurements in leads I and aVF. Between-group comparisons, multivariable regression adjusted for age, sex, body mass index, and heart rate, sensitivity analyses, ROC analysis, and correlations with thyroid function parameters were performed. Results: The median fQRS-T angle was greater in patients with OHT than in controls (21.89° [12.37–44.09] vs. 17.36° [9.02–27.29], p = 0.006), with a rank-biserial correlation of 0.328 (95% CI 0.106–0.535). An fQRS-T angle >45° occurred in 23.6% of patients with OHT and in none of the controls (p < 0.001), whereas the QRS and T axes did not differ significantly between groups. After adjustment for age, sex, body mass index, and heart rate, OHT remained associated with a greater fQRS-T angle (β = 9.00°, 95% CI 1.77–16.22; p = 0.015), with consistent findings in sensitivity analyses. Discriminatory performance was modest (AUC 0.664, 95% CI 0.552–0.768). No significant associations were observed between fQRS-T angle and FT3, FT4, TSH, or heart rate.
Discussion: Patients with Graves’ disease and OHT exhibited greater discordance between ventricular depolarization and repolarization despite similar individual QRS and T axes. This association persisted after adjustment for heart rate and other potential confounders, suggesting that fQRS-T widening may reflect electrophysiological alterations associated with OHT rather than tachycardia alone.
Conclusion: Overt hyperthyroidism due to Graves’ disease is associated with a wider fQRS-T angle independently of age, sex, body mass index, and heart rate. Larger prospective, multicenter studies with longitudinal ECG assessment are needed to determine the reversibility and prognostic significance of these alterations.
Related
- Association of pre-existing cardiovascular disease with cardiovascular and clinical outcomes in patients receiving immune checkpoint inhibitors
- Association between insulin resistance-related indices and cardiovascular disease in patients with atopic dermatitis: mutual validation using real-world and NHANES data
- Non-linear association between average daily sleep duration and cardiovascular disease in patients with diabetes or prediabetes
- Association of 24 h Pulse Pressure Derived from Ambulatory Blood Pressure Monitoring with All-Cause and Cardiovascular Mortality in Patients Undergoing Peritoneal Dialysis: A Prospective Cohort Study
- Association of delayed graft function with cardiovascular outcomes in kidney transplant recipients
BibTeX
@article{klosowicz2026frontal,
title = {{Frontal QRS-T angle in patients with Graves’ disease: association with thyroid function and cardiovascular parameters}},
author = {Maksymilian Kłosowicz and Magdalena Urbańczuk and Aleksandra Burbelka and Agnieszka Gala-Błądzińska and Krzysztof Balawender},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1979248},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1979248/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Frontal QRS-T angle in patients with Graves’ disease: association with thyroid function and cardiovascular parameters
AU - Maksymilian Kłosowicz
AU - Magdalena Urbańczuk
AU - Aleksandra Burbelka
AU - Agnieszka Gala-Błądzińska
AU - Krzysztof Balawender
PY - 2026
DA - 2026/10/22
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1979248
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1979248/full
AB - Introduction: Thyroid hormone excess may alter ventricular electrophysiology, affecting both depolarization and repolarization. The frontal QRS-T (fQRS-T) angle reflects the directional relationship between these processes and may provide information on ventricular electrical heterogeneity. However, data on the fQRS-T angle in overt hyperthyroidism (OHT) remain limited. We evaluated the fQRS-T angle in patients with Graves’ disease presenting with OHT compared with euthyroid controls. Materials and methods: This retrospective single-center study included 55 patients with Graves’ disease and biochemically confirmed OHT and 42 euthyroid controls. Frontal QRS and T axes were calculated from ECG measurements in leads I and aVF. Between-group comparisons, multivariable regression adjusted for age, sex, body mass index, and heart rate, sensitivity analyses, ROC analysis, and correlations with thyroid function parameters were performed. Results: The median fQRS-T angle was greater in patients with OHT than in controls (21.89° [12.37–44.09] vs. 17.36° [9.02–27.29], p = 0.006), with a rank-biserial correlation of 0.328 (95% CI 0.106–0.535). An fQRS-T angle >45° occurred in 23.6% of patients with OHT and in none of the controls (p < 0.001), whereas the QRS and T axes did not differ significantly between groups. After adjustment for age, sex, body mass index, and heart rate, OHT remained associated with a greater fQRS-T angle (β = 9.00°, 95% CI 1.77–16.22; p = 0.015), with consistent findings in sensitivity analyses. Discriminatory performance was modest (AUC 0.664, 95% CI 0.552–0.768). No significant associations were observed between fQRS-T angle and FT3, FT4, TSH, or heart rate. Discussion: Patients with Graves’ disease and OHT exhibited greater discordance between ventricular depolarization and repolarization despite similar individual QRS and T axes. This association persisted after adjustment for heart rate and other potential confounders, suggesting that fQRS-T widening may reflect electrophysiological alterations associated with OHT rather than tachycardia alone. Conclusion: Overt hyperthyroidism due to Graves’ disease is associated with a wider fQRS-T angle independently of age, sex, body mass index, and heart rate. Larger prospective, multicenter studies with longitudinal ECG assessment are needed to determine the reversibility and prognostic significance of these alterations.
SN - 1664-2392
ER -