Predictive Role of f-QRST Angle in Subarachnoid Hemorrhage

NCT07196891 | Completed DMC

• 1 other identifier: 135-2025
• Study Type: observational
• Target: 354
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators investigated the association between the frontal QRS/T angle measured on admission ECG and 28-day mortality, as well as neurological outcome in patients with non-traumatic aneurysmal SAH. Specifically, the investigators tested the hypothesis that an increased frontal QRS/T angle would be independently associated with higher mortality and poorer clinical outcomes in patients with SAH. Accordingly, the investigators also analyzed the relationship between the frontal QRS/T angle and neurological status assessed based on Glasgow Outcome Scale (GOS), as well as disease severity determined by the Hunt-Hess and Fisher grading systems.

Conditions

Subarachnoid Hemorrhage, Aneurysmal

Keywords

Subarachnoid Hemorrhage; Aneurysmal; Non-traumatic; Electrocardiography; frontal-QRST angle; 28-day mortality

Outcome Measures

Primary Outcomes (1)

• Predictive ability of frontal-QRST angle for 28-day mortality

  The investigators assessed the predictive ability of frontal-QRST angle in determining 28-day mortality.

  From admission to 28 days

Secondary Outcomes (1)

• Predictive ability of frontal-QRST angle for neurological survival

  From admission to 28 days

Study Arms (2)

Survivors

Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.

Other: frontal-QRST angle; Other: Hunt-Hess scale; Other: modified Fisher scale

Non-survivors

Non-survivors had passed away within 28 days of admission to the emergency department.

Other: frontal-QRST angle; Other: Hunt-Hess scale; Other: modified Fisher scale

Interventions

frontal-QRST angle OTHER

The frontal QRS/T angle represents the angle between the ventricular depolarization (QRS) and repolarization (T) vectors on the ECG and serves as a parameter for assessing cardiac electrical heterogeneity. In this study, the frontal QRS/T angle was calculated using data obtained from standard 12-lead surface ECGs. The QRS and T axes in the frontal plane were derived from the automated ECG device reports.

Non-survivors; Survivors

Hunt-Hess scale OTHER

The Hunt-Hess scale was used to assess SAH severity according to the clinical presentation and the visible neurological deficits. The Grades run from 1 to 5: - Grade 1: Asymptomatic or minimal headache, slight neck stiffness. - Grade 2: Moderate to severe headache, and neck stiffness, but no neurological deficit except cranial nerve palsy. - Grade 3: Drowsiness, confusion, or a mild focal deficit. - Grade 4: Stupor, moderate to severe hemiparesis, early decerebrate rigidity, and vegetative disturbance. - Grade 5: Deep coma, decerebrate rigidity, and a moribund appearance.

Non-survivors; Survivors

modified Fisher scale OTHER

The modified Fisher scale was used to evaluate SAH severity by reference to the extent of hemorrhage as revealed by CT of the brain. Four grades are depending on the degree of bleeding observed: - Grade 0: No hemorrhage apparent in CT. - Grade 1: Minimal hemorrhage without intraventricular hemorrhage (IVH). - Grade 2: Thin or diffusely thin (\<1mm) hemorrhage with bilateral IVH. - Grade 3: Thick (\> 1 mm) hemorrhage without bilateral IVH. - Grade 4: Thick (\> 1 mm) hemorrhage with bilateral IVH.

Non-survivors; Survivors

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

This multicenter, retrospective, observational cohort study enrolled 354 consecutive adult patients (aged ≥ 18 years) who presented to the emergency departments of the seven major and highest-volume tertiary hospitals in Istanbul with non-traumatic Subarachnoid Hemorrhage between July 2020 and July 2025. Data were collected by searching for I60.9 International Classification of Diseases (ICD) codes in the hospital's automation systems and archives.

You may qualify if:

• \- patients (aged ≥ 18 years) who presented to the emergency department with non-traumatic Subarachnoid Hemorrhage between July 2020 and July 2025

You may not qualify if:

• patients younger than 18 years
• patients with missing information
• patients with traumatic SAH
• patients with subdural or epidural hemorrhage
• patients with concurrent ischemic stroke

Sponsors & Collaborators

• Haseki Training and Research Hospital: lead

Study Sites (1)

Haseki Training and Research Hospital

Istanbul, Fatih, 34265, Turkey (Türkiye)

Location

Related Publications (6)

• Gunduz R, Yildiz BS, Ozgur S, Ozen MB, Bakir EO, Ozdemir IH, Cetin N, Usalp S, Duman S. Frontal QRS/T angle can predict mortality in COVID-19 patients. Am J Emerg Med. 2022 Aug;58:66-72. doi: 10.1016/j.ajem.2022.05.034. Epub 2022 May 25.

  PMID: 35636045 BACKGROUND

• Hocanli I, Tanriverdi Z, Kabak M, Gungoren F, Tascanov MB. The relationship between frontal QRS-T angle and the severity of newly diagnosed chronic obstructive pulmonary disease. Int J Clin Pract. 2021 Oct;75(10):e14500. doi: 10.1111/ijcp.14500. Epub 2021 Jun 29.

  PMID: 34117683 BACKGROUND

• Zhang X, Zhu Q, Zhu L, Jiang H, Xie J, Huang W, Xu B. Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis. PLoS One. 2015 Aug 18;10(8):e0136174. doi: 10.1371/journal.pone.0136174. eCollection 2015.

  PMID: 26284799 BACKGROUND

• Bilginer HA, Sogut O, Az A, Ergenc H. Electrocardiographic abnormalities are prognostic of the clinical outcomes and mortality of patients with subarachnoid hemorrhages. Am J Emerg Med. 2024 Jul;81:140-145. doi: 10.1016/j.ajem.2024.04.055. Epub 2024 May 3.

  PMID: 38728937 BACKGROUND

• Thilak S, Brown P, Whitehouse T, Gautam N, Lawrence E, Ahmed Z, Veenith T. Diagnosis and management of subarachnoid haemorrhage. Nat Commun. 2024 Feb 29;15(1):1850. doi: 10.1038/s41467-024-46015-2.

  PMID: 38424037 BACKGROUND

• Cetinkaya O, Arslan U, Temel H, Kavakli AS, Cakin H, Cengiz M, Yilmaz M, Barcin NE, Ikiz F. Factors Influencing the Mortality of Patients with Subarachnoid Haemorrhage in the Intensive Care Unit: A Retrospective Cohort Study. J Clin Med. 2025 Feb 28;14(5):1650. doi: 10.3390/jcm14051650.

  PMID: 40095649 BACKGROUND

MeSH Terms

Conditions

Subarachnoid Hemorrhage

Condition Hierarchy (Ancestors)

Intracranial Hemorrhages; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Hemorrhage; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Adem Az

  Haseki Training and Research Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: September 20, 2025
• First Posted: September 29, 2025
• Study Start: July 1, 2020
• Primary Completion: July 1, 2025
• Study Completion: September 1, 2025
• Last Updated: September 29, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)