![]() A study from Japan was the first to report that clockwise and counterclockwise rotation of QRS transition zone in 12‐lead ECGs were associated with significantly higher and lower risk of mortality caused by composite cardiovascular disease (CVD) and all causes, respectively, as compared with no rotation. 1, 2, 3, 4 In this context, clockwise and counterclockwise rotations of QRS transition zone in horizontal plane are long‐recognized ECG findings, but their prognostic value is not fully understood. In addition, several ECG parameters (eg, bundle branch block, frontal QRS‐T angle, QT interval, left ventricular hypertrophy) predict future cardiovascular events. However, QRS transitional zone information is automatically obtained when ECG is assessed, and, thus, in such a case, clinical attention should be paid to persons with clockwise rotation, particularly for the risk of heart failure.ĮCG has been useful for diagnosing several heart conditions including cardiac arrhythmia, cardiac ischemia, and structural changes such as left ventricular hypertrophy. Overall modest associations may question the prognostic value of QRS transitional zone. Our results support a proposal from some experts to rethink the definition of “normal” QRS transitional zone. On the contrary, counterclockwise rotation was significantly related to lower risk of composite CVD (hazard ratio, 0.93 95% CI, 0.87–0.99]), CVD mortality (hazard ratio, 0.76 95% CI, 0.65–0.88), and non‐ CVD deaths (hazard ratio, 0.92 95% CI, 0.85–0.99 ). Clockwise rotation was significantly associated with higher risk of heart failure (hazard ratio, 1.20 95% confidence interval, 1.02–1.41) and non‐ CVD death (hazard ratio, 1.28 95% CI, 1.12–1.46) after adjusting for potential confounders including other ECG parameters. Of patients with no rotation, 57.9% experienced counterclockwise or clockwise rotation during follow‐up, with diabetes mellitus and black race significantly predicting clockwise and counterclockwise conversion, respectively. At baseline, counterclockwise rotation was most prevalent (52.9%), followed by no (40.5%) and clockwise (6.6%) rotation. ![]() Stroke: Vascular and Interventional NeurologyĪmong 13 567 ARIC (Atherosclerosis Risk in Communities) study participants aged 45 to 64 years, we studied key correlates of changes in the status of clockwise and counterclockwise rotation over time as well as the association of rotation status with incidence of coronary heart disease (2408 events), heart failure (2196 events), stroke (991 events), composite CVD (4124 events), 898 CVD deaths, and 3469 non‐ CVD deaths over 23 years of follow‐up. ![]()
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