Spatial QRS-T Angle and Cognitive Decline in Older Subjects

Simin Mahinrad, Ian Ferguson, Peter W. Macfarlane, Elaine N. Clark, David J. Stott, Ian Ford, Simon P. Mooijaart, Stella Trompet, Diana Van Heemst, J. Wouter Jukema, Behnam Sabayan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: An abnormally wide spatial QRS-T angle on an ECG is a marker of heterogeneity in electrical activity of cardiac ventricles and is linked with cardiovascular events. Growing evidence suggests that cardiac dysfunction might signal future cognitive decline. Objective: In this study, we investigated whether spatial QRS-T angle associates with future cognitive decline in older subjects at high cardiovascular risk. Methods: We included 4,172 men and women (mean age 75.2±3.3 years) free of cardiac arrhythmias from the PROSPER cohort. Spatial QRS-T angle was calculated from baseline 12-lead ECGs using a matrix transformation method. Cognitive function was assessed using 4 neuropsychological tests including Stroop test, letter-digit coding test, immediate and delayed picture word learning tests. Cognitive function was assessed at baseline and repeatedly during a mean follow-up time of 3.2 years. Using linear mixed models, we calculated the annual changes of cognitive scores in sex-specific thirds of spatial QRS-T angle. Results: Participants with wider spatial QRS-T angle had a steeper decline in letter-digit coding test (β = -0.0106, p = 0.004), immediate picture-word learning test (β = -0.0049, p = 0.001), and delayed picture-word learning test (β = -0.0055, p = 0.013). All associations were independent of arrhythmias, cardiovascular risk factors, comorbidities, medication use, cardiovascular events, and other ECG abnormalities including QRS duration, QTc interval, T wave abnormalities, and left ventricular hypertrophy. Conclusion: Abnormal cardiac electrical activity characterized by wide spatial QRS-T angle associates with accelerated cognitive decline independent of conventional cardiovascular factors. These findings suggest a link between a non-traditional ECG measure of pre-clinical cardiac pathology and future cognitive decline.

Original languageEnglish (US)
Pages (from-to)279-289
Number of pages11
JournalJournal of Alzheimer's Disease
Issue number1
StatePublished - 2019


  • Cardiac dysfunction
  • cognitive function
  • old age
  • spatial QRS-T angle

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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