Ecem Ermete GÜLER, Süleyman KIRIK, Deniz ÇINAROĞLU, Mehmet Göktuğ EFGAN
Comprehensive Medicine - 2026;18(2):121-130
Objective: COVID-19 pneumonia is associated not only with respiratory failure but also with an increased risk of cardiac involvement and mortality. The frontal QRS/T angle, automatically obtained from a standard ECG, reflects the electrical difference between ventricular depolarization and repolarization. This study aimed to investigate the prognostic value of the frontal QRS/T angle in patients presenting to the emergency department with COVID-19 pneumonia. Materials and Methods: In this retrospective study, 288 adult patients who presented to the emergency department with a diagnosis of COVID-19 pneumonia were included. Demographic, clinical, and laboratory data, along with frontal QRS/T angles obtained from initial ECGs, were analyzed. Clinical outcomes (discharge, ICU admission, mortality) were compared with laboratory and ECG parameters. Results: ROC analysis identified >47.5 derece as the optimal threshold for fQRS/T (AUC=0.628; sensitivity 55.9%; specificity 72.6%). In-hospital mortality was approximately three times higher in patients with fQRS/T >47.5 derece compared to those with <=47.5 derece. The fQRS/T angle showed positive correlations with troponin, CK-MB, BUN, creatinine, and CRP . Logistic regression analysis revealed that pulse rate and length of hospital stay were independently associated with mortality. Conclusion: A widened fQRS/T angle is associated with increased mortality in COVID-19 pneumonia and may serve as a noninvasive marker of systemic inflammation. Due to its simplicity, cost-effectiveness, and rapid applicability, it may be a valuable parameter for early risk stratification in emergency departments. Prospective multicenter studies are needed to validate these findings.
