Subarachnoid Hemorrhage, Aneurysmalf-QRST in SAHNCT07196891
Predictive Role of f-QRST Angle in Subarachnoid Hemorrhage
An observational study of Subarachnoid Hemorrhage, Aneurysmal, run by Haseki Training and Research Hospital at 1 site in Turkey (Türkiye).
Trial 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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Subarachnoid Hemorrhage, Aneurysmal
- What is being tested?
- frontal-QRST angle, Hunt-Hess scale and modified Fisher scale
- How many people
- 354 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Jul 2020to 1 Sep 2025
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
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.
Who may be able to join
- patients (aged ≥ 18 years) who presented to the emergency department with non-traumatic Subarachnoid Hemorrhage between July 2020 and July 2025
Who cannot join
- patients younger than 18 years
- patients with missing information
- patients with traumatic SAH
- patients with subdural or epidural hemorrhage
- patients with concurrent ischemic stroke
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Haseki Training and Research Hospital
Istanbul, Fatih, 34265
About this study
Official title: Prognostic Value of the Frontal QRS/T Angle for 28-day Mortality and Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage
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.
Read the detailed description
Patients were divided into two groups: survivors and non-survivors. Survivors were further classified as mobile or immobile according to the Glasgow Outcome Scale (GOS). Patients who remained comatose or dependent in daily activities were classified as immobile (GOS 1-3), while those who returned to normal life or were able to perform daily activities independently were classified as mobile (GOS 4-5). Demographic and clinical characteristics as well as ECG findings were compared between these groups, and the relationship between the frontal QRS/T angle, 28-day mortality, and disease severity was evaluated. Independent predictors of mortality were determined by multivariate logistic regression analysis of variables (demographic characteristics, clinical characteristics, and ECG changes) that differed significantly between survivors and non-survivors. An area under the curve (AUC) analysis was then conducted to identify the predictive role of the f-QRST angle in patients with SAH.
- Conditions
- Subarachnoid Hemorrhage, Aneurysmal
- Being tested
- frontal-QRST angle, Hunt-Hess scale, modified Fisher scale
- Keywords
- Subarachnoid Hemorrhage, Aneurysmal, Non-traumatic, Electrocardiography, frontal-QRST angle, 28-day mortality
- Medical subject headings
- Subarachnoid Hemorrhage
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
frontal-QRST angleOther
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.
Hunt-Hess scaleOther
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.
modified Fisher scaleOther
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.
| Study group | Role | What they receive |
|---|---|---|
| Survivors | Survivors were defined as patients who were still alive after 28 days of admission to the emergency department. Receives: 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. Receives: Other: frontal-QRST angle; Other: Hunt-Hess scale; Other: modified Fisher scale |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: From admission to 28 days
Secondary outcomes (1)
Predictive ability of frontal-QRST angle for neurological survival
The investigators assessed the predictive ability of frontal-QRST angle in determining neurological survival
Measured: From admission to 28 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Sep 2025
- Study start1 Jul 2020
- Primary completion1 Jul 2025
- Study completion1 Sep 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Subarachnoid Hemorrhage, AneurysmalStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 354 participants (actual)
Sponsor and investigators
- Lead sponsor
- Haseki Training and Research Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Adem Az, Haseki Training and Research Hospital
- Investigators
- Adem Az, Principal investigator, Haseki Training and Research Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07196891
- Sponsor's protocol ID
- 135-2025
- Acronym
- f-QRST in SAH
- Status last verified
- Sep 2025
- First submitted
- 20 Sep 2025
- Last updated
- 29 Sep 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Stored in non-publicly available Available on request
Publications
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.
PubMed 35636045Hocanli 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.
PubMed 34117683Zhang 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.
PubMed 26284799Bilginer 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.
PubMed 38728937Thilak 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.
PubMed 38424037Cetinkaya 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.
PubMed 40095649
Study at a glance
From the registry record, last updated by the sponsor on 29 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Prognostic Value of the Frontal QRS/T Angle for 28-day Mortality and Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage
- ClinicalTrials.gov ID
- NCT07196891
- Acronym / sponsor ID
- f-QRST in SAH / 135-2025
- Conditions
- Subarachnoid Hemorrhage, Aneurysmal
- Keywords
- Subarachnoid Hemorrhage, Aneurysmal, Non-traumatic, Electrocardiography, frontal-QRST angle, 28-day mortality
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 354 participants (actual)
- Lead sponsor
- Haseki Training and Research HospitalUniversity, hospital or other
- Study start
- 1 Jul 2020 (actual)
- Primary completion
- 1 Jul 2025 (actual)
- Study completion
- 1 Sep 2025 (actual)
- First posted
- 29 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
Patients were divided into two groups: survivors and non-survivors. Survivors were further classified as mobile or immobile according to the Glasgow Outcome Scale (GOS). Patients who remained comatose or dependent in daily activities were classified as immobile (GOS 1-3), while those who returned to normal life or were able to perform daily activities independently were classified as mobile (GOS 4-5). Demographic and clinical characteristics as well as ECG findings were compared between these groups, and the relationship between the frontal QRS/T angle, 28-day mortality, and disease severity was evaluated. Independent predictors of mortality were determined by multivariate logistic regression analysis of variables (demographic characteristics, clinical characteristics, and ECG changes) that differed significantly between survivors and non-survivors. An area under the curve (AUC) analysis was then conducted to identify the predictive role of the f-QRST angle in patients with SAH.
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Survivors | – | Other: frontal-QRST angle, Other: Hunt-Hess scale, Other: modified Fisher scaleSurvivors were defined as patients who were still alive after 28 days of admission to the emergency department. |
| Non-survivors | – | Other: frontal-QRST angle, Other: Hunt-Hess scale, Other: modified Fisher scaleNon-survivors had passed away within 28 days of admission to the emergency department. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- 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.
Key inclusion criteria (1 listed)
- patients (aged ≥ 18 years) who presented to the emergency department with non-traumatic Subarachnoid Hemorrhage between July 2020 and July 2025
Key exclusion criteria (5 listed)
- patients younger than 18 years
- patients with missing information
- patients with traumatic SAH
- patients with subdural or epidural hemorrhage
- patients with concurrent ischemic stroke
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| frontal-QRST angleThe 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. | Other | Non-survivors, Survivors |
| Hunt-Hess scaleThe 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. | Other | Non-survivors, Survivors |
| modified Fisher scaleThe 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. | Other | Non-survivors, Survivors |
Primary outcome
Predictive ability of frontal-QRST angle for 28-day mortality
Time frame: From admission to 28 days
The investigators assessed the predictive ability of frontal-QRST angle in determining 28-day mortality.
1 secondary outcome
Predictive ability of frontal-QRST angle for neurological survival
Time frame: From admission to 28 days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Sep 2025.
- Results publication: PubMed 35636045Gunduz 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.
- Results publication: PubMed 34117683Hocanli 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.
- Results publication: PubMed 26284799Zhang 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.
- Results publication: PubMed 38728937Bilginer 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.
- Results publication: PubMed 38424037Thilak 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.
- Results publication: PubMed 40095649Cetinkaya 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.
- Individual participant dataSharing planned: No. Stored in non-publicly available Available on request
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Adem Az principal investigator
Haseki Training and Research Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Subarachnoid Hemorrhage, Aneurysmal, run by Haseki Training and Research Hospital at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 29 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Predictive ability of frontal-QRST angle for 28-day mortality (time frame: From admission to 28 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07196891, which also lists 6 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Sep 2025.