成人病毒性心肌炎患者QRS-T夹角增宽的意义

Clinical significance of abnormal electrocardiogram with wide QRS-T angle in adult patients with acute viral myocarditis

目的额面QRS-T角可预测心衰患者预后,本研究拟探讨QRS-T角在成人急性病毒性心肌炎患者死亡与心衰的临床价值。方法通过对146例住院确诊的急性病毒性心肌炎患者入院时心电图分析计算QRS-T角,比较QRS-T角增宽(≥100°)与非增宽患者(<100°)院内死亡及6个月随访中发生心力衰竭的比例。结果心肌炎院内死亡10例(6.8%),随访中新发心力衰竭或扩张型心肌病患者9例(6.2%)。最常见的心电图改变包括T波异常(27%)、ST段异常(28%)、QTc延长(46%)、QRS-T角增宽(15%)。QRS-T角增宽患者,死亡率增加(29%vs.2.5%;p<0.001),心力衰竭发生率明显更高(29%vs.1.6%;p<0.001)。Cox回归分析表明,宽QRS-T角(≥100°)是死亡与心力衰竭联合终点的重要独立预测因子(OR 3.595,95%CI 1.237~10.455,p=0.019)。结论QRS-T角增宽是成人患者急性心肌炎的死亡和心力衰竭的重要独立预测因子。

Objective Given the role of frontal QRS-T angle in predicting the prognosis of patients with heart failure,this study was to investigate the clinical value of QRS-T angle in predicting death and heart failure in adults with acute viral myocarditis.Methods The QRS-T angle was calculated from 12-lead surface electrocardiograph in146 cases of hospitalized patients with acute viral myocarditis.The death rate and proportion of heart failure during the6-month follow-up were compared between patients with(≥100°)or without QRS-T angle widening(<100°).Results Ten patients(6.8%)died of myocarditis,and 9 patients(6.2%)had new occurrence of heart failure or dilated cardiomyopathy during follow-up.The most common ECG changes included abnormal T wave(27%),abnormal ST segment(28%),QTc prolongation(46%),and widen QRS-T angle(15%).Patients with wide QRS-T angel have increased mortality inhospital(29%vs.2.5%;p<0.001)and high proportion of heart failure(29%vs.1.6%;p<0.001).Cox regression analysis showed that the wide QRS-T angle(≥100°)was an important independent predictor of death and heart failure(OR 3.595,95%CI 1.237~10.455,p=0.019).Conclusions Widen QRS-T angle is an important independent predictor of death and heart failure in predicting acute myocarditis.