心电图Selvester QRS积分评价急性病毒性心肌炎并发左心功能异常的临床价值

Clinical significance of Selvester QRS score derive from electrocardiogram in the assessment of cardiac dysfunction in acute viral myocarditis

目的:Selvester QRS积分可反映缺血或非缺血心肌纤维化水平,本研究拟探讨Selvester QRS积分能否评价急性病毒性心肌炎患者后期心肌纤维化。方法:通过对112例住院确诊的急性病毒性心肌炎患者1年后随访的心电图分析,比较1年后发生心脏功能异常[左室射血分数(LVEF)<50%或E/A<1]者心电图参数,评价心电图Selvester QRS积分对心肌炎后心功能不全的诊断价值。结果:随访1年后有12例患者出现心脏收缩(3例,2.7%)或舒张功能异常(9例,8%);左心室功能异常组重症心肌炎比例高(83%∶24%),心电图分析显示,左心室功能异常组心率更快、QRS-T角更宽、Selvester QRS积分更高,估测左心室纤维化程度更高。相关性分析显示,左心功能异常与重症、心率、年龄、Selvester QRS积分显著相关。Logistic回归分析显示,仅重症心肌炎和Selvester QRS积分(OR=2.958,95%CI 1.118~7.825)是左心功能受损的预测因素。ROC分析显示,Selvester QRS积分为2.5时,对左心室功能异常的预测性最佳,敏感性为75%,特异性为85%(AUC=0.841,95%CI 0.702~0.981,P<0.001)。结论:Selvester QRS积分是急性病毒性心肌炎后期并发左心功能异常的独立预测因素,可应用于心肌炎患者的临床随访。

Objective: The Selvester QRS score on electrocardiogram(ECG) can reflect the level of myocardial fibrosis in patients with or without myocardial ischemia. This study is aimed to investigate whether Selvester QRS score can evaluate cardiac fibrosis and dysfunction in patients with acute viral myocarditis. Methods: The Selvester QRS score was calculated from 12-lead surface electrocardiograph in 112 cases of acute viral myocarditis after 12 months follow-up. The electrocardiographic parameters were compared between patients with or without cardiac dysfunction(LVEF<50% or E/A<1). Results: After 12 months follow-up, 12 patients had occurrence of cardiac systolic dysfunction(3 cases, 2.7%) and diastolic dysfunction(9 cases, 8%) by ultrasonography. Patients with cardiac dysfunction have high proportion of fulminant myocarditis(83% vs 24%), accelerated heart rate, widen QRS-T angle and high Selvester QRS score. Spareman analysis showed that severity, HR, age and QRS score were positive correlated with cardiac dysfunction. Logistics regression analysis showed that only severe myocarditis(OR= 11.66, 95%CI1.587-85.693, P=0.012) and Selvester QRS score were independent predictors of cardiac dysfunction(OR=2.958, 95%CI1.118-7.825, P=0.029). Receiver-operating-characteristic(ROC) analysis showed that the optimal cut-off value of the QRS score for predicting the presence of cardiac dysfunction was 2.5. Sensitivity, specificity, and area under the curve were 75%, 85%, and 0.841, respectively. Conclusion: The Selvester QRS score derived from simple and widely available ECG may be a useful parameter for assuring the presence of cardiac dysfunction during the follow-up of patients with acute viral myocarditis.