Weir Robin A P, Martin Thomas N, Murphy Charles Aengus, Petrie Colin J, Clements Suzanne, Steedman Tracey, Dargie Henry J, Wagner Galen S
Cardiology Department, Western Infirmary, Glasgow, Scotland, UK.
J Electrocardiol. 2010 May-Jun;43(3):230-6. doi: 10.1016/j.jelectrocard.2010.01.003. Epub 2010 Feb 1.
Left ventricular ejection fraction (LVEF) is a powerful prognostic marker after acute myocardial infarction and is dependent on infarct magnitude. Contrast-enhanced cardiac magnetic resonance (ceCMR) represents the current criterion standard means of LVEF and infarct size measurement. Infarct size and LVEF can be estimated from the 12-lead electrocardiogram (ECG) using the Selvester QRS score. We examined for the first time the relationship between serial measures of LVEF and infarct size by ceCMR and ECG in patients with reperfused anterior ST-elevation myocardial infarction (STEMI) and depressed LVEF.
Thirty-four patients (mean +/- SD age, 59 +/- 11.8 years; 70.6% male) underwent ceCMR and simultaneous ECG at mean 93 hours after admission and at 12 and 24 weeks. The QRS score was calculated on each ECG, from which infarct size and LVEF were estimated and compared with the equivalent ceCMR measurements.
Infarct size on ceCMR was higher than that by QRS score at each time-point (P < .001) with modest correlation (r = 0.56-0.78, P < .001). Left ventricular ejection fraction was consistently significantly higher on CMR than on ECG, with weak correlation (r = 0.37-0.51, P < .05). We derived a novel equation relating QRS score to CMR-measured LVEF in the subacute phase of infarction: LVEF = 61 - (1.7 x QRS score) (%).
In patients with reperfused anterior ST-elevation myocardial infarction and depressed LVEF, ceCMR is moderately correlated with the QRS in the serial measurement of infarct size and LVEF. Infarct size (measured by ceCMR) and LVEF are consistently higher than those calculated on the QRS score in the acute and subacute phases of infarction.
左心室射血分数（LVEF）是急性心肌梗死后一个强有力的预后指标，且取决于梗死面积。对比增强心脏磁共振成像（ceCMR）是目前测量LVEF和梗死面积的标准方法。梗死面积和LVEF可使用塞尔维斯特QRS评分从12导联心电图（ECG）中估算出来。我们首次研究了再灌注性前壁ST段抬高型心肌梗死（STEMI）且LVEF降低的患者中，通过ceCMR和ECG对LVEF和梗死面积进行系列测量之间的关系。
34例患者（平均±标准差年龄，59±11.8岁；70.6%为男性）在入院后平均93小时、12周和24周时接受了ceCMR检查及同步ECG检查。在每份ECG上计算QRS评分，据此估算梗死面积和LVEF，并与ceCMR的等效测量值进行比较。
在每个时间点，ceCMR测量的梗死面积均高于QRS评分测量的结果（P < 0.001），相关性一般（r = 0.56 - 0.78，P < 0.001）。CMR测量的左心室射血分数始终显著高于ECG测量的结果，相关性较弱（r = 0.37 - 0.51，P < 0.05）。我们得出了一个在梗死亚急性期将QRS评分与CMR测量的LVEF相关联的新方程：LVEF = 61 - （1.7×QRS评分）（%）。
在再灌注性前壁ST段抬高型心肌梗死且LVEF降低的患者中，在梗死面积和LVEF的系列测量中，ceCMR与QRS评分具有中等程度的相关性。在梗死的急性期和亚急性期，梗死面积（通过ceCMR测量）和LVEF始终高于根据QRS评分计算得出的结果。
