心电图上心肌缺血的迹象与急性肺栓塞时血浆心肌肌钙蛋白升高和右心室收缩功能障碍相关。

Signs of myocardial ischemia on electrocardiogram correlate with elevated plasma cardiac troponin and right ventricular systolic dysfunction in acute pulmonary embolism.

机构信息

Department of Internal Medicine and Cardiology, The Medical University of Warsaw, Poland.

出版信息

Cardiol J. 2010;17(2):157-62.

PMID:20544614

Abstract

BACKGROUND

Plasma cardiac troponins (cTn) are frequently elevated in acute pulmonary embolism (APE). ST-segment abnormalities on electrocardiography are also commonly observed in APE patients. However, it has not been defined which ventricle is a potential source of cTn release. We assessed the potential relationship between electrocardiographic signs of myocardial ischemia, systolic dysfunction of both ventricles at echocardiography and cTn levels in APE.

METHODS

We evaluated 94 consecutive patients (42 male, 52 female, aged 63 +/- 19 years) with APE. On admission, blood samples were collected for cTnI or cTnT and standard 12-lead electrocardiogram was performed. The following signs of myocardial ischemia were analyzed: T-wave inversion [T (-)] and ST-depression or elevation (> or = 1 mV, at > or = 2 leads). The assessment of systolic function of both ventricles was performed by echocardiography.

RESULTS

In 33 (35%) patients, cTn exceeded the upper reference limit of our laboratory. The history of coronary artery disease (27% vs. 31%) and previous myocardial infarction (12% vs. 10%) did not differ in patients with elevated cTn [cTn (+)] and non-elevated cTn [cTn (-)]. In cTn (+) group T (-) or ST-depression were observed more frequently than in cTn (-) [32 (97%) vs. 46 (75%), p < 0.01]. However, both groups presented similar frequency of ST-elevation [7 (21%) vs. 11 (18%), p = NS). Interestingly, cTn levels correlated with the number of leads with T (-) or ST-depression (R = 0.30, p < 0.01). Moreover, in cTn (+) group right ventricular systolic dysfunction was more frequent [15 (54%) vs. 4 (7%), p = 0.0001], while left ventricle contractility abnormalities occurred similarly in both groups [3 (11%) vs. 8 (15%), p = NS].

CONCLUSIONS

Signs of myocardial ischemia (ST-segment changes) on electrocardiography in APE correlate with an elevated cTn and with the impairment of right, but not left, ventricle systolic function at echocardiography.

摘要

背景

在急性肺栓塞（APE）中，血浆心肌肌钙蛋白（cTn）经常升高。心电图上的 ST 段异常在 APE 患者中也很常见。然而，尚未确定哪个心室是 cTn 释放的潜在来源。我们评估了心电图心肌缺血征象、超声心动图双心室收缩功能障碍与 APE 中 cTn 水平之间的潜在关系。

方法

我们评估了 94 例连续的 APE 患者（42 名男性，52 名女性，年龄 63 +/- 19 岁）。入院时采集 cTnI 或 cTnT 血样，并进行标准 12 导联心电图检查。分析了以下心肌缺血征象：T 波倒置[T(-)]和 ST 压低或抬高（>或= 1 mV，>或= 2 个导联）。通过超声心动图评估双心室收缩功能。

结果

在 33 例（35%）患者中，cTn 超过了我们实验室的上参考限。cTn 升高[cTn(+)]和 cTn 不升高[cTn(-)]患者的冠心病病史（27%比 31%）和既往心肌梗死（12%比 10%）无差异。在 cTn(+)组中，T(-)或 ST 压低比 cTn(-)组更常见[32(97%)比 46(75%)，p < 0.01]。然而，两组 ST 抬高的发生率相似[7(21%)比 11(18%)，p = NS]。有趣的是，cTn 水平与 T(-)或 ST 压低的导联数相关（R = 0.30，p < 0.01）。此外，在 cTn(+)组中，右心室收缩功能障碍更为常见[15(54%)比 4(7%)，p = 0.0001]，而左心室收缩功能障碍在两组中发生率相似[3(11%)比 8(15%)，p = NS]。