Knippenberg Stephanie A M, Wagner Galen S, Ubachs Joey F A, Gorgels Anton, Hedström Erik, Arheden Håkan, Engblom Henrik
Department of Cardiology, University of Maastricht, The Netherlands.
Ann Noninvasive Electrocardiol. 2010 Jul;15(3):238-44. doi: 10.1111/j.1542-474X.2010.00370.x.
It has previously been shown that there is a good agreement between the Selvester QRS score and myocardial infarct (MI) size determined by postmortem histopathology in patients with nonreperfused MI. Currently, however, most patients with acute coronary thrombosis receive reperfusion therapy. Therefore, the aim of this study was to test the hypothesis that early reperfusion alters the quantitative relationship between Selvester QRS score and MI size.
Twenty-seven patients with acute first-time reperfused MI were studied. Infarct size was determined by delayed contrast-enhanced magnetic resonance imaging (DE-MRI) and estimated with the 50-criteria/31-point Selvester QRS scoring system 1 week after admission. The findings in the present study were compared with previous postmortem studies exploring the quantitative relationship between Selvester QRS score and MI size in nonreperfused patients.
The quantitative relationship between QRS score and MI size by DE-MRI in the present study of early reperfused MI was significantly different from previous postmortem histopathology studies of nonreperfused MI (P < 0.0001). In the present study, each QRS point represented approximately 2% of the left ventricle, compared to approximately 3% in previous postmortem histopathology studies of nonreperfused MI. When only considering small to moderate MI sizes, there was no significant difference in the quantitative relationship between QRS score and infarct size (P > 0.05).
There is a different quantitative relationship between QRS score and MI size in early reperfused MI compared to nonreperfused MI, partly explained by differences in MI size. Thus, the Selvester QRS scoring system may not be linearly related to MI size.
先前的研究表明，在未接受再灌注治疗的心肌梗死（MI）患者中，塞尔维斯特QRS评分与死后组织病理学确定的心肌梗死面积之间存在良好的一致性。然而，目前大多数急性冠状动脉血栓形成患者接受再灌注治疗。因此，本研究的目的是检验早期再灌注会改变塞尔维斯特QRS评分与心肌梗死面积之间定量关系这一假设。
对27例首次发生急性再灌注心肌梗死的患者进行研究。入院1周后，通过延迟对比增强磁共振成像（DE-MRI）确定梗死面积，并用50标准/31分的塞尔维斯特QRS评分系统进行评估。将本研究的结果与先前探索未再灌注患者中塞尔维斯特QRS评分与心肌梗死面积定量关系的死后研究结果进行比较。
在本早期再灌注心肌梗死研究中，DE-MRI测得的QRS评分与心肌梗死面积之间的定量关系与先前未再灌注心肌梗死的死后组织病理学研究结果显著不同（P<0.0001）。在本研究中，每个QRS点约占左心室的2%，而在先前未再灌注心肌梗死的死后组织病理学研究中约为3%。仅考虑小到中度心肌梗死面积时，QRS评分与梗死面积之间的定量关系无显著差异（P>0.05）。
与未再灌注心肌梗死相比，早期再灌注心肌梗死中QRS评分与心肌梗死面积之间存在不同的定量关系，部分原因是心肌梗死面积的差异。因此，塞尔维斯特QRS评分系统可能与心肌梗死面积不存在线性关系。
