Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Via Consolare Valeria No. 1, 98100 Messina, Italy.
Clin Res Cardiol. 2012 Aug;101(8):617-24. doi: 10.1007/s00392-012-0433-5. Epub 2012 Mar 3.
Delayed-contrast-enhancement (DCE) magnetic resonance imaging (MRI) can identify areas of myocardial damage in patients with acute myocarditis (AM). The aim of this study was to assess the electrocardiographic findings in AM diagnosed by DCE-MRI. Eighty-one patients (72 men, 35 ± 13 years) with AM were prospectively enrolled. All of them underwent MRI and 12-lead-ECG recordings. In the admission electrocardiogram (ECG 1), as well as in that obtained 48 h later (ECG 2), the following parameters were analyzed: rhythm, PR, QRS, and QTc-intervals, intraventricular conduction, abnormal Q waves, ST segment elevation, and T wave inversion. On admission, 77 patients (95%) were in sinus rhythm, while four patients (6%) manifested severe arrhythmias. No difference between ECG 1 and ECG 2 was observed regarding abnormal Q waves, PR, QRS, and QTc-intervals. Electrocardiogram 1 was normal in 26 patients (32%, normal ECG group), and abnormal in 55 patients (68%, abnormal ECG group). ST elevation was found in 46 patients (57%), inverted T wave in seven patients (9%) and left bundle branch block (LBBB) in two patients (3%). Areas of DCE suggesting AM were found in each patient. No relationship concerning the location of the involved region (s) was found between ECG (leads with ST/T abnormalities) and MRI (areas showing DCE). The ECG in AM can either be normal or reflect abnormalities including arrhythmias, LBBB, ST segment elevation, and T wave inversion. The location of myocardial involvement deduced on the basis of ECG leads showing ST/T changes is not in close relationship with the areas of ventricular damage detected by MRI.
延迟对比增强（DCE）磁共振成像（MRI）可识别急性心肌炎（AM）患者的心肌损伤区域。本研究旨在评估 DCE-MRI 诊断 AM 的心电图表现。前瞻性纳入 81 例 AM 患者（72 例男性，35±13 岁），所有患者均行 MRI 和 12 导联心电图检查。在入院心电图（ECG1）和 48 小时后获得的心电图（ECG2）中，分析了以下参数：节律、PR、QRS 和 QTc 间期、室内传导、异常 Q 波、ST 段抬高和 T 波倒置。入院时，77 例（95%）患者为窦性心律，4 例（6%）患者出现严重心律失常。异常 Q 波、PR、QRS 和 QTc 间期方面，ECG1 和 ECG2 无差异。26 例（32%，正常 ECG 组）心电图正常，55 例（68%，异常 ECG 组）心电图异常。46 例（57%）患者出现 ST 段抬高，7 例（9%）患者出现 T 波倒置，2 例（3%）患者出现左束支传导阻滞（LBBB）。每位患者均发现 DCE 提示 AM 的区域。未发现心电图（出现 ST/T 异常的导联）和 MRI（出现 DCE 的区域）之间与受累区域（s）位置相关的关系。AM 的心电图可以正常或反映包括心律失常、LBBB、ST 段抬高和 T 波倒置等异常。根据出现 ST/T 改变的心电图导联推断的心肌受累部位与 MRI 检测到的心室损伤区域之间无密切关系。
