心肌弥漫性纤维化和瘢痕的心电图影响：动脉粥样硬化多民族研究（MESA）
Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis).
作者信息
Inoue Yuko Y, Ambale-Venkatesh Bharath, Mewton Nathan, Volpe Gustavo J, Ohyama Yoshiaki, Sharma Ravi K, Wu Colin O, Liu Chia-Ying, Bluemke David A, Soliman Elsayed Z, Lima João A C, Ashikaga Hiroshi
机构信息
From the Department of Medicine, Division of Cardiology (Y.Y.I., B.A., N.M., G.J.V., Y.O., R.K.S., J.A.C.L., H.A.), Department of Radiology (B.A., C.Y.L., D.A.B., J.A.C.L.), and Department of Biomedical Engineering (H.A.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Carnegie 568, Baltimore, MD 21287; Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, Md (C.O.W.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (C.Y.L., D.A.B.); and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences (E.Z.S.), and Department of Medicine, Cardiology Section (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC.
出版信息
Radiology. 2017 Mar;282(3):690-698. doi: 10.1148/radiol.2016160816. Epub 2016 Oct 13.
Purpose To examine the associations of myocardial diffuse fibrosis and scar with surface electrocardiographic (ECG) parameters in individuals free of prior coronary heart disease in four different ethnicities. Materials and Methods This prospective cross-sectional study was approved by the institutional review boards, and all participants gave informed consent. A total of 1669 participants in the Multi-Ethnic Study of Atherosclerosis, or MESA, who were free of prior myocardial infarction underwent both ECG and cardiac magnetic resonance imaging. In individuals without a late gadolinium enhancement-defined myocardial scar (n = 1131), T1 mapping was used to assess left ventricular (LV) interstitial diffuse fibrosis. The associations of LV diffuse fibrosis or myocardial scar with ECG parameters (QRS voltage, QRS duration, and corrected QT interval [QTc]) were evaluated by using multivariable regression analyses adjusted for demographic data, risk factors for scar, LV end-diastolic volume, and LV mass. Results The mean age of the 1669 participants was 67.4 years ± 8.7 (standard deviation); 49.8% were women. Lower postcontrast T1 time at 12 minutes was significantly associated with lower QRS Sokolow-Lyon voltage (β = 15.1 µV/10 msec, P = .004), lower QRS Cornell voltage (β = 9.2 µV/10 msec, P = .031), and shorter QRS duration (β = 0.16 msec/10 msec, P = .049). Greater extracellular volume (ECV) fraction was also significantly associated with lower QRS Sokolow-Lyon voltage (β = -35.2 µV/1% ECV increase, P < .001) and Cornell voltage (β = -23.7 µV/1% ECV increase, P < .001), independent of LV structural indexes. In contrast, the presence of LV scar (n = 106) was associated with longer QTc (β = 4.3 msec, P = .031). Conclusion In older adults without prior coronary heart disease, underlying greater LV diffuse fibrosis is associated with lower QRS voltage and shorter QRS duration at surface ECG, whereas clinically unrecognized myocardial scar is associated with a longer QT interval. RSNA, 2016 Online supplemental material is available for this article.
目的 研究在四个不同种族中无既往冠心病的个体中心肌弥漫性纤维化和瘢痕与体表心电图（ECG）参数之间的关联。材料与方法 本前瞻性横断面研究获机构审查委员会批准，所有参与者均签署知情同意书。动脉粥样硬化多民族研究（MESA）中共有1669名无既往心肌梗死的参与者接受了ECG和心脏磁共振成像检查。在无延迟钆增强定义的心肌瘢痕的个体（n = 1131）中，采用T1映射评估左心室（LV）间质弥漫性纤维化。通过对人口统计学数据、瘢痕危险因素、LV舒张末期容积和LV质量进行校正的多变量回归分析，评估LV弥漫性纤维化或心肌瘢痕与ECG参数（QRS电压、QRS时限和校正QT间期[QTc]）之间的关联。结果 1669名参与者的平均年龄为67.4岁±8.7（标准差）；49.8%为女性。12分钟时造影后T1时间较低与较低的QRS Sokolow-Lyon电压（β = 15.1 µV/10毫秒，P = 0.004）、较低的QRS Cornell电压（β = 9.2 µV/10毫秒，P = 0.031）和较短的QRS时限（β = 0.16毫秒/10毫秒，P = 0.049）显著相关。较高的细胞外容积（ECV）分数也与较低的QRS Sokolow-Lyon电压（β = -35.2 µV/ECV增加1%，P < 0.001）和Cornell电压（β = -23.7 µV/ECV增加1%，P < 0.001）显著相关，与LV结构指标无关。相比之下，LV瘢痕（n = 106）的存在与较长的QTc相关（β = 4.3毫秒，P = 0.031）。结论 在无既往冠心病的老年人中，潜在的LV弥漫性纤维化程度较高与体表ECG上较低的QRS电压和较短的QRS时限相关，而临床上未识别的心肌瘢痕与较长的QT间期相关。RSNA，2016 本文提供在线补充材料。
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