Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
J Card Fail. 2018 Jan;24(1):3-8. doi: 10.1016/j.cardfail.2017.11.001. Epub 2017 Nov 20.
Acute myocarditis carries a variable prognosis. We evaluated the morbidity and mortality rates in patients with acute myocarditis and admission electrocardiographic predictors of outcome.
Patients admitted to a tertiary hospital with a clinical diagnosis of acute myocarditis were evaluated; 193 patients were included. Median follow-up was 5.7 years, 82% were male, and overal median age was 30 years (range 21-39). The most common clinical presentations were chest pain (77%) and fever (53%). The 30-day survival rate was 98.9%. Overall survival during follow-up was 94.3%. The most common abnormalities observed on electrocardiography were T-wave changes (36%) and ST-segment changes (32%). Less frequent changes included abnormal T-wave axis (>105° or < -15°; 16%), abnormal QRS axis (12%), QTc >460 ms (11%), and QRS interval ≥120 ms (5%). Wide QRS-T angle (≥100°) was demonstrated in 13% of the patients and was associated with an increased mortality rate compared with patients with a narrow QRS-T angle (20% vs 4%; P = .007). The rate of heart failure among patients with a wide QRS-T angle was significantly higher (36% vs 10%; P = .001). Cox regression analysis demonstrated that a wide QRS-T angle (≥100°) was a significant independent predictor of heart failure (hazard ratio [HR] 3.20, 95% confidence interval [CI] 1.35-7.59; P < .01) and of the combined end point of death or heart failure (HR 2.56, 95% CI 1.14-5.75; P < .05).
QRS-T angle is a predictor of increased morbidity and mortality in acute myocarditis.
急性心肌炎的预后存在差异。我们评估了急性心肌炎患者的发病率和死亡率，以及入院时心电图预测结果的指标。
评估了因临床诊断为急性心肌炎而入住一家三级医院的患者；共纳入 193 例患者。中位随访时间为 5.7 年，82%为男性，总体中位年龄为 30 岁（范围 21-39 岁）。最常见的临床表现为胸痛（77%）和发热（53%）。30 天生存率为 98.9%。随访期间的总生存率为 94.3%。心电图最常见的异常表现为 T 波改变（36%）和 ST 段改变（32%）。较少见的改变包括异常 T 波电轴（>105°或 <-15°；16%）、异常 QRS 电轴（12%）、QTc >460ms（11%）和 QRS 间隔≥120ms（5%）。13%的患者存在宽 QRS-T 角，与窄 QRS-T 角患者相比，死亡率更高（20%比 4%；P =.007）。宽 QRS-T 角患者心力衰竭发生率明显更高（36%比 10%；P =.001）。Cox 回归分析显示，宽 QRS-T 角（≥100°）是心力衰竭（危险比[HR]3.20，95%置信区间[CI]1.35-7.59；P<.01）和死亡或心力衰竭复合终点（HR 2.56，95%CI 1.14-5.75；P<.05）的独立显著预测因素。
QRS-T 角是急性心肌炎患者发病率和死亡率增加的预测指标。
