疑似心肌梗死患者的 QRS 时限和 QTc 间期的诊断和预后价值。

Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction.

机构信息

University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.

出版信息

Cardiol J. 2018;25(5):601-610. doi: 10.5603/CJ.a2018.0033. Epub 2018 Apr 3.

DOI:10.5603/CJ.a2018.0033

PMID:29611166

Abstract

BACKGROUND

While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans.

METHODS

Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up.

RESULTS

Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality.

CONCLUSIONS

Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.

摘要

背景

已有研究报告称急性心肌梗死（AMI）动物模型中存在 QRS 时限和 QT 间期延长，但是人类中这些易于获得的心电图（ECG）标志物的相关数据有限。

方法

前瞻性诊断多中心研究中，对疑似 AMI 患者的 QRS 时限和 QT 间期的诊断和预后价值进行了前瞻性评估。就诊时记录数字化 12 导联心电图。以盲法自动计算 QRS 时限和 QT 间期。最终诊断由两位独立的心脏病专家裁定。预后终点为 24 个月随访期间的全因死亡率。

结果

在 4042 例患者中，19%的患者最终诊断为 AMI。与其他最终诊断相比，AMI 患者的中位 QRS 时限和中位 QT 间期显著更长（98ms[IQR 88-108] vs. 94ms[IQR 86-102]和 436ms[IQR 414-462] vs. 425ms[IQR 407-445]，p<0.001 均为双侧比较）。然而，这两个 ECG 特征的诊断价值均仅为中等（AUC 分别为 0.56 和 0.60）。2 年后的累积死亡率在 QRS>120ms 的患者中为 15.9%，在 QRS 持续时间≤120ms 的患者中为 5.6%（p<0.001）；在 QTc>440ms 的患者中为 11.4%，在 QRS 持续时间≤440ms 的患者中为 4.3%（p<0.001）。校正年龄和重要的 ECG 和临床参数后，QTc 间期但不是 QRS 持续时间仍然是死亡率的独立预测因素。