Department of Cardiology, Nagoya University Graduate School of Medicine.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.
Circ J. 2018 Jul 25;82(8):2089-2095. doi: 10.1253/circj.CJ-18-0136. Epub 2018 Jun 1.
Fulminant myocarditis (FM) presents various abnormal findings on ECG, the prognostic impact of which has not been not fully elucidated. The aim of this study was therefore to clarify the prognostic value of ECG data in FM patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO).
In this multicenter chart review, we investigated 99 patients with FM supported by VA-ECMO. The final cohort consisted of 87 patients (mean age, 52±16 years; female, 42%) after 12 patients who required conversion to other forms of mechanical circulatory support were excluded. The median LVEF was 14.5%. At the time of VA-ECMO initiation, 38 patients (44%) had arrhythmias including atrial fibrillation (6%), complete atrioventricular block (CAVB; 17%), and ventricular tachycardia or fibrillation (VT/VF; 15%). Of the 49 patients with sinus rhythm (SR), 26 had QRS duration ≥120 ms (wide QRS). On logistic regression analysis, wide QRS predicted in-hospital death in patients with SR (OR, 3.6; 95% CI: 1.07-13.61, P=0.04). Compared with SR with narrow QRS (QRS duration <120 ms), CAVB and VT/VF had a higher risk of in-hospital death (CAVB: OR, 7.20; 95% CI: 1.78-34.15, P=0.005; VT/VF: OR, 8.10; 95% CI: 1.86-42.31, P=0.005).
In patients with FM, CAVB and VT/VF carried a higher risk of in-hospital death. Wide QRS also predicted a higher risk of in-hospital death in patients with SR.
暴发性心肌炎（FM）在心电图上呈现出各种异常表现，但其对预后的影响尚未完全阐明。因此，本研究旨在阐明在接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的 FM 患者中，心电图数据的预后价值。
在这项多中心病历回顾研究中，我们调查了 99 例接受 VA-ECMO 支持的 FM 患者。在排除了 12 例需要转换为其他形式机械循环支持的患者后，最终队列由 87 例患者（平均年龄 52±16 岁；女性 42%）组成。中位 LVEF 为 14.5%。在开始 VA-ECMO 时，38 例（44%）患者出现心律失常，包括心房颤动（6%）、完全性房室传导阻滞（CAVB；17%）和室性心动过速或颤动（VT/VF；15%）。在 49 例窦性心律（SR）患者中，26 例 QRS 时限≥120ms（宽 QRS）。在逻辑回归分析中，宽 QRS 预测 SR 患者院内死亡（OR，3.6；95%CI：1.07-13.61，P=0.04）。与窄 QRS（QRS 时限<120ms）的 SR 相比，CAVB 和 VT/VF 院内死亡风险更高（CAVB：OR，7.20；95%CI：1.78-34.15，P=0.005；VT/VF：OR，8.10；95%CI：1.86-42.31，P=0.005）。
在 FM 患者中，CAVB 和 VT/VF 与院内死亡风险增加相关。宽 QRS 也预示着 SR 患者院内死亡风险增加。
