缺血性卒中和颅内出血中心肌复极离散情况

The dispersion of myocardial repolarization in ischemic stroke and intracranial hemorrhage.

作者信息

Danese Alessandra, Cappellari Manuel, Pancheri Elia, Mugnai Giacomo, Micheletti Nicola, Tomelleri Giampaolo, Carletti Monica, Turri Giulia, Marafioti Vincenzo, Monaco Salvatore, Bonetti Bruno, Bovi Paolo

机构信息

Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy.

Department of Neurosciences, Stroke Unit, Verona Hospital, Piazzale A. Stefani 1 -, 37126 Verona, Italy.

出版信息

J Electrocardiol. 2018 Jul-Aug;51(4):691-695. doi: 10.1016/j.jelectrocard.2018.05.007. Epub 2018 May 17.

DOI:10.1016/j.jelectrocard.2018.05.007

PMID:29997015

Abstract

BACKGROUND

Markers of dispersion of myocardial repolarization have been proposed to identify the patients at higher risk of malignant arrhythmic events. The aim of the present study is to assess a possible association of the electrocardiografic (ECG) markers of the dispersion of repolarization with the type of stroke, involvement of insula, neurological severity (National Institutes of Health Stroke Scale, NIHSS score), and disability (modified Rankin Scale, mRS score) in patients with a cerebrovascular event.

METHODS

We conducted a retrospective analysis based on data prospectively collected from consecutive patients with a cerebrovascular event who underwent 12‑lead ECG at admission to the Verona Stroke Unit.

RESULTS

Of the 63 patients included in the study, 55 had ischemic stroke and 8 intracranial hemorrhage. TpTe (time between the peak and the end of the T wave) and TpTe/QTc (TpTe/corrected time between the start of the Q wave and the end of the T wave) in lead V5 were higher in intracranial hemorrhage than in ischemic stroke (p = 0.03 and p = 0.04, respectively) and QT max (the longest QT calculated in the 12 leads) was higher in patients with involvement of insula (p ≤ 0.01). A correlation was found between QTc max and NIHSS score at admission (p = 0.02), QT max and NIHSS score at discharge (p = 0.05), and QT max and mRS score at discharge (p = 0.02).

CONCLUSIONS

TpTe and TpTe/QTc in V5 lead were associated with intracranial hemorrhage and QT max was associated with involvement of insula. The prolongation of QT was correlated with neurological severity and disability.

摘要

背景

心肌复极离散度标志物已被提出用于识别发生恶性心律失常事件风险较高的患者。本研究旨在评估复极离散度的心电图（ECG）标志物与脑血管事件患者的卒中类型、岛叶受累情况、神经功能严重程度（美国国立卫生研究院卒中量表，NIHSS评分）以及残疾程度（改良Rankin量表，mRS评分）之间的可能关联。

方法

我们基于前瞻性收集的连续脑血管事件患者的数据进行了一项回顾性分析，这些患者在维罗纳卒中单元入院时接受了12导联心电图检查。

结果

在纳入研究的63例患者中，55例为缺血性卒中，8例为颅内出血。V5导联的TpTe（T波峰值与终点之间的时间）和TpTe/QTc（TpTe/校正后的Q波起点至T波终点时间）在颅内出血患者中高于缺血性卒中患者（分别为p = 0.03和p = 0.04），岛叶受累患者的QT max（12导联中计算出的最长QT）更高（p≤0.01）。入院时QTc max与NIHSS评分之间存在相关性（p = 0.02），出院时QT max与NIHSS评分之间存在相关性（p = 0.05），出院时QT max与mRS评分之间存在相关性（p = 0.02）。