Almer Jakob, Elmberg Viktor, Bränsvik Josef, Nordlund David, Khoshnood Ardavan, Ringborn Michael, Carlsson Marcus, Ekelund Ulf, Engblom Henrik
Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden.
Department of Clinical Physiology, Blekingesjukhuset, Karlskrona, Sweden.
Ann Noninvasive Electrocardiol. 2019 Jan;24(1):e12601. doi: 10.1111/anec.12601. Epub 2018 Sep 28.
Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI).
Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2-6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer-generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre-PCI, 12-lead ECG.
Median absolute IQP was 10 ms (range 0-115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = -0.01, p = 0.89; MSI, r = -0.05, p = 0.68).
Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first-time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context.
急性冠状动脉闭塞（ACO）患者不仅可能出现与缺血相关的ST段改变，还可能出现QRS波群变化。最近在犬类动物研究中发现，ACO期间更大的缺血性QRS波增宽（IQP）与较低的侧支血流有关。这表明更大的IQP可能提示更严重的缺血，从而梗死发展更快。因此，本研究旨在评估急性ST段抬高型心肌梗死（STEMI）患者中IQP与心肌损伤指标之间的关系。
回顾性纳入最近发表的SOCCER试验中的77例首次发生STEMI的患者。所有患者在急性事件发生后2 - 6天接受心脏磁共振（CMR）检查。评估梗死面积（IS）、危险心肌（MaR）和心肌挽救指数（MSI），并将其与IQP相关联。评估的IQP指标包括：计算机生成的QRS波时限、ST段最大偏移时的QRS波时限、绝对IQP和相对IQP，均来自PCI术前的12导联心电图。
绝对IQP的中位数为10毫秒（范围0 - 115毫秒）。IQP指标与任何CMR心肌损伤指标之间均无统计学显著相关性（绝对IQP与IS，r = 0.03，p = 0.80；MaR，r = -0.01，p = 0.89；MSI，r = -0.05，p = 0.68）。
与先前的实验研究不同，在首次发生STEMI并在急诊室就诊的患者中，IQP有限，且未发现这些患者的IQP与CMR心肌损伤变量之间存在相关性。因此，在这种临床情况下，IQP似乎不是用于对患者进行分诊的合适生物标志物。
