Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Circ Arrhythm Electrophysiol. 2019 Mar;12(3):e006969. doi: 10.1161/CIRCEP.118.006969.
An early repolarization electrocardiographic (ER-ECG) pattern is caused by various pathophysiological conditions and is reported to be a predictor of life-threatening ventricular tachyarrhythmias. However, little evidence has been reported on the prevalence and significance of the ER-ECG pattern in acute myocarditis. This study aimed to investigate the prevalence and significance of the ER-ECG pattern and its mechanistic insight based on the cardiac magnetic resonance findings in patients with acute myocarditis.
Thirty patients (23 men; 39.2±19.1 years) with a diagnosis of acute myocarditis by a clinical presentation between March 2011 and April 2018 were retrospectively evaluated. The patients were divided into 2 groups depending on the presence of an ER-ECG pattern on admission.
Nine cases had an ER-ECG pattern, which was defined as terminal QRS notching or slurring with an amplitude of >0.1 mV in at least 2 inferior or lateral leads (early repolarization [ER] group), whereas the remaining 21 cases had broad ST-segment elevation or pathological Q waves (non-ER group). The cardiac troponin T level was significantly higher in the non-ER group than ER group (3.2±4.3 versus 0.9±1.2 ng/mL; P=0.036). The ECG changes returned to baseline along with the normalization of the cardiac biomarkers. Nine of the 21 non-ER group patients, but none of the 9 ER group patients, developed a fulminant course and lethal ventricular tachyarrhythmias. T2-weighted cardiac magnetic resonance showed high-intensity signals over the entire transmural left ventricle in the non-ER group, whereas they were localized to the left ventricular epicardium in the ER group.
The ER-ECG pattern in acute myocarditis was transient and reversible and was not associated with a worse prognosis. Inflammation/swelling localized to the left ventricular epicardium because of acute myocarditis might provide a mechanistic insight into the ER-ECG pattern.
早期复极心电图（ER-ECG）模式是由各种病理生理条件引起的，被报道为致命性室性心动过速/颤动的预测因子。然而，关于急性心肌炎中 ER-ECG 模式的发生率和意义，很少有证据报道。本研究旨在探讨急性心肌炎患者中 ER-ECG 模式的发生率和意义，以及基于心脏磁共振检查的机制见解。
回顾性分析 2011 年 3 月至 2018 年 4 月期间诊断为急性心肌炎的 30 例患者（23 名男性；39.2±19.1 岁）。根据入院时是否存在 ER-ECG 模式，将患者分为 2 组。
9 例患者出现 ER-ECG 模式，定义为至少 2 个下壁或侧壁导联的终末 QRS 切迹或顿挫，幅度＞0.1 mV（早期复极[ER]组），而其余 21 例患者则表现为广泛的 ST 段抬高或病理性 Q 波（非 ER 组）。非 ER 组的心脏肌钙蛋白 T 水平显著高于 ER 组（3.2±4.3 与 0.9±1.2 ng/mL；P=0.036）。心电图改变随心脏生物标志物的正常化而恢复基线水平。21 例非 ER 组患者中有 9 例发展为暴发性病程和致命性室性心动过速/颤动，而 9 例 ER 组患者中无一例发生。非 ER 组 T2 加权心脏磁共振显示整个左心室心外膜的高强度信号，而 ER 组则局限于心外膜。
急性心肌炎中的 ER-ECG 模式是短暂和可逆的，与预后不良无关。急性心肌炎导致的局限于心外膜的炎症/肿胀可能为 ER-ECG 模式提供了一种机制见解。
