Chen Jiaozhen, Chen Shouquan, Li Zhangping, Zhou Peisen, Huang Weijia, Wang Hete, Shi Jincun, Ni Yunchao, Lin Lili, Lei Yuanli
Department of Electrocardiogram, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, P.R. China.
Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China.
Exp Ther Med. 2020 Nov;20(5):20. doi: 10.3892/etm.2020.9148. Epub 2020 Aug 27.
Acute myocarditis is a severe disease with a high mortality rate and various dynamic changes visible on electrocardiograms (ECGs). The purpose of the present study was to investigate ECG findings of patients with acute myocarditis, ECG findings associated with fulminant myocarditis (FM) and the characteristics of ST elevation on admission. A retrospective analysis of 1,814 ECGs of 274 consecutive patients with acute myocarditis aged ≥13 years, who were hospitalized in two centres between August 2007 and November 2019, was performed. A total of 251 patients with myocarditis (91.6%) presented with ECG abnormalities. The most common ECG findings were T-wave inversion and ST elevation. Univariate logistic regression analysis demonstrated that 12 ECG findings were associated with FM. Multivariate regression analysis revealed that the independent predictive factors for FM included ventricular tachycardia, high-degree atrioventricular block, sinus tachycardia, low voltage and QRS duration of ≥120 msec (all P<0.05). A total of 112 cases displayed ST elevation at admission. Of these, ST elevation without T-wave inversion (n=87) was associated with a shorter duration of cardiac symptoms (1.5 vs. 3.1 days; P<0.001) compared with ST elevation with T-wave inversion (n=25). Of the aforementioned 87 patients, 71 (81.6%) presented with T-wave inversion at the hospital. The median time from the onset of cardiac symptoms to T-wave inversion was 4.0 days. In conclusion, patients with acute myocarditis exhibited various dynamic changes on ECG. Thus, ECGs should be widely used for the assessment of severity and the characteristics of ST elevation on admission.
急性心肌炎是一种死亡率高的严重疾病，心电图（ECG）可见多种动态变化。本研究的目的是调查急性心肌炎患者的心电图表现、暴发性心肌炎（FM）相关的心电图表现以及入院时ST段抬高的特征。对2007年8月至2019年11月期间在两个中心住院的274例年龄≥13岁的连续急性心肌炎患者的1814份心电图进行了回顾性分析。共有251例心肌炎患者（91.6%）出现心电图异常。最常见的心电图表现是T波倒置和ST段抬高。单因素逻辑回归分析表明，12种心电图表现与FM相关。多因素回归分析显示，FM的独立预测因素包括室性心动过速、高度房室传导阻滞、窦性心动过速、低电压和QRS时限≥120毫秒（均P<0.05）。共有112例患者入院时出现ST段抬高。其中，与伴有T波倒置的ST段抬高（n=25）相比，不伴有T波倒置的ST段抬高（n=87）与心脏症状持续时间较短相关（1.5天对3.1天；P<0.001）。在上述87例患者中，71例（81.6%）在医院出现T波倒置。从心脏症状发作到T波倒置的中位时间为4.0天。总之，急性心肌炎患者心电图表现出多种动态变化。因此，心电图应广泛用于评估病情严重程度和入院时ST段抬高的特征。
