Sakhnova T A, Blinova E V, Merkulova I N, Shakhnovich R M, Zhukova N S, Sukhinina T S, Barysheva N A, Staroverov I I
National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow.
Kardiologiia. 2020 Dec 15;60(11):1295. doi: 10.18087/cardio.2020.11.n1295.
Aim To identify clinical, echocardiographic, and angiographic factors related with an increase in the frontal QRS-T angle (fQRS-T) and the spatial QRS-T angle (sQRS-T) in patients with inferior myocardial infarction.Material and methods The study included 128 patients aged (median [25th percentile; 75th percentile]) 59.5 [51.5; 67.0] years diagnosed with inferior wall acute myocardial infarction. fQRS-T was calculated as a module of difference between the QRS axis and the Т axis in the frontal plane. sQRS-T was calculated by a synthesized vectorcardiogram as a spatial angle between the QRS and Т integral vectors.Results The fQRS-T for the group was 54.0 [18; 80] and sQRS-T was 80.1 [53; 110]. The correlation coefficient for fQRS-T and sQRS-T values was 0.42 (p<0.001). Both fQRS-T >80° and sQRS-T >110° compared to their lower values were associated with a higher frequency of history of postinfarction cardiosclerosis (44% and 12 %, respectively; p<0.05), a lower left ventricular ejection fraction (51 [47; 60]% at fQRS-T >80° and 55 [50; 60]% at fQRS-T <80° (p<0,05); 49 [44; 57]% at sQRS-T >110° and 57 [51; 60] % at sQRS-T <110° (p<0.01); more frequent development of acute heart failure (16 and 2 %, respectively; p<0.05); and early postinfarction angina (13 and 2 %, respectively; p<0.05). The increased fQRS-T was associated with a higher incidence of damage to the circumflex artery (45 and 20 %, respectively; p<0.05). The increased sQRS-T was associated with a history of arterial hypertension (97 and 76 %, respectively; p<0.05), chronic heart failure (22 and 3 %, respectively; p<0.05), chronic kidney disease (19 and 4 %, respectively; p<0.05), and a larger myocardial lesion (mean number of damaged segments by echocardiography was 3.8 [2; 6] at sQRS-T >110° and 2.6 [1; 4] at sQRS-T <110°; p<0.01). sQRS-T was significantly greater in multivascular damage (87 [68; 121]° than in one- or two-vascular damage (72 [51; 100]°; p<0.05). sQRS-T values were significantly lower with spontaneous reperfusion (66 [29; 79] than without spontaneous reperfusion (77 [55; 115]°; p<0.05).Conclusion In patients after inferior wall acute myocardial infarction, increases in fQRS-T and sQRS-T were associated with more severe damage of coronary vasculature, decreased left ventricular ejection fraction, and more severe course of disease.
确定下壁心肌梗死患者中与额面QRS-T角（fQRS-T）和空间QRS-T角（sQRS-T）增大相关的临床、超声心动图和血管造影因素。
该研究纳入了128例年龄（中位数[第25百分位数；第75百分位数]）为59.5[51.5；67.0]岁、诊断为下壁急性心肌梗死的患者。fQRS-T通过额面QRS轴与T轴之间差值的模值计算得出。sQRS-T通过合成向量心电图计算得出，为QRS与T积分向量之间的空间角度。
该组患者的fQRS-T为54.0[18；80]，sQRS-T为80.1[53；110]。fQRS-T和sQRS-T值的相关系数为0.42（p<0.001）。与较低值相比，fQRS-T>80°和sQRS-T>110°均与梗死后心肌硬化病史的发生率较高相关（分别为44%和12%；p<0.05），左心室射血分数较低（fQRS-T>80°时为51[47；60]%，fQRS-T<80°时为55[50；60]%（p<0.05）；sQRS-T>110°时为49[44；57]%，sQRS-T<110°时为57[51；60]%（p<0.01）），急性心力衰竭的发生更频繁（分别为16%和2%；p<0.05），以及梗死后早期心绞痛（分别为13%和2%；p<0.05）。fQRS-T增大与回旋支动脉损伤的发生率较高相关（分别为45%和20%；p<0.05）。sQRS-T增大与动脉高血压病史（分别为97%和76%；p<0.05）、慢性心力衰竭（分别为22%和3%；p<0.05）、慢性肾病（分别为19%和4%；p<0.05）以及更大的心肌损伤相关（超声心动图显示，sQRS-T>110°时受损节段的平均数量为3.8[2；6]，sQRS-T<110°时为2.6[1；4]；p<0.01）。多支血管损伤时的sQRS-T显著大于单支或双支血管损伤时（87[68；121]°比72[51；100]°；p<0.05）。自发再灌注时的sQRS-T值显著低于无自发再灌注时（66[29；79]°比77[55；115]°；p<0.05）。
在下壁急性心肌梗死患者中，fQRS-T和sQRS-T增大与冠状动脉血管更严重的损伤、左心室射血分数降低以及更严重的病程相关。
