Fabiszak Tomasz, Kasprzak Michał, Koziński Marek, Kubica Jacek
Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Department of Cardiology and Internal Medicine, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland.
J Clin Med. 2021 Nov 22;10(22):5445. doi: 10.3390/jcm10225445.
To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI).
We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI.
Patients presenting with LVSD ( = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R = 0.448; < 0.00001).
According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
评估十个心电图（ECG）参数对首次ST段抬高型心肌梗死（STEMI）后左心室收缩功能障碍（LVSD）的预测性能。
我们分析了纳入单中心队列研究的249例接受直接经皮冠状动脉介入治疗（PCI）的患者（男性占74.7%）。我们探寻STEMI后6个月时基线和PCI后ECG参数与LVSD（定义为超声心动图显示左心室射血分数[LVEF]≤40%）存在之间的关联。
与无LVSD的患者相比，出现LVSD的患者（n = 52）在基线时以及PCI后即刻的心率、ST段抬高导联数和病理性Q波数量，以及ST段总抬高和最大抬高值均显著更高。他们还显示前壁STEMI的患病率显著更高，且PCI后QRS波群明显更宽，而基线时QRS时限测量无显著差异。此外，6个月后出现LVSD的患者入院时缺血明显更严重，这通过Sclarovsky-Birnbaum缺血评分评估，基线时镜像ST段压低更小，PCI后ST段回落程度更低。在对人口统计学、临床、生化和血管造影变量进行校正的多变量回归分析中，STEMI的前壁位置（比值比[OR] 17.78；95%置信区间[CI] 6.45 - 48.96；P < 0.001）、PCI后QRS时限（OR 1.56；95% CI 1.22 - 2.00；P < 0.001，每增加10毫秒表示）以及梗死相关动脉（IRA）PCI后血流受损（TIMI 3级与<3级相比；OR 0.14；95% CI 0.04 - 0.46；P = 0.001）被确定为LVSD的独立预测因素（逻辑回归模型的Nagelkerke伪R² = 0.462）。同样，在多元回归分析中，STEMI的前壁位置、PCI后更宽的QRS波、更高的基线病理性Q波数量和更高的基线Sclarovsky-Birnbaum缺血评分，以及IRA的PCI后血流受损、入院时更高的体重指数和血糖浓度与6个月时更低的LVEF值独立相关（校正R² = 0.448；P < 0.00001）。
根据我们的研究，基线和PCI后ECG参数对首次STEMI后6个月LVSD发生的预测价值有限。
