Wieczorkiewicz Paulina, Przybylak Katarzyna, Supel Karolina, Kidawa Michal, Zielinska Marzenna
Department of Interventional Cardiology, Medical University of Lodz, 92-213 Lodz, Poland.
J Clin Med. 2022 Feb 10;11(4):916. doi: 10.3390/jcm11040916.
Myocarditis may mimic myocardial infarction (MI) due to a similar clinical presentation, including chest pain, electrocardiography changes, and laboratory findings. The purpose of the study was to investigate the diagnostic value of clinical, laboratory, and electrocardiography characteristics of patients with acute coronary syndrome - like myocarditis and MI. We analysed 90 patients (≤45 years old) with an initial diagnosis of ST-segment elevation myocardial infarction; 40 patients (44.4%), through the use of cardiac magnetic resonance, were confirmed to have myocarditis, and 50 patients (55.6%) were diagnosed with MI. Patients with myocarditis were younger and had fewer cardiovascular risk factors than those with MI. The cutoff value distinguishing between myocarditis and MI was defined as the age of 36 years. The history of recent infections (82.5% vs. 6%) and C-reactive protein (CRP) levels on admission (Me 45.9 vs. 3.4) was more associated with myocarditis. Further, the QTc interval was inversely correlated with the echocardiographic ejection fraction in both groups but was significantly longer in patients with MI. Non-invasive diagnostics based on clinical features and laboratory findings are basic but still essential tools for differentiation between MI and myocarditis. The three-factor model including the criteria of age, abnormal CRP, and history of recent infections might become a valuable clinical indication.
心肌炎可能因临床表现相似而酷似心肌梗死（MI），包括胸痛、心电图改变和实验室检查结果。本研究的目的是探讨急性冠状动脉综合征样心肌炎和心肌梗死患者的临床、实验室和心电图特征的诊断价值。我们分析了90例初始诊断为ST段抬高型心肌梗死的患者（年龄≤45岁）；通过心脏磁共振成像，40例患者（44.4%）被确诊为心肌炎，50例患者（55.6%）被诊断为心肌梗死。心肌炎患者比心肌梗死患者更年轻，心血管危险因素更少。区分心肌炎和心肌梗死的临界值定义为36岁。近期感染史（82.5%对6%）和入院时C反应蛋白（CRP）水平（中位数45.9对3.4）与心肌炎的相关性更强。此外，两组患者的QTc间期均与超声心动图射血分数呈负相关，但心肌梗死患者的QTc间期明显更长。基于临床特征和实验室检查结果的非侵入性诊断是区分心肌梗死和心肌炎的基本但仍必不可少的工具。包括年龄标准、CRP异常和近期感染史的三因素模型可能成为有价值的临床指标。
