Luczak-Wozniak Katarzyna, Obsznajczyk Klaudia, Niszczota Cezary, Werner Bożena
Department of Pediatric Cardiology and General Pediatrics, Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland.
Department of Pediatric Cardiology and General Pediatrics, Jozef Polikarp Brudzinski Public Pediatric Hospital, 02-091 Warsaw, Poland.
J Clin Med. 2022 Nov 24;11(23):6930. doi: 10.3390/jcm11236930.
Cardiomyopathies have a low prevalence in children and thus may lead to malignant ventricular arrhythmias or the progression of heart failure, resulting in death. In adults, the QRS-T angle derived from ECG has been associated with adverse outcomes in patients with hypertrophic and dilated cardiomyopathies. We aimed to assess the electrocardiographic parameters, including QRS-T angle, associated with adverse cardiac events in children with cardiomyopathies. Forty-two children with cardiomyopathies were included in this study: 19 with dilated cardiomyopathy, 17 with hypertrophic cardiomyopathy, and 6 with left ventricular non-compaction. Additionally, 19 control subjects were recruited. In terms of ECG parameters, the QRS-T angle was significantly greater among patients with adverse outcomes compared to patients without the end points of the study (133° vs. 65°, p < 0.001). On Kaplan−Meier survival curves, QRS-T angle > 120°, increased serum concentrations of NT-proBNP and troponin I levels as well as greater NYHA or Ross scale were associated with the greatest risk of unfavorable outcome. The QRS-T angle appears to be a valuable component of 12-lead ECG interpretation, and might be helpful in outlining patients with the greatest cardiovascular risk. Additionally, serum biomarkers such as NT-proBNP (p = 0.003) and troponin (p < 0.001) are useful in outlining patients with the worst survival.
心肌病在儿童中的患病率较低，因此可能导致恶性室性心律失常或心力衰竭进展，进而导致死亡。在成人中，心电图得出的QRS-T角与肥厚型和扩张型心肌病患者的不良预后相关。我们旨在评估与心肌病患儿不良心脏事件相关的心电图参数，包括QRS-T角。本研究纳入了42例心肌病患儿：19例扩张型心肌病、17例肥厚型心肌病和6例左心室致密化不全。此外，招募了19名对照受试者。在心电图参数方面，与无研究终点的患者相比，有不良预后的患者QRS-T角显著更大（133°对65°，p<0.001）。在Kaplan-Meier生存曲线上，QRS-T角>120°、血清NT-proBNP浓度升高、肌钙蛋白I水平升高以及NYHA或Ross分级更高与不良结局风险最大相关。QRS-T角似乎是12导联心电图解读的一个有价值的组成部分，可能有助于勾勒出心血管风险最大的患者。此外，血清生物标志物如NT-proBNP（p=0.003）和肌钙蛋白（p<0.001）有助于勾勒出生存最差的患者。
