Chetran Adriana, Costache Alexandru Dan, Ciongradi Carmen Iulia, Duca Stefania Teodora, Mitu Ovidiu, Sorodoc Victorita, Cianga Corina Maria, Tuchilus Cristina, Mitu Ivona, Mitea Raluca Daria, Badescu Minerva Codruta, Afrasanie Irina, Huzum Bogdan, Moisa Stefana Maria, Prepeliuc Cristian Sorin, Roca Mihai, Costache Irina Iuliana
Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
Cardiology Clinic, Clinical Emergency Hospital "Sfantul Spiridon", 700111 Iasi, Romania.
Diagnostics (Basel). 2022 Dec 3;12(12):3037. doi: 10.3390/diagnostics12123037.
Background: Biomarkers, electrocardiogram (ECG) and Holter ECG are basic, accessible and feasible cardiac investigations. The combination of their results may lead to a more complex predictive model that may improve the clinical approach in acute heart failure (AHF). The main objective was to investigate which ECG parameters are correlated with the usual cardiac biomarkers (prohormone N-terminal proBNP, high-sensitive cardiac troponin I) in patients with acute heart failure, in a population from Romania. The relationship between certain ECG parameters and cardiac biomarkers may support future research on their combined prognostic value. Methods: In this prospective case-control study were included 49 patients with acute heart failure and 31 participants in the control group. For all patients we measured levels of prohormone N-terminal proBNP (NT-proBNP), high-sensitive cardiac troponin I (hs-cTnI) and MB isoenzyme of creatine phosphokinase (CK-MB) and evaluated the 12-lead ECG and 24 h Holter monitoring. Complete clinical and paraclinical evaluation was performed. Results: NT-proBNP level was significantly higher in patients with AHF (p < 0.001). In patients with AHF, NT-proBNP correlated with cQTi (p = 0.027), pathological Q wave (p = 0.029), complex premature ventricular contractions (PVCs) (p = 0.034) and ventricular tachycardia (p = 0.048). Hs-cTnI and CK-MB were correlated with ST-segment modification (p = 0.038; p = 0.018) and hs-cTnI alone with complex PVCs (p = 0.031). Conclusions: The statistical relationships found between cardiac biomarkers and ECG patterns support the added value of ECG in the diagnosis of AHF. We emphasize the importance of proper ECG analysis of more subtle parameters that can easily be missed. As a non-invasive technique, ECG can be used in the outpatient setting as a warning signal, announcing the acute decompensation of HF. In addition, the information provided by the ECG complements the biomarker results, supporting the diagnosis of AHF in cases of dyspnea of uncertain etiology. Further studies are needed to confirm long-term prognosis in a multi-marker approach.
生物标志物、心电图（ECG）和动态心电图是基础、可及且可行的心脏检查手段。它们结果的组合可能会形成一个更复杂的预测模型，从而改善急性心力衰竭（AHF）的临床治疗方法。主要目的是在罗马尼亚的人群中，研究急性心力衰竭患者中哪些心电图参数与常用心脏生物标志物（前体激素N末端脑钠肽原、高敏心肌肌钙蛋白I）相关。某些心电图参数与心脏生物标志物之间的关系可能支持未来对其联合预后价值的研究。
在这项前瞻性病例对照研究中，纳入了49例急性心力衰竭患者和31名对照组参与者。对所有患者测量了前体激素N末端脑钠肽原（NT-proBNP）、高敏心肌肌钙蛋白I（hs-cTnI）和肌酸磷酸激酶MB同工酶（CK-MB）的水平，并评估了12导联心电图和24小时动态心电图监测。进行了完整的临床和辅助检查评估。
AHF患者的NT-proBNP水平显著更高（p < 0.001）。在AHF患者中，NT-proBNP与校正QT间期（cQTi）（p = 0.027）、病理性Q波（p = 0.029）、复杂性室性早搏（PVCs）（p = 0.034）和室性心动过速（p = 0.048）相关。Hs-cTnI和CK-MB与ST段改变相关（p = 0.038；p = 0.018），单独hs-cTnI与复杂性PVCs相关（p = 0.031）。
心脏生物标志物与心电图模式之间发现的统计关系支持了心电图在AHF诊断中的附加价值。我们强调对更易被遗漏的细微参数进行正确心电图分析的重要性。作为一种非侵入性技术，心电图可在门诊环境中用作警示信号，提示心力衰竭急性失代偿。此外，心电图提供的信息补充了生物标志物的结果，在病因不明的呼吸困难病例中支持AHF的诊断。需要进一步研究以证实多标志物方法的长期预后。
