Yan Y C, Dai M Y, Wang L Y, Wang D W, Zhao C X
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Aug 24;52(8):914-921. doi: 10.3760/cma.j.cn112148-20230821-00101.
To investugate the unique electrocardiogram (ECG) characteristics of fulminant myocarditis (FM) patients and provide important clues for the diagnosis of FM. This was a retrospective study. Patients diagnosed with acute myocarditis at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 2017 to April 2022 were enrolled and divided into fulminant myocarditis group (FM) and non-fulminant myocarditis group (NFM) according to clinical diagnosis. A total of 246 healthy people who underwent physical examination in the Health examination Center of Tongji Hospital at the same period were selected as the control group. The clinical data and ECG characteristics of the above 3 groups were analyzed and compared. Logistic regression model was used to analyze the influence of ECG parameters on left ventricular ejection fraction in FM patients. Receiver operating curves were constructed to evaluate the predictive value of different ECG parameters for FM. A total of 180 patients were included in this study (FM group: =123; NFM group: =57), with an age of (35.0±16.2) years and 106 males (58.89%). Compared with NFM group, ECG was significantly abnormal in FM group, with a higher incidence of sinus tachycardia, ventricular tachycardia or ventricular fibrillation, escape rhythm, right bundle branch block, third degree atrioventricular block, ST-segment elevation, low voltage, prolonged QTc interval, and widened QRS wave in the FM group (all <0.05). The ECG parameters showed that the amplitude of the full lead QRS wave in FM group was lower than that in NFM group (<0.01). The average heart rate and QTc interval of FM group were significantly higher than those of NFM and control groups (all <0.05). Although ST-segment elevation had a higher incidence in the FM group, ECG parameters showed that except for leads Ⅲ and aVF, the ST segment levels in all leads in the FM group were lower than those in the control group (all <0.05). There was a statistically significant difference in some ST segment changes between FM and NFM groups, while there was no statistical difference between the NFM and control groups. Multivariate regression analysis showed that widened QRS wave and increased heart rate were the influencing factors for left ventricular systolic dysfunction in FM patients (=16.914, 95%: 1.367-209.224, =0.028; =1.026, 95%: 1.010-1.042, =0.001). Receiver operating curve analysis showed that heart rate>86.90 beat/min, QTc>431.50 ms, and RV5+SV1<1.72 mV had certain predictive value for FM diagnosis. FM patients displayed marked and severe ECG abnormalities, and characteristic changes in ECG can provide important first clues for the diagnosis of FM.
探讨暴发性心肌炎（FM）患者独特的心电图（ECG）特征，为FM的诊断提供重要线索。本研究为回顾性研究。选取2017年2月至2022年4月在华中科技大学同济医学院附属同济医院诊断为急性心肌炎的患者，根据临床诊断分为暴发性心肌炎组（FM）和非暴发性心肌炎组（NFM）。同期在同济医院健康体检中心进行体检的246例健康人作为对照组。对上述3组的临床资料和ECG特征进行分析比较。采用Logistic回归模型分析ECG参数对FM患者左心室射血分数的影响。绘制受试者工作曲线，评估不同ECG参数对FM的预测价值。本研究共纳入180例患者（FM组：n = 123；NFM组：n = 57），年龄为（35.0±16.2）岁，男性106例（58.89%）。与NFM组相比，FM组ECG明显异常，窦性心动过速、室性心动过速或室颤、逸搏心律、右束支传导阻滞、三度房室传导阻滞、ST段抬高、低电压、QTc间期延长、QRS波增宽的发生率更高（均P<0.05）。ECG参数显示，FM组全导联QRS波振幅低于NFM组（P<0.01）。FM组平均心率和QTc间期显著高于NFM组和对照组（均P<0.05）。虽然FM组ST段抬高发生率较高，但ECG参数显示，除Ⅲ导联和aVF导联外，FM组所有导联的ST段水平均低于对照组（均P<0.05）。FM组和NFM组在一些ST段变化上存在统计学差异，而NFM组和对照组之间无统计学差异。多因素回归分析显示，QRS波增宽和心率增加是FM患者左心室收缩功能障碍的影响因素（β = 16.914，95%CI：1.367 - 209.224，P = 0.028；β = 1.026，95%CI：1.010 - 1.042，P = 0.001）。受试者工作曲线分析显示，心率>86.90次/分、QTc>431.50 ms、RV5 + SV1<1.72 mV对FM诊断有一定的预测价值。FM患者表现出明显且严重的ECG异常，ECG的特征性变化可为FM的诊断提供重要的首要线索。
