Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
Ann Noninvasive Electrocardiol. 2024 Sep;29(5):e70001. doi: 10.1111/anec.70001.
Manually derived electrocardiographic (ECG) parameters were not associated with mortality in mechanically ventilated COVID-19 patients in earlier studies, while increased high-sensitivity cardiac troponin-T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were. To provide evidence for vectorcardiography (VCG) measures as potential cardiac monitoring tool, we investigated VCG trajectories during critical illness.
All mechanically ventilated COVID-19 patients were included in the Maastricht Intensive Care Covid Cohort between March 2020 and October 2021. Serum hs-cTnT and NT-proBNP concentrations were measured daily. Conversion of daily 12-lead ECGs to VCGs by a MATLAB-based script provided QRS area, T area, maximal QRS amplitude, and QRS duration. Linear mixed-effect models investigated trajectories in serum and VCG markers over time between non-survivors and survivors, adjusted for confounders.
In 322 patients, 5461 hs-cTnT, 5435 NT-proBNP concentrations and 3280 ECGs and VCGs were analyzed. Non-survivors had higher hs-cTnT concentrations at intubation and both hs-cTnT and NT-proBNP significantly increased compared with survivors. In non-survivors, the following VCG parameters decreased more when compared to survivors: QRS area (-0.27 (95% CI) (-0.37 to -0.16, p < .01) μVs per day), T area (-0.39 (-0.62 to -0.16, p < .01) μVs per day), and maximal QRS amplitude (-0.01 (-0.01 to -0.01, p < .01) mV per day). QRS duration did not differ.
VCG-derived QRS area and T area decreased in non-survivors compared with survivors, suggesting that an increase in myocardial damage and tissue loss play a role in the course of critical illness and may drive mortality. These VCG markers may be used to monitor critically ill patients.
在早期的研究中，手动得出的心电图（ECG）参数与机械通气的 COVID-19 患者的死亡率无关，而高敏心肌肌钙蛋白 T（hs-cTnT）和 N 末端 pro-B 型利钠肽（NT-proBNP）的升高则有关。为了提供向量心电图（VCG）测量作为潜在的心脏监测工具的证据，我们研究了危重病期间的 VCG 轨迹。
所有接受机械通气的 COVID-19 患者均纳入 2020 年 3 月至 2021 年 10 月期间的马斯特里赫特重症监护 COVID 队列。每天测量血清 hs-cTnT 和 NT-proBNP 浓度。通过基于 MATLAB 的脚本将每日 12 导联 ECG 转换为 VCG，提供 QRS 面积、T 面积、最大 QRS 幅度和 QRS 持续时间。线性混合效应模型调整混杂因素后，比较了非幸存者和幸存者之间血清和 VCG 标志物随时间的变化轨迹。
在 322 名患者中，分析了 5461 次 hs-cTnT、5435 次 NT-proBNP 浓度和 3280 次 ECG 和 VCG。非幸存者在插管时的 hs-cTnT 浓度更高，且与幸存者相比，hs-cTnT 和 NT-proBNP 均显著增加。与幸存者相比，非幸存者的以下 VCG 参数下降更多：QRS 面积（-0.27（95%CI）（-0.37 至-0.16，p<.01）μVs/天）、T 面积（-0.39（-0.62 至-0.16，p<.01）μVs/天）和最大 QRS 幅度（-0.01（-0.01 至-0.01，p<.01）mV/天）。QRS 持续时间没有差异。
与幸存者相比，非幸存者的 VCG 衍生 QRS 面积和 T 面积减小，这表明心肌损伤和组织损失的增加在危重病过程中起作用，并可能导致死亡率增加。这些 VCG 标志物可用于监测危重症患者。
