Abstract
BackgroundThe study was performed to assess the diagnostic capability of ECG on the cardiogenic shock (CS) in acute myocarditis. A new score was derived from the combination of the ECG parameters and the diagnostic value was also evaluated.MethodsTotal 103 consecutive patients with acute myocarditis admitted in Nanjing Drum Hospital were enrolled in the current study. The cohort was divided into fulminant myocarditis group (FM, n = 20) and non fulminant myocarditis group (NFM, n = 83). The demographic features, results of electrocardiography (ECG) and ultracardiography were compared. Logistic regression analysis was conducted to identify the relevant factors in ECG parameters. We created a new variable called “ECG score” by certain combination of ECG parameters. The diagnostic capability of ECG score for CS was compared with the existing diagnostic indices using regression model and receiver-operating characteristics (ROC) analysis.ResultsThere were several changes on ECG significantly different between the two groups. Multivariate regression analysis demonstrated PR + QRS interval (P = 0.008), ventricular arrhythmia (P = 0.001) and pathological Q wave (P = 0.003) were the independent relevant factors of CS. The derived variable “ECG score” was identified as a significant relevant factor of CS by multivariate regression model. ROC analysis showed PR + QRS interval, ventricular arrhythmia and pathological Q wave all had equivalent diagnostic capability to left ventricular ejection fraction (LVEF) and shock index (SI). ECG score was equivalent to LVEF but superior to SI in diagnosing CSConclusionsECG was valuable in diagnosing CS due to acute myocarditis. The ECG score was superior to the traditional diagnostic indices and could be used for an rapid recognition of CS.
Highlights
The study was performed to assess the diagnostic capability of ECG on the cardiogenic shock (CS) in acute myocarditis
The inclusion criteria were as follows: (1) The included paitents had no age limitation; (2) The symptom onset was less than 1 week before admission; (3) The diagnosis of acute myocarditis was confirmed after clinical, laboratory tests and imaging evaluation; (4) The whole data were available
The exclusions criteria were as follows: (1) The symptom onset was above 1 week before addmission; (2) The myocardial injury was due to other heart diseases, such as worsening of heart failure, acute coronary syndrome (ACS), arrhythmia, cardiomyopathy; (3) The myocardial injury was caused by other systemic diseases, such as tumor, immune disorder, hematological disease, stroke; (4) The patients suffered from acute pericarditis without myocardial injury; (5) The clinical data were not accessible
Summary
The study was performed to assess the diagnostic capability of ECG on the cardiogenic shock (CS) in acute myocarditis. A new score was derived from the combination of the ECG parameters and the diagnostic value was evaluated. Myocarditis is a inflammatory disease involving injury of the cardiac myocytes, the incidence of which is estimated approximate 0.02–0.1% in the general population [1, 2]. Fulminant myocarditis (FM), the most severe type, is characterized with cardiogenic shock (CS) and haemodynamical disorder. It usually undergoes a fatal course and some of the cases probably come to a frustrating end. Nonfulminant myocarditis (NFM) often produces symptoms of heart failure with stable haemodynamical status [3].
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