Usefulness of Q-wave area for threshold-based stratification of global left ventricular myocardial infarct size.
Usefulness of Q-wave area for threshold-based stratification of global left ventricular myocardial infarct size.
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DOI：
10.1016/j.amjcard.2013.03.013
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发表时间：
2013-07-15
影响因子：
2.8
通讯作者：
Weinsaft, Jonathan W.
中科院分区：
文献类型：
--
作者：
Kochav, Jonathan D.;Okin, Peter M.;Wilson, Sean;Afroz, Anika;Renilla, Alfredo;Weinsaft, Jonathan W.
急性心肌梗死（AMI）后左心室（LV）梗死面积影响预后。延迟增强心脏磁共振（DE-CMR）提供准确的梗死定量，但在许多患者中不可用或禁忌。本研究测试了简单的心电图（ECG）参数是否可以分层LV梗死面积。对152例AMI患者进行了DE-CMR和12导联连续心电图检查。对心电图的Q波形态的多个方面进行定量分析，包括除aVR外所有导联的持续时间、振幅和几何面积（QWAr）总和。病理性Q波患者的DE-CMR或酶测得的梗死面积更大（均p <0.001），即使在通过CMR或X线血管造影控制梗死分布后也是如此。早期（AMI后4 ± 0.4天）和随访（29 ± 6天）ECG之间的比较显示，Q波振幅暂时降低（1.8 ± 1.4 vs 1.6 ± 1.6 mV; p = 0.03），但QWAr未降低（41 ± 38 vs 39 ± 43 mV·ms; p = 0.29）。在这两个时间点，随着DE-CMR量化梗死面积，QWAr逐步增加（p <0.001）。在10%的LV梗死阈值时，QWA r显著增加，早期ECG的差异超过3倍（59 ± 39 vs 18 ± 20 mV·ms; p <0.001），随访时差异接近5倍（59 ± 46 vs 13 ± 16 mV·ms; p <0.001）。与10%梗死临界值相比，早期（曲线下面积= 0.84）和随访（曲线下面积= 0.87）ECG的诊断性能良好。灵敏度优化（95%至98%）使QWAr能够排除每个时间点阴性预测值为90%至94%的受影响患者。总之，LV梗死面积伴随着Q波形态的逐步增加，在10% LV梗死阈值时QWAr增加3 - 5倍。基于QWAr的分层为排除较大（≥10%）LV梗死负荷提供了极好的阴性预测值。
Left ventricular (LV) infarct size affects prognosis after acute myocardial infarction (AMI). Delayed enhancement cardiac magnetic resonance (DE-CMR) provides accurate infarct quantification but is unavailable or contraindicated in many patients. This study tested whether simple electrocardiography (ECG) parameters can stratify LV infarct size. One hundred fifty-two patients with AMI underwent DE-CMR and serial 12-lead ECG. Electrocardiograms were quantitatively analyzed for multiple aspects of Q-wave morphology, including duration, amplitude, and geometric area (QWAr) summed across all leads except aVR. Patients with pathologic Q waves had larger infarcts measured by DE-CMR or enzymes (both p <0.001), even after controlling for infarct distribution by CMR or x-ray angiography. Comparison between early (4 ± 0.4 days after AMI) and follow-up (29 ± 6 days) ECG demonstrated temporal reductions in Q-wave amplitude (1.8 ± 1.4 vs 1.6 ± 1.6 mV; p = 0.03) but not QWAr (41 ± 38 vs 39 ± 43 mV•ms; p = 0.29). At both times, QWAr augmented stepwise with DE-CMR quantified infarct size (p <0.001). QWAr increased markedly at 10% LV infarct threshold, with differences more than threefold on early ECG (59 ± 39 vs 18 ± 20 mV•ms; p <0.001) and nearly fivefold (59 ± 46 vs 13 ± 16 mV•ms; p <0.001) on follow-up. Diagnostic performance compared with a 10% infarction cutoff was good on early (area under the curve = 0.84) and follow-up (area under the curve = 0.87) ECG. Optimization of sensitivity (95% to 98%) enabled QWAr to exclude affected patients with 90% to 94% negative predictive value at each time point. In conclusion, LV infarct size is accompanied by stepwise increments in Q-wave morphology, with QWAr increased three- to fivefold at a threshold of 10% LV infarction. Stratification based on QWAr provides excellent negative predictive value for exclusion of large (≥10%) LV infarct burden.
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影响因子：
2.7
作者：
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