Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes: A description of a heretofore unrecognized phenomenon
Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes: A description of a heretofore unrecognized phenomenon
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DOI：
10.1016/s0735-1097(01)01429-2
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发表时间：
2001-09-01
影响因子：
24
通讯作者：
Medepalli, L
中科院分区：
文献类型：
--
作者：
Madias, JE;Bazaz, R;Medepalli, L
目的探讨全身水肿（AN）患者体重变化与心电图（ECG）QRS波振幅的关系。记录的电压是心脏电位、介入组织的电阻率和ECG导联相对于激励传播方向的方向的函数。肺充血和心包积液和胸腔积液可以引起衰减的心电图电位，此外，最近观察到类似的变化与AN患者。方法进行了前瞻性研究，这种现象在28例危重病患者。每天记录心电图和患者的WT。通过连续超声心动图排除心包积液。12个导联的QRS波振幅之和（Sigma QRS）与相应的WT相关。结果入院时WT为148.9 +/- 37.8 lbs，峰值为197.8 +/- 52.3 lbs（p = 0.0005）。入院时Sigma QRS为120.2 ± 41.6 mm，峰值WT时降至54.8 ± 26.9 mm（p = 0.0005）。Sigma QRS对WT的回归显示r = 0.61和p = 0.0005。13例患者的后续WT丢失（从219.0 +/- 40.7 lbs至179.5 +/- 41.7 lbs，p = 0.001）导致YQ，RS从53.5 +/- 24.5 mm增加至86.8 +/- 38.2 mm（p = 0.001）。心内心电图保持稳定，而表面心电图改变与WT的扰动。结论在AN患者的ECG电压衰减与WT增益相关，它可以归因于心脏电位的分流，由于AN流体的低电阻。(C)2001年，美国心脏病学会。
OBJECTIVES The relationship between the changes of weight (WT) and electrocardiogram (ECG) QRS amplitude in patients with anasarca (AN) was evaluated.BACKGROUND Attenuation of the ECG voltage occurs as the electrical current spreads from the epicardium to the body surface. The voltage registered is a function of the cardiac potentials, the electrical resistivities of the intervening tissues and the orientation of the ECG leads with respect to the direction of propagation of excitation. Lung congestion and pericardial and pleural effusions can cause attenuation in the ECG potentials; additionally, a similar change was recently observed in patients with AN.METHODS A prospective study of this phenomenon in 28 patients with a critical illness was carried out. Electrocardiograms and patients' WTs were recorded daily. Pericardial effusions were excluded by serial echocardiograms. The sums of the amplitude of QRS complexes from the 12 ECG leads (Sigma QRS) were correlated with the corresponding WTs. Intracardiac ECGs, done in three patients, were correlated with surface ECGs.RESULTS Admission WT was 148.9 +/- 37.8 lbs, and it peaked to 197.8 +/- 52.3 lbs (p = 0.0005). Admission Sigma QRS was 120.2 +/- 41.6 mm and dropped to 54.8 +/- 26.9 mm at time of peak WT (p = 0.0005). Regression of Sigma QRS on WT revealed an r = 0.61 and a p = 0.0005. Subsequent WT loss in 13 patients (from 219.0 +/- 40.7 lbs to 179.5 +/- 41.7 lbs, p = 0.001) led to an increase of YQ,RS from 53.5 +/- 24.5 mm to 86.8 +/- 38.2 mm (p = 0.001). Intracardiac ECGs remained stable, while surface ECGs changed with perturbations of WT.CONCLUSIONS Attenuation of ECG voltage in patients with AN correlates with WT gain, and it can be attributed to a shunting of the cardiac potentials due to the low resistance of the AN fluid. (C) 2001 by the American College of Cardiology.