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The prognostic role of fragmented QRS complex in acute myocarditis

Yıl 2019, Cilt: 10 Sayı: 1, 62 - 67, 21.03.2019
https://doi.org/10.18663/tjcl.516494

Öz

Aim:
Although
a fulminant course of the myocarditis is difficult to predict, it may lead to
acute heart failure and death. Previous studies have demonstrated that reduced
left ventricular systolic function and prolonged QRS duration can predict the
fulminant course. This study aimed to identify whether fragmented QRS complex
(fQRS) could also be predictive of fulminant disease in this population.

 

Material and Methods: We retrospectively included 156 patients diagnosed with acute
myocarditis. They were divided into the fulminant group (n = 18) and the
non-fulminant group (n = 138). Multivariate logistic regression analysis was
used to identify the independent factors predictive of fulminant disease.

 

Results: Fragmented
QRS developed in 11 (61%) in the fulminant group and only 10 patients (7%) in
the non-fulminant group (p <0.001).
Patients with fulminant myocarditis had a higher mortality rate
than those with non-fulminant disease (44.6% vs. 0%, p < 0.001).
Multivariate analysis revealed that the presence of fQRS (p=0.019), longer
Tpe/qt ratio (p=0.022) and clinical heart failure (
<0.001) were significant predictors associated with a fulminant course
of myocarditis.

 













Conclusion:
The presence of fQRS complex, as a simple and feasible
electrocardiographic marker, seems to be a novel predictor fulminant
myocarditis.
This
simpleparameter may be used in identifying patients at high risk for fulminancy
and so early mechanical support could provide
improved patient outcomes.

Kaynakça

  • 1. Cooper LT, Jr. Myocarditis. N Engl J Med 2009; 360: 1526-38.
  • 2. Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart 2006; 92: 316-20.
  • 3. Nugent AW, Daubeney PE, Chondros P et al. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med 2003; 348: 1639-46.
  • 4. Towbin JA, Lowe AM, Colan SD et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 2006; 296: 1867-76.
  • 5. Tschope C, Bock CT, Kasner M et al. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation 2005; 111: 879-86.
  • 6. Kuhl U, Pauschinger M, Noutsias M et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction. Circulation 2005; 111: 887-93.
  • 7. McCarthy RE, 3rd, Boehmer JP, Hruban RH et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000; 342: 690-95.
  • 8. Kato S, Morimoto S, Hiramitsu S et al. Risk factors for patients developing a fulminant course with acute myocarditis. Circ J 2004; 68: 734-39.
  • 9. Lee CH, Tsai WC, Hsu CH, Liu PY, Lin LJ, Chen JH. Predictive factors of a fulminant course in acute myocarditis. Int J Cardiol 2006; 109: 142-45.
  • 10. Das MK, Suradi H, Maskoun W et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 2008; 1: 258-68.
  • 11. Das MK, Saha C, El Masry H et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007; 4: 1385-92.
  • 12. Das MK, Maskoun W, Shen C et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010; 7: 74-80.
  • 13. Ammirati E, Cipriani M, Lilliu M et al. Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis. Circulation 2017; 136: 529-45.
  • 14. Veronese G, Ammirati E, Cipriani M, Frigerio M. Fulminant myocarditis: Characteristics, treatment, and outcomes. Anatol J Cardiol 2018; 19: 279-86.
  • 15. Nishii M, Inomata T, Takehana H et al. Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis. J Am Coll Cardiol 2004; 44: 1292-97.
  • 16. Hung Y, Lin WH, Lin CS et al. The Prognostic Role of QTc Interval in Acute Myocarditis. Acta Cardiol Sin 2016; 32: 223-30.
  • 17. Gong B, Li Z. Total Mortality, Major Adverse Cardiac Events, and Echocardiographic-Derived Cardiac Parameters with Fragmented QRS Complex. Ann Noninvasive Electrocardiol 2016; 21: 404-12.
  • 18. Morita H, Kusano KF, Miura D et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation 2008; 118: 1697-704.
  • 19. Zhang B, Zhen Y, Shen D, Zhang G. Significance of fragmented QRS complexes for identifying left ventricular hypertrophy in patients with hypertension. Ann Noninvasive Electrocardiol 2015; 20: 175-80.
  • 20. Yilmaz H, Gungor B, Kemaloglu T et al. The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow. Kardiol Pol 2014; 72: 14-19.
  • 21. Shimizu M, Nishizaki M, Yamawake N et al. J wave and fragmented QRS formation during the hyperacute phase in Takotsubo cardiomyopathy. Circ J 2014; 78: 943-49.

Akut miyokarditte fragmante QRS kompleksinin prognostik rolü

Yıl 2019, Cilt: 10 Sayı: 1, 62 - 67, 21.03.2019
https://doi.org/10.18663/tjcl.516494

Öz

Amaç:
Miyokarditin fulminan seyrini tahmin etmek zor olsa da, akut kalp yetmezliği ve
ölüme neden olabilir. Önceki çalışmalar, sol ventrikül sistolik fonksiyonunun
azaldığını ve uzamış QRS süresinin fulminan seyrini öngörebileceğini
göstermiştir. Bu çalışma, fragmante QRS kompleksinin (fQRS) de bu
popülasyondaki fulminan hastalığın öngörüsü olup olmadığını belirlemeyi
amaçlamıştır.

Gereç ve Yöntemler:
Akut miyokardit tanısı almış 156 hastayı retrospektif olarak dahil ettik.
Hastalar fulminan (n = 18) ve fulminan olmayan gruba (n = 138) ayrıldı.
Fulminan hastalığı öngören bağımsız faktörleri tanımlamak için çok değişkenli
lojistik regresyon analizi kullanılmıştır.

Bulgular:
Fragmante QRS fulminan grupta 11 (% 61), fulminan olmayan grupta sadece 10
hasta (% 7) gelişti (p <0.001). Fulminan miyokardit hastaları fulminan
olmayan hastalardan daha yüksek mortalite oranına sahipti (% 44.6 vs.% 0, p
<0.001). Çok değişkenli analiz, fQRS (p = 0.019), daha uzun Tp-e / QT
oranının (p = 0.022) ve klinik kalp yetmezliğinin (<0.001) varlığında,
fulminan bir miyokardit seyri ile ilişkili önemli belirleyiciler olduğunu
ortaya koydu.







Sonuç:
Basit ve uygulanabilir bir elektrokardiyografik belirteç olarak fQRS
kompleksinin varlığı, fulminan miyokarditin yeni bir belirleyicisi olarak
görünmektedir. Bu basit parametre, uygunluk riski yüksek olan hastaları
belirlemek için kullanılabilir ve bu nedenle erken mekanik destek daha iyi
hasta sonuçları sağlayabilir.

Kaynakça

  • 1. Cooper LT, Jr. Myocarditis. N Engl J Med 2009; 360: 1526-38.
  • 2. Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart 2006; 92: 316-20.
  • 3. Nugent AW, Daubeney PE, Chondros P et al. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med 2003; 348: 1639-46.
  • 4. Towbin JA, Lowe AM, Colan SD et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 2006; 296: 1867-76.
  • 5. Tschope C, Bock CT, Kasner M et al. High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction. Circulation 2005; 111: 879-86.
  • 6. Kuhl U, Pauschinger M, Noutsias M et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction. Circulation 2005; 111: 887-93.
  • 7. McCarthy RE, 3rd, Boehmer JP, Hruban RH et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 2000; 342: 690-95.
  • 8. Kato S, Morimoto S, Hiramitsu S et al. Risk factors for patients developing a fulminant course with acute myocarditis. Circ J 2004; 68: 734-39.
  • 9. Lee CH, Tsai WC, Hsu CH, Liu PY, Lin LJ, Chen JH. Predictive factors of a fulminant course in acute myocarditis. Int J Cardiol 2006; 109: 142-45.
  • 10. Das MK, Suradi H, Maskoun W et al. Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis. Circ Arrhythm Electrophysiol 2008; 1: 258-68.
  • 11. Das MK, Saha C, El Masry H et al. Fragmented QRS on a 12-lead ECG: a predictor of mortality and cardiac events in patients with coronary artery disease. Heart Rhythm 2007; 4: 1385-92.
  • 12. Das MK, Maskoun W, Shen C et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010; 7: 74-80.
  • 13. Ammirati E, Cipriani M, Lilliu M et al. Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis. Circulation 2017; 136: 529-45.
  • 14. Veronese G, Ammirati E, Cipriani M, Frigerio M. Fulminant myocarditis: Characteristics, treatment, and outcomes. Anatol J Cardiol 2018; 19: 279-86.
  • 15. Nishii M, Inomata T, Takehana H et al. Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis. J Am Coll Cardiol 2004; 44: 1292-97.
  • 16. Hung Y, Lin WH, Lin CS et al. The Prognostic Role of QTc Interval in Acute Myocarditis. Acta Cardiol Sin 2016; 32: 223-30.
  • 17. Gong B, Li Z. Total Mortality, Major Adverse Cardiac Events, and Echocardiographic-Derived Cardiac Parameters with Fragmented QRS Complex. Ann Noninvasive Electrocardiol 2016; 21: 404-12.
  • 18. Morita H, Kusano KF, Miura D et al. Fragmented QRS as a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome. Circulation 2008; 118: 1697-704.
  • 19. Zhang B, Zhen Y, Shen D, Zhang G. Significance of fragmented QRS complexes for identifying left ventricular hypertrophy in patients with hypertension. Ann Noninvasive Electrocardiol 2015; 20: 175-80.
  • 20. Yilmaz H, Gungor B, Kemaloglu T et al. The presence of fragmented QRS on 12-lead ECG in patients with coronary slow flow. Kardiol Pol 2014; 72: 14-19.
  • 21. Shimizu M, Nishizaki M, Yamawake N et al. J wave and fragmented QRS formation during the hyperacute phase in Takotsubo cardiomyopathy. Circ J 2014; 78: 943-49.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Sefa Ünal

Samet Yilmaz

Çağrı Yayla

Mevlüt Serdar Kuyumcu

İlke Erbay Bu kişi benim

Burak Açar

Mustafa Karanfil Bu kişi benim

Ahmet Göktuğ Ertem

Koray Demirtaş

Ahmet Akdi

Sinan Aydoğdu

Yayımlanma Tarihi 21 Mart 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 10 Sayı: 1

Kaynak Göster

APA Ünal, S., Yilmaz, S., Yayla, Ç., Kuyumcu, M. S., vd. (2019). The prognostic role of fragmented QRS complex in acute myocarditis. Turkish Journal of Clinics and Laboratory, 10(1), 62-67. https://doi.org/10.18663/tjcl.516494
AMA Ünal S, Yilmaz S, Yayla Ç, Kuyumcu MS, Erbay İ, Açar B, Karanfil M, Ertem AG, Demirtaş K, Akdi A, Aydoğdu S. The prognostic role of fragmented QRS complex in acute myocarditis. TJCL. Mart 2019;10(1):62-67. doi:10.18663/tjcl.516494
Chicago Ünal, Sefa, Samet Yilmaz, Çağrı Yayla, Mevlüt Serdar Kuyumcu, İlke Erbay, Burak Açar, Mustafa Karanfil, Ahmet Göktuğ Ertem, Koray Demirtaş, Ahmet Akdi, ve Sinan Aydoğdu. “The Prognostic Role of Fragmented QRS Complex in Acute Myocarditis”. Turkish Journal of Clinics and Laboratory 10, sy. 1 (Mart 2019): 62-67. https://doi.org/10.18663/tjcl.516494.
EndNote Ünal S, Yilmaz S, Yayla Ç, Kuyumcu MS, Erbay İ, Açar B, Karanfil M, Ertem AG, Demirtaş K, Akdi A, Aydoğdu S (01 Mart 2019) The prognostic role of fragmented QRS complex in acute myocarditis. Turkish Journal of Clinics and Laboratory 10 1 62–67.
IEEE S. Ünal, “The prognostic role of fragmented QRS complex in acute myocarditis”, TJCL, c. 10, sy. 1, ss. 62–67, 2019, doi: 10.18663/tjcl.516494.
ISNAD Ünal, Sefa vd. “The Prognostic Role of Fragmented QRS Complex in Acute Myocarditis”. Turkish Journal of Clinics and Laboratory 10/1 (Mart 2019), 62-67. https://doi.org/10.18663/tjcl.516494.
JAMA Ünal S, Yilmaz S, Yayla Ç, Kuyumcu MS, Erbay İ, Açar B, Karanfil M, Ertem AG, Demirtaş K, Akdi A, Aydoğdu S. The prognostic role of fragmented QRS complex in acute myocarditis. TJCL. 2019;10:62–67.
MLA Ünal, Sefa vd. “The Prognostic Role of Fragmented QRS Complex in Acute Myocarditis”. Turkish Journal of Clinics and Laboratory, c. 10, sy. 1, 2019, ss. 62-67, doi:10.18663/tjcl.516494.
Vancouver Ünal S, Yilmaz S, Yayla Ç, Kuyumcu MS, Erbay İ, Açar B, Karanfil M, Ertem AG, Demirtaş K, Akdi A, Aydoğdu S. The prognostic role of fragmented QRS complex in acute myocarditis. TJCL. 2019;10(1):62-7.


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