Monitoring of myocardial injury by serial measurements of QRS area and T area: The MaastrICCht cohort

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2024-09-04 DOI:10.1111/anec.70001

M. A. Ghossein MD, J. W. T. M. de Kok MS, F. Eerenberg MD, F. van Rosmalen PhD, R. Boereboom MS, F. Duisberg MS, K. Verharen MS, J. E. M. Sels MD, PhD, T. Delnoij MD, Z. Geyik MD, A. M. A. Mingels MD, PhD, S. J. R. Meex MD, PhD, S. M. J. van Kuijk PhD, A. M. W. van Stipdonk MD, PhD, C. Ghossein MD, PhD, F. W. Prinzen MD, PhD, I. C. C. van der Horst MD, PhD, K. Vernooy MD, PhD, B. C. T. van Bussel MD, PhD, R. G. H. Driessen MD, PhD

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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通过连续测量 QRS 波区和 T 波区监测心肌损伤：MaastrICCht队列。

背景：在早期的研究中，人工得出的心电图（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末端前B型钠尿肽（NT-proBNP）的升高则与死亡率有关。为了证明矢量心电图（VCG）测量可作为潜在的心脏监测工具，我们研究了危重病人的矢量心电图轨迹：2020年3月至2021年10月期间，马斯特里赫特重症监护Covid队列纳入了所有机械通气的COVID-19患者。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 导联心电图转换为 VCG，提供 QRS 波区、T 波区、最大 QRS 波幅和 QRS 波长。线性混合效应模型研究了非存活者和存活者的血清和 VCG 指标随时间变化的轨迹，并对混杂因素进行了调整：对 322 名患者中的 5461 个 hs-cTnT、5435 个 NT-proBNP 浓度以及 3280 个心电图和 VCG 进行了分析。与存活者相比，非存活者插管时的 hs-cTnT 浓度较高，且 hs-cTnT 和 NT-proBNP 均显著升高。与存活者相比，非存活者的以下 VCG 参数下降幅度更大：QRS 面积（-0.27 (95% CI) (-0.37 to -0.16, p 结论：在非存活者中，VCG 导出的 QRS 面积比存活者下降得更多：与存活者相比，非存活者的 VCG 导出 QRS 波区和 T 波区减小，这表明心肌损伤和组织损失的增加在危重病过程中起了作用，并可能导致死亡。这些 VCG 标记可用于监测危重病人。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.