Role of electrocardiograms in assessment of severity and analysis of the characteristics of ST elevation in acute myocarditis: A two‑centre study

Chen,Jiaozhen; Chen,Shouquan; Li,Zhangping; Zhou,Peisen; Huang,Weijia; Wang,Hete; Shi,Jincun; Ni,Yunchao; Lin,Lili; Lei,Yuanli

doi:10.3892/etm.2020.9148

Role of electrocardiograms in assessment of severity and analysis of the characteristics of ST elevation in acute myocarditis: A two‑centre study

Authors:
- Jiaozhen Chen
- Shouquan Chen
- Zhangping Li
- Peisen Zhou
- Weijia Huang
- Hete Wang
- Jincun Shi
- Yunchao Ni
- Lili Lin
- Yuanli Lei
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Affiliations: Department of Electrocardiogram, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, P.R. China, Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China, Department of Critical Care Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang 325000, P.R. China
Published online on: August 27, 2020 https://doi.org/10.3892/etm.2020.9148
Article Number: 20
Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Acute myocarditis is a severe disease with a high mortality rate and various dynamic changes visible on electrocardiograms (ECGs). The purpose of the present study was to investigate ECG findings of patients with acute myocarditis, ECG findings associated with fulminant myocarditis (FM) and the characteristics of ST elevation on admission. A retrospective analysis of 1,814 ECGs of 274 consecutive patients with acute myocarditis aged ≥13 years, who were hospitalized in two centres between August 2007 and November 2019, was performed. A total of 251 patients with myocarditis (91.6%) presented with ECG abnormalities. The most common ECG findings were T‑wave inversion and ST elevation. Univariate logistic regression analysis demonstrated that 12 ECG findings were associated with FM. Multivariate regression analysis revealed that the independent predictive factors for FM included ventricular tachycardia, high‑degree atrioventricular block, sinus tachycardia, low voltage and QRS duration of ≥120 msec (all P<0.05). A total of 112 cases displayed ST elevation at admission. Of these, ST elevation without T‑wave inversion (n=87) was associated with a shorter duration of cardiac symptoms (1.5 vs. 3.1 days; P<0.001) compared with ST elevation with T‑wave inversion (n=25). Of the aforementioned 87 patients, 71 (81.6%) presented with T‑wave inversion at the hospital. The median time from the onset of cardiac symptoms to T‑wave inversion was 4.0 days. In conclusion, patients with acute myocarditis exhibited various dynamic changes on ECG. Thus, ECGs should be widely used for the assessment of severity and the characteristics of ST elevation on admission.

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1	Wu S, Yang YM, Zhu J, Wan HB, Wang J, Zhang H and Shao XH: Clinical characteristics and outcomes of patients with myocarditis mimicking ST-segment elevation myocardial infarction: Analysis of a case series. Medicine (Baltimore). 96(e6863)2017.PubMed/NCBI View Article : Google Scholar
2	Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Heliö T, Heymans S, Jahns R, et al: Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 34:2636–2648, 2648a-2648d. 2013.PubMed/NCBI View Article : Google Scholar
3	Biesbroek PS, Beek AM, Germans T, Niessen HW and van Rossum AC: Diagnosis of myocarditis: Current state and future perspectives. Int J Cardiol. 191:211–219. 2015.PubMed/NCBI View Article : Google Scholar
4	Nakashima H, Honda Y and Katayama T: Serial electrocardiographic findings in acute myocarditis. Intern Med. 33:659–666. 1994.PubMed/NCBI View Article : Google Scholar
5	Miyake CY, Teele SA, Chen L, Motonaga KS, Dubin AM, Balasubramanian S, Balise RR, Rosenthal DN, Alexander ME, Walsh EP and Mah DY: In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol. 113:535–540. 2014.PubMed/NCBI View Article : Google Scholar
6	Lee KJ, McCrindle BW, Bohn DJ, Wilson GJ, Taylor GP, Freedom RM, Smallhorn JF and Benson LN: Clinical outcomes of acute myocarditis in childhood. Heart. 82:226–233. 1999.PubMed/NCBI View Article : Google Scholar
7	Ogunbayo GO, Elayi SC, Ha LD, Olorunfemi O, Elbadawi A, Saheed D and Sorrell VL: Outcomes of heart block in myocarditis: A review of 31,760 Patients. Heart Lung Circ. 28:272–276. 2019.PubMed/NCBI View Article : Google Scholar
8	Ukena C, Mahfoud F, Kindermann I, Kandolf R, Kindermann M and Bohm M: Prognostic electrocardiographic parameters in patients with suspected myocarditis. Eur J Heart Fail. 13:398–405. 2011.PubMed/NCBI View Article : Google Scholar
9	Veronese G, Ammirati E, Cipriani M and Frigerio M: Fulminant myocarditis: Characteristics, treatment, and outcomes. Anatol J Cardiol. 19:279–286. 2018.PubMed/NCBI View Article : Google Scholar
10	JCS Joint Working Group. Guidelines for diagnosis and treatment of myocarditis (JCS 2009): Digest version. Circ J. 75:734–743. 2011.PubMed/NCBI View Article : Google Scholar
11	Baksi AJ, Kanaganayagam GS and Prasad SK: Arrhythmias in viral myocarditis and pericarditis. Card Electrophysiol Clin. 7:269–281. 2015.PubMed/NCBI View Article : Google Scholar
12	Ichikawa R, Sumitomo N, Komori A, Abe Y, Nakamura T, Fukuhara J, Matsumura M, Miyashita M, Kanamaru H, Ayusawa M and Mugishima H: The follow-up evaluation of electrocardiogram and arrhythmias in children with fulminant myocarditis. Circ J. 75:932–938. 2011.PubMed/NCBI View Article : Google Scholar
13	Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ Jr, Olsen EG and Schoen FJ: Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol. 1:3–14. 1987.PubMed/NCBI
14	Casadonte JR, Mazwi ML, Gambetta KE, Palac HL, McBride ME, Eltayeb OM, Monge MC, Backer CL and Costello JM: Risk factors for cardiac arrest or mechanical circulatory support in children with fulminant myocarditis. Pediatr Cardiol. 38:128–134. 2017.PubMed/NCBI View Article : Google Scholar
15	Ammirati E, Cipriani M, Lilliu M, Sormani P, Varrenti M, Raineri C, Petrella D, Garascia A, Pedrotti P, Roghi A, et al: Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Circulation. 136:529–545. 2017.PubMed/NCBI View Article : Google Scholar
16	Kligfield P, Gettes LS, Bailey JJ, Childers R, Deal BJ, Hancock EW, van Herpen G, Kors JA, Macfarlane P, Mirvis DM, et al: Recommendations for the standardization and interpretation of the electrocardiogram: Part I: The electrocardiogram and its technology a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American college of cardiology foundation; and the heart rhythm society endorsed by the international society for computerized electrocardiology. J Am Coll Cardiol. 49:1109–1127. 2007.PubMed/NCBI View Article : Google Scholar
17	Lei YL, Chen SQ, Li ZP, Xue JK, Wang TT, Zhou ZL, Xu HQ, Lu YR, Li HP, Huang WJ and Cheng JT: Percutaneous coronary intervention improved outcomes of cardiac arrest after acute myocardial infarction: A 2-year study. Int J Clin Exp Med. 10:3097–3105. 2017.
18	Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R, Deal BJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, et al: AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: Part IV: The ST segment, T and U waves, and the QT interval: a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the american college of cardiology foundation; and the heart rhythm society. Endorsed by the international society for computerized electrocardiology. J Am Coll Cardiol. 53:982–991. 2009.PubMed/NCBI View Article : Google Scholar
19	Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, et al: 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of Sudden cardiac death: A Report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. Circulation. 138:e272–e391. 2018.PubMed/NCBI View Article : Google Scholar
20	Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM, Goldhaber JI, Lathrop DA, Liu P, Niemann JT, et al: Pulseless electric activity: Definition, causes, mechanisms, management, and research priorities for the next decade: Report from a national heart, lung, and blood institute workshop. Circulation. 128:2532–2541. 2013.PubMed/NCBI View Article : Google Scholar
21	Pavlicek V, Kindermann I, Wintrich J, Mahfoud F, Klingel K, Böhm M and Ukena C: Ventricular arrhythmias and myocardial inflammation: Long-term follow-up of patients with suspected myocarditis. Int J Cardiol. 274:132–137. 2019.PubMed/NCBI View Article : Google Scholar
22	Morgera T, Di Lenarda A, Dreas L, Pinamonti B, Humar F, Bussani R, Silvestri F, Chersevani D and Camerini F: Electrocardiography of myocarditis revisited: Clinical and prognostic significance of electrocardiographic changes. Am Heart J. 124:455–467. 1992.PubMed/NCBI View Article : Google Scholar
23	Matshela MR: The role of echocardiography in acute viral myocarditis. Cardiovasc J Afr. 30:239–244. 2019.PubMed/NCBI View Article : Google Scholar
24	Chang YJ, Hsiao HJ, Hsia SH, Lin JJ, Hwang MS, Chung HT, Chen CL, Huang YC and Tsai MH: Analysis of clinical parameters and echocardiography as predictors of fatal pediatric myocarditis. PLoS One. 14(e0214087)2019.PubMed/NCBI View Article : Google Scholar