Objective: To investugate the unique electrocardiogram (ECG) characteristics of fulminant myocarditis (FM) patients and provide important clues for the diagnosis of FM. Methods: This was a retrospective study. Patients diagnosed with acute myocarditis at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 2017 to April 2022 were enrolled and divided into fulminant myocarditis group (FM) and non-fulminant myocarditis group (NFM) according to clinical diagnosis. A total of 246 healthy people who underwent physical examination in the Health examination Center of Tongji Hospital at the same period were selected as the control group. The clinical data and ECG characteristics of the above 3 groups were analyzed and compared. Logistic regression model was used to analyze the influence of ECG parameters on left ventricular ejection fraction in FM patients. Receiver operating curves were constructed to evaluate the predictive value of different ECG parameters for FM. Results: A total of 180 patients were included in this study (FM group: n=123; NFM group: n=57), with an age of (35.0±16.2) years and 106 males (58.89%). Compared with NFM group, ECG was significantly abnormal in FM group, with a higher incidence of sinus tachycardia, ventricular tachycardia or ventricular fibrillation, escape rhythm, right bundle branch block, third degree atrioventricular block, ST-segment elevation, low voltage, prolonged QTc interval, and widened QRS wave in the FM group (all P<0.05). The ECG parameters showed that the amplitude of the full lead QRS wave in FM group was lower than that in NFM group (P<0.01). The average heart rate and QTc interval of FM group were significantly higher than those of NFM and control groups (all P<0.05). Although ST-segment elevation had a higher incidence in the FM group, ECG parameters showed that except for leads Ⅲ and aVF, the ST segment levels in all leads in the FM group were lower than those in the control group (all P<0.05). There was a statistically significant difference in some ST segment changes between FM and NFM groups, while there was no statistical difference between the NFM and control groups. Multivariate regression analysis showed that widened QRS wave and increased heart rate were the influencing factors for left ventricular systolic dysfunction in FM patients (OR=16.914, 95%CI: 1.367-209.224, P=0.028; OR=1.026, 95%CI: 1.010-1.042, P=0.001). Receiver operating curve analysis showed that heart rate>86.90 beat/min, QTc>431.50 ms, and RV5+SV1<1.72 mV had certain predictive value for FM diagnosis. Conclusions: FM patients displayed marked and severe ECG abnormalities, and characteristic changes in ECG can provide important first clues for the diagnosis of FM.
目的： 探讨暴发性心肌炎人群心电图特征，为暴发性心肌炎的诊断提供重要线索。 方法： 该研究为回顾性研究。入选2017年2月至2022年4月在华中科技大学同济医学院附属同济医院确诊为急性心肌炎的患者，根据临床诊断分为暴发性心肌炎组和非暴发性心肌炎组。以同期246名健康体检人群作为对照组，比较3组的临床资料及心电图特征。采用logistic回归模型分析心电图参数对暴发性心肌炎患者左心室射血分数的影响，构建受试者工作特征曲线，评估不同心电图参数对暴发性心肌炎的预测价值。 结果： 共纳入180例患者（暴发性心肌炎组123例，非暴发性心肌炎组57例），年龄（35.0±16.2）岁，男性106例（58.89%）。与非暴发性心肌炎组相比，暴发性心肌炎组患者心电图显著异常：窦性心动过速、室性心动过速/心室颤动（室颤）、逸搏心律、右束支传导阻滞、三度房室传导阻滞、ST段抬高、低电压、QTc间期延长、QRS波增宽的发生率更高（P均<0.05）。心电图参数显示，暴发性心肌炎组患者全导联QRS波振幅低于非暴发性心肌炎组（P<0.01）。暴发性心肌炎组的平均心率及QTc间期高于非暴发性心肌炎组及对照组（P均<0.05）。尽管ST段抬高在暴发性心肌炎组发生率更高，心电图参数显示除Ⅲ和aVF导联外，其余导联ST段水平均较对照组压低（P均<0.05），部分导联ST段改变在暴发性心肌炎组与非暴发性心肌炎组间差异有统计学意义，而各导联在非暴发性心肌炎组与对照组之间差异无统计学意义。多因素logistic回归分析显示QRS波增宽和心率增快是暴发性心肌炎组患者左心室收缩功能减低的影响因素（OR=16.914，95%CI：1.367~209.224，P=0.028；OR=1.026，95%CI：1.010~1.042，P=0.001）。受试者工作特征曲线分析结果显示心率>86.90次/min，QTc>431.50 ms，RV5+SV1<1.72 mV对暴发性心肌炎诊断有一定预测价值。 结论： 暴发性心肌炎患者存在显著且严重的心电图异常，心电图的特征性改变可为暴发性心肌炎患者的诊断提供重要线索。.