Relationship between QRS duration on ECG and Left Ventricular Systolic Function by Echocardiography in patients with Non-ST elevated Myocardial Infarction

Cardiovascular Journal Pub Date : 2022-10-10 DOI:10.3329/cardio.v15i1.61908

M. Z. Rahman, Abdul Kader Akanda, M. Ullah, Md. Shariful Alam, Md Gulam Mostofa, Mohammad Mamoon Islam, Md. Iqbal Hossain, Md. Ahsanul Haque

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Abstract

Background: Early risk stratification of patients with myocardial infarction is critical to determine optimum treatment strategies and enhance outcomes. The present study was therefore undertaken to determine the relationship between QRS duration (QRSd) on admission ECG and left ventricular ejection fraction (LVEF) as a measure of left ventricular function in non-ST elevated myocardial infarction (NSTEMI) patients. Methods: This observational study was carried out from January to December 2020 with total of 120 patients with a history of NSTEMI. Based on the cut-off value of QRS duration 100 msec, the patients were divided into two groups – one group with QRS duration d” 100 msec (normal QRS) and another group with QRS duration > 100 msec (prolonged QRS). Left ventricular systolic function was considered preserved, if it was e” 52% and reduced if it was < 52%. The association and correlation between QRS duration and LVEF was then observed. Results: The prevalence of reduced LVEF in patients with prolonged QRS duration (> 100 msec) was double (38%) than that of preserved (19.5%). The risk of having LV dysfunction in patients with prolonged QRS duration was 2.5 (95% CI = 1.1 – 6.2) times higher than that in patients normal QRS duration (d” 100 msec) (p = 0.039). The QRS duration and LVEF bear a significantly inverse relationship (r = -0.341, p < 0.001). The sensitivity of prolonged QRS duration (> 100 msec) in correctly detecting LV dysfunction was inappreciably low (38%), although its specificity in excluding those who did not have LV dysfunction was optimum (80.5%) with overall diagnostic accuracy being 52.5%. Conclusion: Prolonged QRS duration on a standard 12-lead ECG is associated with reduced echocardiographic LVEF. However, QRS duration in predicting LV dysfunction is much less sensitive, although its specificity is optimum indicating that QRS duration is not a good predictor of LV dysfunction (reduced LVEF), but it can dependably predict those who do not have LV dysfunction (preserved LVEF). Cardiovasc j 2022; 15(1): 36-41

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非st段抬高型心肌梗死患者心电图QRS时间与超声心动图左心室收缩功能的关系

背景:心肌梗死患者的早期风险分层对于确定最佳治疗策略和提高预后至关重要。因此，本研究旨在确定入院心电图上QRS持续时间(QRSd)与左心室射血分数(LVEF)之间的关系，LVEF是衡量非st段升高型心肌梗死(NSTEMI)患者左心室功能的指标。方法:本观察性研究于2020年1月至12月进行，共120例有NSTEMI病史的患者。根据QRS持续时间截断值100 msec，将患者分为QRS持续时间≥100 msec组(正常QRS)和QRS持续时间> 100 msec组(延长QRS)。当左心室收缩功能为0.52%时，认为左心室收缩功能保留;当左心室收缩功能< 52%时，认为左心室收缩功能降低。然后观察QRS持续时间与LVEF之间的相关性。结果:QRS持续时间延长(> 100 msec)患者LVEF降低的发生率(38%)是保留患者(19.5%)的两倍。QRS持续时间延长的患者发生左室功能障碍的风险是QRS持续时间正常(d“100 msec)患者的2.5倍(95% CI = 1.1 - 6.2) (p = 0.039)。QRS持续时间与LVEF呈显著负相关(r = -0.341, p < 0.001)。QRS持续时间延长(> 100 msec)在正确检测左室功能障碍方面的敏感性非常低(38%)，尽管它在排除无左室功能障碍的患者方面的特异性是最佳的(80.5%)，总体诊断准确率为52.5%。结论:标准12导联心电图QRS持续时间延长与超声心动图LVEF降低相关。然而，QRS持续时间在预测左室功能障碍方面的敏感性要低得多，尽管其特异性最佳，表明QRS持续时间不能很好地预测左室功能障碍(LVEF减少)，但它可以可靠地预测无左室功能障碍(LVEF保留)的患者。心血管病杂志[j] 2022;15 (1): 36-41

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Cardiovascular Journal

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