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
{"title":"通过连续测量 QRS 波区和 T 波区监测心肌损伤：MaastrICCht队列。","authors":"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","doi":"10.1111/anec.70001","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>p</i> < .01) μVs per day), T area (−0.39 (−0.62 to −0.16, <i>p</i> < .01) μVs per day), and maximal QRS amplitude (−0.01 (−0.01 to −0.01, <i>p</i> < .01) mV per day). QRS duration did not differ.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"29 5","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70001","citationCount":"0","resultStr":"{\"title\":\"Monitoring of myocardial injury by serial measurements of QRS area and T area: The MaastrICCht cohort\",\"authors\":\"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\",\"doi\":\"10.1111/anec.70001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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, <i>p</i> < .01) μVs per day), T area (−0.39 (−0.62 to −0.16, <i>p</i> < .01) μVs per day), and maximal QRS amplitude (−0.01 (−0.01 to −0.01, <i>p</i> < .01) mV per day). 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Monitoring of myocardial injury by serial measurements of QRS area and T area: The MaastrICCht cohort
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.
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.
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