Difference of Myocardial Repolarization Dispersion in Patients with Acute Ischemic and Hemorrhagic Stroke

doi:10.12114/j.issn.1007-9572.2019.00.522

Abstract

Abstract: Background　Patients with acute stroke often have changes in electrocardiogram （ECG） and discrete markers of cardiac repolarization to identify high-risk patients with malignant arrhythmic events.There are studies on the correlation between the two abroad，but few in China.It is of great significance to explore the difference of myocardial repolarization dispersion and its correlation with prognosis in different types of stroke patients.Objective　To evaluate the myocardial repolarization dispersion ndexes of cardiac repolarization in patients with acute ischemic stroke and hemorrhagic stroke and different stroke sites，and to explore the possible correlation between myocardial repolarization dispersion indexes and neurological severity（National Institutes of Health Stroke Scale score，NIHSS score） and disability （Modified?Rankin?Scale score，mRS score）．Methods　The clinical data of 63 patients with acute ischemic and hemorrhagic stroke in the Department of General Practice，Central South University Xiangya School of Medicine Affiliated Haikou Hospital/Haikou People's Hospital from January 1 2017 to December 31 2017 were retrospectively collected and analyzed.Data of myocardial repolarization dispersion indexes were obtained by 12-lead electrocardiogram at admission，including QT dispersion in V5 lead，QTc dispersion，TpTe dispersion and TpTe/QTc，the maximum value of QT，QTc and TpTe in other leads..The differences of cardiac muscle repolarization dispersion between different stroke types and different brain lesions were compared，and the correlation between myocardial repolarization dispersion indexes and NIHSS scores at admission and discharge and mRS scores at discharge were evaluated by Spearman rank correlation method.Results　Among 63 patients，55 were ischemic stroke（ischemic stroke group） and 8 were hemorrhagic stroke（hemorrhagic stroke group）；TpTe/QTc in V5 lead in hemorrhagic stroke group was higher than that in ischemic stroke group （P=0.034）；the maximum value of QT in insular lobe lesion group was higher than that in non-insular lobe lesion group；the maximum value of QT in non-brainstem lesion group was higher than that in brainstem lesion group（P<0.05）．There was no significant difference in myocardial repolarization dispersion between left and right brain lesions（P>0.05）．There was a correlation between the maximum QT at admission and NIHSS and mRS scores at discharge（rs=0.561，0.346；P=0.04，0.02）．Conclusion　Among myocardial repolarization dispersion indices，TpTe/QTc in V5 lead is associated with hemorrhagic stroke，and the maximum value of QT is associated with insular lesion，neuropathy and disability.

Key words: Stroke；Electrocardiography；Arrhythmias, cardiac；Myocardial repolarization；Cerebrovascular events；T peaks to end；QT prolongation

摘要： 背景　急性脑卒中患者常有心电图的改变，而心肌复极离散度的心电标记物可用于鉴别恶性心律失常事件的高风险患者。国外已经开展了关于两者相关性的研究，而国内较少开展。因此探讨不同类型脑卒中患者心肌复极离散度的差异及其与预后的相关性意义重大。目的　评估心肌复极离散度指标在急性缺血性脑卒中和出血性脑卒中患者以及颅脑不同病变部位的差异，并探讨其与神经病损程度〔美国国立卫生研究院脑卒中量表（NIHSS）评分〕和残疾程度〔改良Rankin量表（mRS）评分〕的可能关联。方法　回顾性收集2017-01-01至2017-12-31在中南大学湘雅医学院附属海口医院海口市人民医院全科医学科、急诊科、神经内科就诊的63例缺血性脑卒中和出血性脑卒中患者的临床资料进行分析。通过入院时标准12导联心电图检查获取心肌复极离散度指标，包括V5导联中的Q波开始和T波结束之间的时间离散度（QT离散度）、校正的QT（QTc）离散度、T波峰值与结束时时间间隔的离散度（TpTe离散度）和TpTe/QTc，其他导联中的QT间期最大值、QTc间期最大值和TpTe最大值。比较不同脑卒中类型、颅脑不同病变部位患者中心肌复极离散度指标的差异，采用Spearman秩相关法评价心肌复极离散度指标与出院时NIHSS评分及mRS评分的相关性。结果　63例患者中，缺血性脑卒中55例（缺血性脑卒中组），出血性脑卒中8例（出血性脑卒中组）；出血性脑卒中组中V5导联中TpTe/QTc高于缺血性脑卒中组（P=0.034）；颅脑岛叶病变组QT间期最大值较无颅脑岛叶病变组高；无脑干病变组QT间期最大值较有脑干病变组高（P<0.05）。左、右侧颅脑病变患者心肌复极离散度指标比较，差异均无统计学意义（P>0.05）。入院时QT间期最大值与出院时NIHSS、mRS评分间存在相关性（rs=0.561、0.346，P=0.04、0.02）。结论　心肌复极离散度指标中，V5导联的TpTe/QTc与出血性脑卒中有关，QT间期最大值与颅脑岛叶的病变及出院时神经病损程度、残疾程度相关。

关键词: 脑卒中；心电描记术；心律失常, 心性；心肌复极；脑血管事件；T波峰值和波谷之间的时间；QT延长

LI Minglan,PAN Biyun,CHEN Shiyin, et al. Difference of Myocardial Repolarization Dispersion in Patients with Acute Ischemic and Hemorrhagic Stroke　[J]. Chinese General Practice, 2019, 22(30): 3667-3671. DOI: 10.12114/j.issn.1007-9572.2019.00.522.
李名兰,潘碧云,陈仕银等. 缺血性脑卒中和出血性脑卒中患者心肌复极离散度差异研究[J]. 中国全科医学, 2019, 22(30): 3667-3671. DOI: 10.12114/j.issn.1007-9572.2019.00.522.

References

［1］CHEN C H，TANG S C，LEE D Y，et al．Impact of supratentorial cerebral hemorrhage on the complexity of heart rate variability in acute stroke［J］．Sci Rep，2018，8（1）：11473．DOI：10.1038/s41598-018-29961-y.
［2］ACAMPA M，LAZZERINI P E，MARTINI G.Atrial cardiopathy and sympatho-vagal imbalance in cryptogenic stroke：pathogenic mechanisms and effects on electrocardiographic markers［J］．Front Neurol，2018，9：469．DOI：10.3389/fneur.2018.00469.
［3］IM S I，KIM S H，KIM B J，et al．Association of frequent premature ventricular complex >10% and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack［J］．Int J Cardiol Heart Vasc，2018，19：58-62．DOI：10.1016/j.ijcha.2018.05.001.
［4］MEMON M，ALHAZZA M，HEENA H.Stroke presenting as a complication of sarcoidosis in an otherwise asymptomatic patient［J］．Cureus，2018，10（3）：e2362．DOI：10.7759/cureus.2362.
［5］HADI A，BENDRISS L，KHATOURI A.The contribution of systematic implementation of cardiovascular explorations for the detection of cardiac sources of embolism in patients with stroke：About 230 patients［J］．Ann Cardiol Angeiol （Paris），2018，67（4）：256-259．DOI：10.1016/j.ancard.2018.04.002.
［6］SEONG C S，GWAG H B，HWANG J K，et al．Clinical significance of fragmented QRS complexes or J waves in patients with idiopathic ventricular arrhythmias［J］．PLoS One，2018，13（4）：e0194363．DOI：10.1371/journal.pone.0194363.
［7］DOUS G V，GRIGOS A C，GRODMAN R.Elevated troponin in patients with acute stroke - Is it a true heart attack?［J］．Egypt Heart J，2017，69（3）：165-170．DOI：10.1016/j.ehj.2017.01.005.
［8］中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014［J］．中华神经科杂志，2015，48（4）：246-257.
［9］MAGNUSSON P，KOYI H，MATTSSON G.A protocol for a prospective observational study using chest and thumb ECG：transient ECG assessment in stroke evaluation （TEASE） in Sweden［J］．BMJ Open，2018，8（4）：e019933．DOI：10.1136/bmjopen-2017-019933.
［10］KAMEL H，BARTZ T M，ELKIND M S V，et al．Atrial cardiopathy and the risk of ischemic stroke in the CHS （cardiovascular health study）［J］．Stroke，2018，49（4）：980-986．DOI：10.1161/STROKEAHA.117.020059.
［11］RICCI B，CHANG A D，HEMENDINGER M，et al．A simple score that predicts paroxysmal atrial fibrillation on outpatient cardiac monitoring after embolic stroke of unknown source［J］．J Stroke Cerebrovasc Dis，2018，27（6）：1692-1696．DOI：10.1016/j.jstrokecerebrovasdis.2018.01.028.
［12］JOHNSON L S B，PERSSON A P，WOLLMER P，et al．Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation and ischemic stroke［J］．Heart Rhythm，2018，15（6）：805-811．DOI：10.1016/j.hrthm.2018.02.011.
［13］BRAVATA D M，MYERS L J，ARLING G，et al．Quality of care for veterans with transient ischemic attack and minor stroke［J］．JAMA Neurol，2018，75（4）：419-427．DOI：10.1001/jamaneurol.2017.4648.
［14］ROSS L S，BETTIN M，KOCHH?USER S，et al．Sensitive detection of atrial fibrillation in acute stroke patients by short-term bedside electrocardiography monitoring software analysis［J］．Cerebrovasc Dis，2018，45（1/2）：54-60．DOI：10.1159/000485193.
［15］BRAUN F，PROEN?A M，ADLER A，et al．Accuracy and reliability of noninvasive stroke volume monitoring via ECG-gated 3D electrical impedance tomography in healthy volunteers［J］．PLoS One，2018，13（1）：e0191870．DOI：10.1371/journal.pone.0191870.
［16］ANDERSSON E，BOHLIN L，HERLITZ J，et al．Prehospital identification of patients with a final hospital diagnosis of stroke［J］．Prehosp Disaster Med，2018，33（1）：63-70．DOI：10.1017/S1049023X17007178.
［17］WHITE R D，FLAKER G.Smartphone-based arrhythmia detection：should we encourage patients to use the ECG in their pocket?［J］．J Atr Fibrillation，2017，9（6）：1605．DOI：10.4022/jafib.1605.
［18］REINKE F，BETTIN M，ROSS L S，et al．Refinement of detecting atrial fibrillation in stroke patients：results from the TRACK-AF Study［J］．Eur J Neurol，2018，25（4）：631-636．DOI：10.1111/ene.13538.