Prevalence and Significance of an Early Repolarization Electrocardiographic Pattern and its Mechanistic Insight Based on Cardiac Magnetic Resonance Imaging in Patients with Acute Myocarditis

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  • Oka Eiichiro
    Department of Cardiovascular Medicine, Nippon Medical School
  • Iwasaki Yu-ki
    Department of Cardiovascular Medicine, Nippon Medical School
  • Shimizu Wataru
    Department of Cardiovascular Medicine, Nippon Medical School

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  • 急性心筋炎における早期再分極心電図所見の頻度と臨床的意義，および心臓磁気共鳴画像法に基づく機序の検討

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Abstract

<p>An early repolarization electrocardiogram（ER-ECG）pattern is caused by various pathophysiological conditions. However, little evidence on the relationship between ER-ECG pattern and acute myocarditis has been reported. The purpose of this study was to investigate the prevalence and significance of the ER-ECG pattern in acute myocarditis. Thirty patients（23 males, 39.2±19.1 years）diagnosed with acute myocarditis by clinical presentations between March 2011 and April 2018 were retrospectively evaluated. Nine cases showed localized ER-ECG pattern which was defined as terminal QRS notching or slurring with amplitude of＞0.1mV in at least 2 leads（ER Group）, while the remaining 21 cases had broad ST elevation or pathologic Q waves（non-ER group）. Cardiac troponin T level was much higher in the non-ER group than in the ER-group（3.2±4.3 vs 0.9±1.2ng/ml, p=0.036）. ECG changes returned to baseline along with the normalization of cardiac biomarkers. Nine of the 21 non-ER group patients, but none of the 9 ER-group patients, developed fulminant course and lethal ventricular tachyarrhythmias. T2-weighted cardiac MRI showed high intensity signal over the entire transmural left ventricle（LV）in the non-ER group, whereas it showed at only LV epicardial lesion in the ER group. In conclusion, inflammation/swelling localized to the LV epicardium due to acute myocarditis leading to a ventricular transmural voltage gradient might provide a mechanistic insight for the ER-ECG pattern. The ER-ECG pattern in patients with acute myocarditis was not associated with the development of lethal ventricular tachyarrhythmias.</p>

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