Introduction
Materials and methods
Study population
ECG data analysis
CMR imaging protocol and data analysis
Statistical analysis
Results
Baseline characteristics
n = 51 | ||
---|---|---|
Baseline parameter
| ||
Age (years) | 32 ± 13 | |
Male | 42 (82) | |
BMI (kg/m2) | 27 ± 5 | |
Cardiovascular risk factors
| ||
Hypertension | 5 (10) | |
Diabetes | 2 (4) | |
Dyslipidemia | 3 (6) | |
Smoking | 24 (47) | |
active smoker | 18 (35) | |
Family risk of CAD | 12 (24) | |
Clinical presentation
| ||
Chest pain | 44 (86) | |
Dyspnea | 10 (20) | |
Palpitation | 9 (18) | |
Dizziness or syncope | 5 (10) | |
Fever | 15 (29) | |
Recent respiratory infection or flu | 22 (43) | |
Recent gastrointestinal infection | 14 (27) | |
Recent other infection | 4 (6) | |
Laboratory parameter at admission
| ||
CRP (mg/ml) | 26 (IQR: 7–66) | |
CK (U/l) | 218 (IQR: 109–426) | |
Hs-TnT (ng/l) | 303 (IQR: 134–803) | |
Myoglobin (µg/l) | 33 (IQR: 23–75) | |
NT-proBNP (ng/l) | 177 (IQR: 71–734) | |
Timing of examinations
| ||
Admission to baseline CMR (days) | 2 (IQR: 1–3) | |
Baseline to follow-up CMR (days) | 93 (81–110) | |
Follow-up ECG and CMR (days) | 8 (1–11) |
ECG findings at baseline and at follow-up
n = 51 | |||
---|---|---|---|
ECG parameters
|
Baseline
|
Follow-up
|
p-value
|
Non-sinus rhythm | 1 (2) | 1 (2) | 1.000 |
Ventricular extrasystole | 3 (6) | 2 (4) | 1.000 |
Atrioventricular-block | 1 (2) | 1 (2) | 1.000 |
Fascicular-block | 2 (4) | 5 (10) | 0.250 |
> 0.5 mm PQ depression | 2 (4) | 1 (2) | 1.000 |
> 1 mm ST-segment elevation | 16 (31) | 1 (2) | < 0.001 |
> 1 mm ST-segment depression | 3 (6) | 1 (2) | 0.500 |
T-inversion | 19 (37) | 14 (27) | 0.332 |
Pathological QRS-T angle (> 100o) | 4 (8) | 2 (4) | 0.500 |
Wide QRS complex (> 120 ms) | 2 (4) | 0 (0) | 1.000 |
Prolonged QTc interval (> 420 ms) | 19 (37) | 8 (16) | 0.007 |
CMR parameters
|
Baseline
|
Follow-up
|
p-value
|
LVEDDi (mm/m2) | 27 ± 3 | 27 ± 3 | 0.231 |
Septum thickness (mm) | 8 ± 1 | 8 ± 1 | 0.702 |
Lateral wall thickness (mm) | 9 ± 2 | 8 ± 1 | < 0.001 |
LVEF (%) | 57 ± 7 | 57 ± 5 | 0.619 |
LVEDVi (ml/m2) | 84 ± 16 | 82 ± 16 | 0.199 |
LVESVi (ml/m2) | 37 ± 11 | 35 ± 9 | 0.273 |
LV mass index (g/m2) | 60 ± 14 | 51 ± 9 | < 0.001 |
RVEF (%) | 59 ± 10 | 60 ± 6 | 0.852 |
RVEDVi (ml/m2) | 79 ± 15 | 80 ± 17 | 0.390 |
RVESVi (ml/m2) | 33 ± 8 | 32 ± 10 | 0.285 |
Visual presence score (VPS) | 3 (IQR: 1–5) | 2 (IQR: 1–4) | < 0.001 |
Visual transmurality score (VTS) | 6 (IQR: 3–11) | 3 (IQR: 1–6) | < 0.001 |
CMR findings at baseline and at follow-up
Association between ECG and CMR abnormalities
Outcome | Predictor | Univariate analysis | Multivariate analysis | ||||||
---|---|---|---|---|---|---|---|---|---|
Beta | 95% CI | p-value | Beta | 95% CI | p-value | ||||
VPS | Non-sinus rhythm | -3.58 | -8.8 | 1.64 | 0.19 | - | - | - | - |
Ventricular extrasystole | -1.6 | -4.7 | 1.49 | 0.32 | - | - | - | - | |
Atrioventricular-block | 0.5 | -4.81 | 5.81 | 0.85 | - | - | - | - | |
Fascicular-block | -3.13 | -6.82 | 0.56 | 0.85 | - | - | - | - | |
> 0.5 mm PQ depression | -1.57 | -5.34 | 2.2 | 0.42 | - | - | - | - | |
> 1 mm ST- elevation | 3.08 | 1.75 | 4.41 |
< 0.001
| 3.08 | 1.75 | 4.41 |
< 0.001
| |
> 1 mm ST- depression | 1.94 | -1.15 | 5.02 | 0.22 | - | - | - | - | |
T-inversion | -0.56 | -2.08 | 0.95 | 0.47 | - | - | - | - | |
Pathological QRS-T angle | -0.02 | -0.04 | 0.01 | 0.18 | - | - | - | - | |
Wide QRS complex | 0.02 | -0.02 | 0.06 | 0.34 | - | - | - | - | |
Prolonged QTc interval | -0.02 | -0.04 | < 0.01 | 0.05 | - | - | - | - | |
VTS | Non-sinus rhythm | -7.78 | -20.15 | 4.59 | 0.19 | - | - | - | - |
Ventricular extrasystole | -3.15 | 10.5 | 4.21 | 0.41 | - | - | - | - | |
Atrioventricular-block | 0.38 | -12.18 | 12.94 | 0.95 | - | - | - | - | |
Fascicular-block | -6.32 | -15.17 | 2.42 | 0.16 | - | - | - | - | |
> 0.5 mm PQ depression | -2.74 | -11.68 | 6.21 | 0.55 | - | - | - | - | |
> 1 mm ST- elevation | 6.46 | 3.17 | 9.75 |
< 0.001
| 5.4 | 1.92 | 8.88 |
0.004
| |
> 1 mm ST- depression | 9.6 | 2.71 | 16.5 |
0.008
| 5.67 | -1.2 | 12.54 | 0.11 | |
T-inversion | -1.59 | -5.16 | 1.99 | 0.39 | - | - | - | - | |
Pathological QRS-T angle | -0.05 | -0.1 | 0.003 | 0.069 | - | - | - | - | |
Wide QRS complex | 0.08 | -0.01 | 0.16 | 0.09 | - | - | - | - | |
Prolonged QTc interval | -0.03 | -0.08 | 0.02 | 0.27 | - | - | - | - |
Region
| Outcome | Predictor | Univariate analysis | Multivariate analysis | ||||||
---|---|---|---|---|---|---|---|---|---|---|
β
|
95% CI
|
p-value
|
β
|
95% CI
|
p-value
| |||||
Anterior-septal
| VPS | > 1 mm ST- elevation | 0.11 | -0.79 | 1.00 | 0.81 | - | - | - | - |
> 1 mm ST- depression | 0.10 | -1.13 | 1.33 | 0.87 | - | - | - | - | ||
T-inversion | 0.45 | -1.04 | 1.94 | 0.56 | - | - | - | - | ||
VTS | > 1 mm ST- elevation | -0.13 | -1.87 | 1.60 | 0.88 | - | - | - | - | |
> 1 mm ST- depression | -1.06 | -1.06 | 3.64 | 0.29 | - | - | - | - | ||
T-inversion | 0.92 | -1.95 | 3.78 | 0.53 | - | - | - | - | ||
Lateral
| VPS | > 1 mm ST- elevation | 1.60 | 0.74 | 2.46 |
< 0.001
| 1.60 | 0.74 | 2.46 |
< 0.001
|
> 1 mm ST- depression | 0.82 | -2.30 | 3.94 | 0.61 | - | - | - | - | ||
T-inversion | 0.33 | -1.28 | 1.94 | 0.69 | - | - | - | - | ||
VTS | > 1 mm ST- elevation | 3.46 | 1.06 | 5.86 |
0.007
| 3.46 | 1.06 | 5.86 |
0.007
| |
> 1 mm ST- depression | 7.44 | -0.63 | 15.51 | 0.08 | - | - | - | - | ||
T-inversion | -1.04 | -5.33 | 3.25 | 0.64 | - | - | - | - | ||
Inferior
| VPS | > 1 mm ST- elevation | 0.85 | 0.28 | 1.42 |
0.005
| 0.79 | 0.24 | 1.35 |
0.008
|
> 1 mm ST- depression | - | - | - | - | - | - | - | - | ||
T-inversion | -0.50 | -0.98 | -0.02 |
0.045
| -0.43 | -0.88 | 0.02 | 0.07 | ||
VTS | > 1 mm ST- elevation | 1.72 | 0.18 | 3.26 |
0.033
| 1.72 | 0.18 | 3.26 |
0.033
| |
> 1 mm ST- depression | 2.29 | -0.82 | 5.39 | 0.16 | - | - | - | - | ||
T-inversion | -0.94 | -2.22 | 0.34 | 0.16 | - | - | - | - |
ECG parameter | Baseline | Follow-up |
Univariate analysis
|
Multivariate analysis
| |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
VPS change | VTS change | VPS change | VTS change | ||||||||||||||||
β
|
95%CI
|
p value
|
β
|
95% CI
|
p value
|
β
|
95%CI
|
p value
|
β
|
95%CI
|
p value
| ||||||||
NS rhythm | - | + | 1.12 | -2.07 | 4.32 | 0.50 | 3.78 | -4.76 | 12.31 | 0.39 |
-
|
-
| - |
-
|
-
|
-
|
-
|
-
| |
+ | - | 1.12 | -2.08 | 4.32 | 0.50 | 3.78 | -4.76 | 12.31 | 0.39 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
+ | + |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
VES | - | + | 1.15 | -2.07 | 4.37 | 0.49 | 3.81 | -4.84 | 12.46 | 0.39 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| |
+ | - | 1.15 | -1.15 | 3.45 | 0.33 | 1.31 | -4.87 | 7.49 | 0.07 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
+ | + | 0.15 | -3.07 | 3.37 | 0.93 | 2.81 | -5.84 | 11.46 | 0.53 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
AV-block | - | + |
-
|
-
|
-
|
-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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+ | - |
-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
| ||
+ | + | 0.08 | -3.16 | 3.26 | 0.96 | -0.38 | -8.96 | 8.20 | 0.93 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
FA-block | - | + | -0.58 | -2.46 | 1.30 | 0.59 | -8.78 | -13.19 | -4.38 |
< 0.001
| - | - | - |
-
| -2.70 | -6.29 | 0.86 | 0.15 | |
+ | - |
-
|
-
|
-
|
-
|
-
|
-
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-
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-
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-
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-
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-
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-
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-
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-
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-
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-
| ||
+ | + | 1.09 | -1.19 | 3.36 | 0.35 | 2.72 | -2.62 | 8.06 | 0.323 |
-
|
-
|
-
|
-
| 0.09 | -3.66 | 3.83 | 0.96 | ||
PQ depression | - | + |
-
|
-
|
-
|
-
| - | - | - | - | |||||||||
+ | - | 1.08 | -2.12 | 4.29 | 0.51 | -1.37 | -10.01 | 7.28 | 0.76 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
+ | + | 0.91 | -4.12 | 2.29 | 0.58 | 1.63 | -7.01 | 10.28 | 0.71 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
ST- elevation | - | + |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| |||||||||
+ | - | -1.49 | -2.41 | -0.57 |
0.003
| -4.87 | -7.18 | -2.56 |
0.001
| -0.47 | -1.43 | 0.49 | 0.34 | -2.39 | -4.32 | -0.47 |
0.02
| ||
+ | + | -0.34 | -2.46 | 1.77 | 0.75 | 1.34 | -3.97 | 6.66 | 0.62 | 0.44 | -1.46 | 2.35 | 0.65 | 2.67 | -1.07 | 6.34 | 0.17 | ||
ST- depression | - | + |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| |||||||||
+ | - | -0.94 | -3.22 | 1.34 | 0.42 | -7.08 | -12.90 | -1.27 |
0.021
|
-
|
-
|
-
|
-
| -0.63 | -4.76 | 3.50 | 0.77 | ||
+ | + | 1.06 | -2.13 | 4.26 | 0.52 | 3.42 | -4.72 | 11.55 | 0.41 |
-
|
-
|
-
|
-
| 10.57 | 5.08 | 16.06 |
< 0.001
| ||
T-inversion | - | + | -0.01 | -1.46 | 1.44 | 0.99 | 0.83 | -3.07 | 4.74 | 0.68 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| |
+ | - | -0.03 | -1.18 | 1.13 | 0.96 | 0.36 | -2.74 | 3.46 | 0.82 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
+ | + | 0.53 | -0.77 | 1.83 | 0.43 | 1.25 | -2.24 | 4.74 | 0.49 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| ||
QRS-T angle change [°] | 0.008 | -0.004 | 0.021 | 0.20 | 0.023 | -0.011 | 0.057 | 0.19 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| |||
QRS interval change [msec] | 0.001 | -0.009 | 0.011 | 0.79 | -0.006 | -0.033 | 0.021 | 0.67 |
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
| |||
QTc change [msec] | -0.003 | -0.017 | 0.011 | 0.70 | -0.011 | -0.048 | 0.027 | 0.58 |
-
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-
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-
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-
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-
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-
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