cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2021.12.n1896cardio-1896Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESФакторы, связанные с увеличением пространственного и фронтального углов QRS-T у больных инфарктом миокарда передней локализацииFactors associated with an increase in spatial and frontal QRS-T angles in patients with anterior myocardial infarctionhttps://orcid.org/0000-0002-5543-7184СахноваТ. А.SakhnovaT. A.

старший научный сотрудник Лаборатории ЭКГ, SPIN-код: 4206-2550 

Senior Researcher, ECG Laboratory

tamara-sahnova@mail.ruhttps://orcid.org/0000-0001-8725-7084БлиноваЕ. В.BlinovaE. V.

научный сотрудник Лаборатории ЭКГ, SPIN-код: 3306-6128 

Researcher, ECG Laboratory

blinova2009.73@mail.ruhttps://orcid.org/0000-0003-3577-712XМеркуловаИ. Н.MerkulovaI. N.

ведущий научный сотрудник Отдела неотложной кардиологии, SPIN-код: 8864-5161 

Leading Researcher, Department of Emergency Cardiology

irina_merkulova@list.ruhttps://orcid.org/0000-0003-3248-0224ШахновичР. М.ShakhnovichR. M.

ведущий научный сотрудник Отдела неотложной кардиологии, SPIN-код: 9864-1107 

Leading Researcher, Department of Emergency Cardiology

shakhnovich@mail.ruhttps://orcid.org/0000-0002-3547-4527ЖуковаН. С.ZhukovaN. S.

старший научный сотрудник Отдела неотложной кардиологии, SPIN-код: 9033-7228 

Senior Researcher, Department of Emergency Cardiology

cardionat@gmail.comhttps://orcid.org/0000-0002-5509-6623СухининаТ. С.SukhininaT. S.

научный сотрудник Отдела неотложной кардиологии, SPIN-код: 6629-7608 

Researcher, Department of Emergency Cardiology

sukhinina.t@mail.ruБарышеваН. А.BaryshevaN. A.

младший научный сотрудник Отдела неотложной кардиологии, SPIN-код: 5450-6524

junior researcher, Department of Emergency Cardiology

nataly-siu@mail.ruhttps://orcid.org/0000-0002-0049-6101СтароверовИ. И.StaroverovI. I.

главный научный сотрудник Отдела неотложной кардиологии

Chief Researcher, Department of Emergency Cardiology

i-staroverov@yandex.ruФГБУ «НМИЦ кардиологии» МЗ РФ, Москва, РоссияРоссияNational Medical Research Center of Cardiology, Moscow, RussiaRussian Federation20213112202161122230Copyright © Kardiomag, 20212021KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1896

Цель    Определить наличие связи каких‑либо клинических, эхокардиографических и коронарографических факторов с увеличением пространственного угла QRS-T (sQRS-T) и фронтального угла QRS-T (fQRS-T) у больных инфарктом миокарда передней локализации.Материал и методы    В исследование было включено 137 больных в возрасте 62 [53; 72] лет, находившихся на лечении в ИКК им. А. Л. Мясникова с диагнозом «острый инфаркт миокарда передней локализации». fQRS-T вычислялся, как модуль разницы между осью комплекса QRS и осью зубца Т во фронтальной плоскости. sQRS-T вычисляли, как пространственный угол между интегральными векторами QRS и Т с использованием синтезированной векторкардиограммы.Результаты    Значения fQRS-T в группе (медиана [25‑й; 75‑й перцентиль]) составили 81 [37; 120]°, значения sQRS-T составили 114 [80; 141]°. Коэффициент корреляции между значениями fQRS-T и sQRS-T составил 0,41 (p<0,001). fQRS-T имел слабые, но статистически значимые корреляционные связи с возрастом больных (r=0,28; p=0,001), фракцией выброса левого желудочка (ФВ ЛЖ, r= –0,22; p=0,01) и скоростью клубочковой фильтрации (r=–0,32; p=0,0002). sQRS-T имел слабые, но статистически значимые корреляционные связи с конечным диастолическим размером левого желудочка (r=0,24; p=0,0048), ФВ ЛЖ (r=–0,28; p=0,0009) и числом пораженных сегментов по данным эхокардиографии (r=0,27; p=0,002). Значения fQRS-T были статистически значимо больше при наличии сопутствующей артериальной гипертонии. Значения sQRS-T были статистически значимо больше при наличии в анамнезе хронической сердечной недостаточности. Значения как fQRS-T, так и sQRS-T нарастали по мере увеличения числа пораженных сосудов и класса острой сердечной недостаточности по Killip.Заключение    У больных, перенесших острый инфаркт миокарда передней локализации, увеличение fQRS-T и sQRS-T сопряжено с более тяжелым поражением коронарного русла, снижением ФВ ЛЖ и, соответственно, более тяжелым клиническим течением заболевания.

Aim    To determine existence of a relationship between any clinical, echocardiographic and coronarographic factors and increased spatial QRS-T (sQRS-T) angle and frontal QRS-T (fQRS-T) angle in patients with anterior myocardial infarction.Material and methods    This study included 137 patients aged 62 [53; 72] years with anterior acute myocardial infarction managed at the A.L. Myasnikov Institute of Clinical Cardiology. fQRS-T was calculated as the module of difference between the frontal plane QRS complex axis and the T wave axis. sQRS-T was calculated as a spatial angle between QRS and T integral vectors from a synthesized vectorcardiogram.Results    fQRS-T values for a group (median [25th; 75th percentile]) were 81 [37; 120]°; sQRS-T values were 114 [80; 141]°. The correlation coefficient between fQRS-T and sQRS-T values was 0.41 (p<0.001). fQRS-T weakly but statistically significantly correlated with patients’ age (r=0.28; p=0.001), left ventricular ejection fraction (LV EF, r= –0.22; p=0.01), and glomerular filtration rate (r=–0.32; p=0.0002). sQRS-T weakly but statistically significantly correlated with left ventricular end-diastolic dimension (r=0.24; p=0.0048), LV EF (r=–0.28; p=0.0009), and the number of affected segments according to echocardiography data (r=0.27; p=0.002). fQRS-T values were significantly higher in the presence of concurrent arterial hypertension. sQRS-T values were significantly higher in the presence of a history of chronic heart failure. Both fQRS-T and sQRS-T values increased with increasing number of affected blood vessels and Killip class of acute heart failure.Conclusion    In patients after anterior acute myocardial infarction, increases in fQRS-T and sQRS-T are associated with more severe damage of the vasculature, decreased LV EF, and, thus, more severe clinical course of disease.

 

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The authors declare that there are no conflicts of interest present.