Objective: To investigate the association of a wide QRS-T angle on the surface ECG and late gadolinium enhancement on contrast-enhanced cardiovascular magnetic (CMR) imaging in patients with clinically suspected myocarditis./nBackground: Diagnosis and risk stratification in patients with suspected myocarditis is particularly challenging due to a great spectrum of clinical presentations. Late gadolinium enhancement (LGE) visualizes myocardial necrosis and fibrosis in patients with biopsy-proven myocarditis. The presence or absence of late gadolinium enhancements in these patients is prognostically meaningful. The QRS-T angle from the surface ECG, on the other hand, may serve as a simple and easily available risk marker in suspected myocarditis./nMethods: We enrolled 97 consecutive patients that were referred to CMR imaging for a clinical suspicion of myocarditis. All patients obtained a standardized digital 12-lead ECG for the calculation of the QRS-T angle and underwent contrast-enhanced CMR imaging. Patients were divided into two groups according to the absence or presence of LGE on CMR./nResults: 78 of 97 patients with suspected myocarditis had LGE on CMR. Patients with LGE had wider QRS-T angles as compared to the patient group without LGE (53.95-47.5 vs. 26.2-21.2; p<0.001). The sensivity, specificity, negative predictive value and positive predictive value for a QRS-T angle above 90 degrees for LGE positive myocarditis were 16.5%, 100%, 24.7%, and 100%, respectively./nConclusion: A wide QRS-T angle of 90 degrees or more is linked to myocardial fibrosis or necrosis (late gadolinium enhancement) in patients with suspected myocarditis.

中文翻译：

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临床疑似心肌炎患者 QRS-T 角与晚期钆增强的关系

目的：探讨临床疑似心肌炎患者表面心电图宽 QRS-T 角与对比增强心血管磁 (CMR) 成像晚期钆增强之间的关系。/n背景：疑似心肌炎患者的诊断和风险分层由于临床表现多种多样，心肌炎尤其具有挑战性。晚期钆增强（LGE）可显示活检证实的心肌炎患者的心肌坏死和纤维化。这些患者是否存在晚期钆增强具有预后意义。另一方面，表面心电图的 QRS-T 角可以作为疑似心肌炎的简单且容易获得的风险标记。/n方法：我们连续招募了 97 名因临床怀疑心肌炎而转诊至 CMR 成像的患者。所有患者均获得标准化数字 12 导联心电图，用于计算 QRS-T 角，并接受对比增强 CMR 成像。根据 CMR 上是否存在 LGE，将患者分为两组。/n结果： 97 名疑似心肌炎患者中，有 78 名 CMR 上有 LGE。与无 LGE 的患者组相比，患有 LGE 的患者具有更宽的 QRS-T 角（53.95-47.5 vs. 26.2-21.2；p<0.001）。QRS-T 角大于 90 度的 LGE 阳性心肌炎的敏感性、特异性、阴性预测值和阳性预测值分别为 16.5%、100%、24.7% 和 100%。/n 结论：宽QRS-T 90度或更大的角度与疑似心肌炎患者的心肌纤维化或坏死（晚期钆增强）有关。