{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T08:39:34Z","timestamp":1775291974866,"version":"3.50.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81700392"],"award-info":[{"award-number":["81700392"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81700389"],"award-info":[{"award-number":["81700389"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Municipal Medical Science Technology Development Foundation of Nanjing","award":["YKK19063"],"award-info":[{"award-number":["YKK19063"]}]},{"name":"The Municipal Medical Science Technology Development Foundation of Nanjing","award":["YKK17085"],"award-info":[{"award-number":["YKK17085"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The study was performed to assess the diagnostic capability of ECG on the cardiogenic shock (CS) in acute myocarditis. A new score was derived from the combination of the ECG parameters and the diagnostic value was also evaluated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Total 103 consecutive patients with acute myocarditis admitted in Nanjing Drum Hospital were enrolled in the current study. The cohort was divided into fulminant myocarditis group (FM, n\u2009=\u200920) and non fulminant myocarditis group (NFM, n\u2009=\u200983). The demographic features, results of electrocardiography (ECG) and ultracardiography were compared. Logistic regression analysis was conducted to identify the relevant factors in ECG parameters. We created a new variable called \u201cECG score\u201d by certain combination of ECG parameters. The diagnostic capability of ECG score for CS was compared with the existing diagnostic indices using regression model and receiver-operating characteristics (ROC) analysis.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were several changes on ECG significantly different between the two groups. Multivariate regression analysis demonstrated PR\u2009+\u2009QRS interval (<jats:italic>P<\/jats:italic>\u2009=\u20090.008), ventricular arrhythmia (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) and pathological Q wave (<jats:italic>P<\/jats:italic>\u2009=\u20090.003) were the independent relevant factors of CS. The derived variable \u201cECG score\u201d was identified as a significant relevant factor of CS by multivariate regression model. ROC analysis showed PR\u2009+\u2009QRS interval, ventricular arrhythmia and pathological Q wave all had equivalent diagnostic capability to left ventricular ejection fraction (LVEF) and shock index (SI). ECG score was equivalent to LVEF but superior to SI in diagnosing CS<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>ECG was valuable in diagnosing CS due to acute myocarditis. The ECG score was superior to the traditional diagnostic indices and could be used for an rapid recognition of CS.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12872-020-01796-4","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T01:02:33Z","timestamp":1606784553000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The diagnostic capability of electrocardiography on the cardiogenic shock in the patients with acute myocarditis"],"prefix":"10.1186","volume":"20","author":[{"given":"Dan","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianzhou","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingmei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1087-5487","authenticated-orcid":false,"given":"Zhonghai","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"key":"1796_CR1","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1093\/aje\/kwk076","volume":"165","author":"V Kyto","year":"2007","unstructured":"Kyto V, Saraste A, Voipio-Pulkki LM, Saukko P. Incidence of fatal myocarditis: a population-based study in Finland. Am J Epidemiol. 2007;165:570\u20134.","journal-title":"Am J Epidemiol"},{"key":"1796_CR2","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1016\/S0140-6736(15)60692-4","volume":"386","author":"Global Burden of Disease Study 2013 Collaborators","year":"2015","unstructured":"Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990\u20132013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386:743\u2013800.","journal-title":"Lancet"},{"key":"1796_CR3","doi-asserted-by":"publisher","first-page":"1954","DOI":"10.1016\/j.amjcard.2019.09.017","volume":"124","author":"AN Sharma","year":"2019","unstructured":"Sharma AN, Stultz JR, Bellamkonda N, Amsterdam EA. Fulminant myocarditis: epidemiology, pathogenesis, diagnosis, and management. Am J Cardiol. 2019;124:1954\u201360.","journal-title":"Am J Cardiol"},{"key":"1796_CR4","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1056\/NEJM200003093421003","volume":"342","author":"RE McCarthy 3rd","year":"2000","unstructured":"McCarthy RE 3rd, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM, Baughman KL. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000;342:690\u20135.","journal-title":"N Engl J Med"},{"key":"1796_CR5","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1161\/CIRCULATIONAHA.117.026386","volume":"136","author":"E Ammirati","year":"2017","unstructured":"Ammirati E, Cipriani M, Lilliu M, Sormani P, Varrenti M, Raineri C, Petrella D, Garascia A, Pedrotti P, Roghi A, Bonacina E, Moreo A, Bottiroli M, Gagliardone MP, Mondino M, Ghio S, Totaro R, Turazza FM, Russo CF, Oliva F, Camici PG, Frigerio M. Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Circulation. 2017;136:529\u201345.","journal-title":"Circulation"},{"key":"1796_CR6","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1007\/s00380-011-0211-8","volume":"28","author":"K Ishida","year":"2013","unstructured":"Ishida K, Wada H, Sakakura K, Kubo N, Ikeda N, Sugawara Y, Ako J, Momomura S. Long-term follow-up on cardiac function following fulminant myocarditis requiring percutaneous extracorporeal cardiopulmonary support. Heart Vessels. 2013;28:86\u201390.","journal-title":"Heart Vessels"},{"key":"1796_CR7","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1177\/1076029609351877","volume":"17","author":"A Bircan","year":"2011","unstructured":"Bircan A, Karadeniz N, Ozden A, Cakir M, Varol E, Oyar O, Ozaydin M. A simple clinical model composed of ECG, shock index, and arterial blood gas analysis for predicting severe pulmonary embolism. Clin Appl Thromb Hemost. 2011;17:188\u201396.","journal-title":"Clin Appl Thromb Hemost"},{"key":"1796_CR8","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1016\/j.ajem.2013.01.014","volume":"31","author":"LD Rappaport","year":"2013","unstructured":"Rappaport LD, Deakyne S, Carcillo JA, McFann K, Sills MR. Age- and sex-specific normal values for shock index in national health and nutrition examination survey 1999\u20132008 for ages 8 years and older. Am J Emerg Med. 2013;31:838\u201342.","journal-title":"Am J Emerg Med"},{"key":"1796_CR9","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1002\/jhm.779","volume":"5","author":"AS Keller","year":"2010","unstructured":"Keller AS, Kirkland LL, Rajasekaran SY, Cha S, Rady MY, Huddleston JM. Unplanned transfers to the intensive care unit: the role of the shock index. J Hosp Med. 2010;5:460\u20135.","journal-title":"J Hosp Med"},{"key":"1796_CR10","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.ejim.2010.12.009","volume":"22","author":"P Sankaran","year":"2011","unstructured":"Sankaran P, Kamath AV, Tariq SM, Ruffell H, Smith AC, Prentice P, Subramanian DN, Musonda P, Myint PK. Are shock index and adjusted shock index useful in predicting mortality and length of stay in community-acquired pneumonia? Eur J Intern Med. 2011;22:282\u20135.","journal-title":"Eur J Intern Med"},{"key":"1796_CR11","doi-asserted-by":"publisher","first-page":"12726","DOI":"10.1111\/anec.12726","volume":"25","author":"C Butt\u00e0","year":"2020","unstructured":"Butt\u00e0 C, Zappia L, Laterra G, Roberto M. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Ann Noninvasive Electrocardiol. 2020;25:12726.","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"1796_CR12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.emc.2005.08.003","volume":"24","author":"D Demangone","year":"2006","unstructured":"Demangone D. ECG manifestations: noncoronary heart disease. Emerg Med Clin N Am. 2006;24:113\u201331.","journal-title":"Emerg Med Clin N Am"},{"key":"1796_CR13","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.ajem.2008.12.017","volume":"28","author":"M Punja","year":"2010","unstructured":"Punja M, Mark DG, McCoy JV, Javan R, Pines JM, Brady W. Electrocardiographic manifestations of cardiac infectious-inflammatory disorders. Am J Emerg Med. 2010;28:364\u201377.","journal-title":"Am J Emerg Med"},{"key":"1796_CR14","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1253\/circj.CJ-18-0136","volume":"82","author":"A Sawamura","year":"2018","unstructured":"Sawamura A, Okumura T, Ito M, Ozaki Y, Ohte N, Amano T, Murohara T. Prognostic value of electrocardiography in patients with fulminant myocarditis supported by percutaneous venoarterial extracorporeal membrane oxygenation\u2014analysis from the change pump study. Circ J. 2018;82:2089\u201395.","journal-title":"Circ J"},{"key":"1796_CR15","doi-asserted-by":"publisher","first-page":"e14697","DOI":"10.1097\/MD.0000000000014697","volume":"98","author":"Z Wang","year":"2019","unstructured":"Wang Z, Wang Y, Lin H, Wang S, Cai X, Gao D. Early characteristics of fulminant myocarditis vs non-fulminant myocarditis: a meta-analysis. Medicine (Baltimore). 2019;98:e14697.","journal-title":"Medicine (Baltimore)"},{"issue":"2636\u20132648","key":"1796_CR16","first-page":"2648a","volume":"34","author":"AL Caforio","year":"2013","unstructured":"Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Helio T, Heymans S, Jahns R, Klingel K, Linhart A, Maisch B, McKenna W, Mogensen J, Pinto YM, Ristic A, Schultheiss HP, Seggewiss H, Tavazzi L, Thiene G, Yilmaz A, Charron P, Elliott PM. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on myocardial and pericardial diseases. Eur Heart J. 2013;34(2636\u20132648):2648a\u20132648d.","journal-title":"Eur Heart J"},{"key":"1796_CR17","doi-asserted-by":"publisher","first-page":"e69","DOI":"10.1161\/CIR.0000000000000745","volume":"141","author":"RD Kociol","year":"2020","unstructured":"Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA, Shah RV, Sims DB, Thiene G, Vardeny O. Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association. Circulation. 2020;141:e69\u201392.","journal-title":"Circulation"},{"key":"1796_CR18","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1093\/eurheartj\/ehs104","volume":"33","author":"JJ McMurray","year":"2012","unstructured":"McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur Heart J. 2012;33:1787\u2013847.","journal-title":"Eur Heart J."},{"key":"1796_CR19","doi-asserted-by":"publisher","first-page":"659","DOI":"10.2169\/internalmedicine.33.659","volume":"33","author":"H Nakashima","year":"1994","unstructured":"Nakashima H, Honda Y, Katayama T. Serial electrocardiographic findings in acute myocarditis. Intern Med. 1994;33:659\u201366.","journal-title":"Intern Med"},{"key":"1796_CR20","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/j.jelectrocard.2014.07.018","volume":"47","author":"S Jhamnani","year":"2014","unstructured":"Jhamnani S, Fuisz A, Lindsay J. The spectrum of electrocardiographic manifestations of acute myocarditis: an expanded understanding. J Electrocardiol. 2014;47:941\u20137.","journal-title":"J Electrocardiol"},{"key":"1796_CR21","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.ijcard.2011.07.090","volume":"165","author":"CC Deluigi","year":"2013","unstructured":"Deluigi CC, Ong P, Hill S, Wagner A, Kispert E, Klingel K, Kandolf R, Sechtem U, Mahrholdt H. ECG findings in comparison to cardiovascular MR imaging in viral myocarditis. Int J Cardiol. 2013;165:100\u20136.","journal-title":"Int J Cardiol"},{"key":"1796_CR22","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.ccc.2013.03.004","volume":"29","author":"F Ginsberg","year":"2013","unstructured":"Ginsberg F, Parrillo JE. Fulminant myocarditis. Crit Care Clin. 2013;29:465\u201383.","journal-title":"Crit Care Clin"},{"key":"1796_CR23","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1002\/clc.22088","volume":"36","author":"G Nucifora","year":"2013","unstructured":"Nucifora G, Miani D, Di Chiara A, Piccoli G, Artico J, Puppato M, Slavich G, De Biasio M, Gasparini D, Proclemer A. Infarct-like acute myocarditis: relation between electrocardiographic findings and myocardial damage as assessed by cardiac magnetic resonance imaging. Clin Cardiol. 2013;36:146\u201352.","journal-title":"Clin Cardiol"},{"key":"1796_CR24","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1136\/hrt.2005.079053","volume":"93","author":"M Graner","year":"2007","unstructured":"Graner M, Lommi J, Kupari M, Raisanen-Sokolowski A, Toivonen L. Multiple forms of sustained monomorphic ventricular tachycardia as common presentation in giant-cell myocarditis. Heart. 2007;93:119\u201321.","journal-title":"Heart"},{"key":"1796_CR25","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1161\/CIRCULATIONAHA.118.035319","volume":"138","author":"E Ammirati","year":"2018","unstructured":"Ammirati E, Cipriani M, Moro C, Raineri C, Pini D, Sormani P, Mantovani R, Varrenti M, Pedrotti P, Conca C, Mafrici A, Grosu A, Briguglia D, Guglielmetto S, Perego GB, Colombo S, Caico SI, Giannattasio C, Maestroni A, Carubelli V, Metra M, Lombardi C, Campodonico J, Agostoni P, Peretto G, Scelsi L, Turco A, Di Tano G, Campana C, Belloni A, Morandi F, Mortara A, Ciro A, Senni M, Gavazzi A, Frigerio M, Oliva F, Camici PG. Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis. Circulation. 2018;138:1088\u201399.","journal-title":"Circulation"},{"key":"1796_CR26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12968-015-0185-2","volume":"17","author":"F Sanguineti","year":"2015","unstructured":"Sanguineti F, Garot P, Mana M, O\u2019H-Ici D, Hovasse T, Unterseeh T, Louvard Y, Troussier X, Morice MC, Garot J. Cardiovascular magnetic resonance predictors of clinical outcome in patients with suspected acute myocarditis. J Cardiovasc Magn Reson. 2015;17:78.","journal-title":"J Cardiovasc Magn Reson"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-020-01796-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12872-020-01796-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-020-01796-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T08:03:14Z","timestamp":1608624194000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-020-01796-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1796"],"URL":"https:\/\/doi.org\/10.1186\/s12872-020-01796-4","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]},"assertion":[{"value":"14 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 November 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 December 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2020","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"In the original publication, the authors' email addresses should be swapped in the footnote. The article has been updated.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study has been approved by the Medical Ethics Committee of Nanjing Drum Tower Hospital, Medical School of Nanjing University (2019-190-01). All the participants were consent to participate with the verbal consent and it has been approved by the ethics committee. The database is not open to public, thus the individual privacy of the participants could be well protected.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"502"}}