Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Tako-Tsubo cardiomyopathy
- PMID: 22975421
- DOI: 10.1016/j.hrthm.2012.09.004
Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Tako-Tsubo cardiomyopathy
Abstract
Background: Tako-Tsubo cardiomyopathy (TTC) presents with chest pain, ST-segment elevation followed by T-wave inversion and QT interval prolongation (Wellens' electrocardiographic [ECG] pattern), and left ventricular dysfunction, which may mimic an acute coronary syndrome.
Objective: To assess the pathophysiologic basis of the Wellens' ECG pattern in TTC by characterization of underlying myocardial changes by using cardiac magnetic resonance (CMR).
Methods: The study population included 20 consecutive patients with TTC (95% women; mean age 65.3 ± 10.4 years) who underwent CMR studies both in the initial phase and after 3-month follow-up by using a protocol that included cine images, T2-weighted sequences for myocardial edema, and post-contrast sequences for late gadolinium enhancement. Quantitative ECG indices of repolarization, such as maximal amplitude of negative T waves, sum of the amplitudes of negative T waves, and maximum corrected QT interval (QTc max), were correlated to CMR findings.
Results: At the time of initial CMR study, there was a significant linear correlation between the apicobasal ratio of T2-weighted signal intensity for myocardial edema and the maximal amplitude of negative T waves (ρ = 0.498; P = .02), sum of the amplitudes of negative T waves (ρ = 0.483; P = .03), and maximum corrected QT interval (ρ = 0.520; P = .02). Repolarization indices were unrelated to either late gadolinium enhancement or quantitative cine parameters. Wellens' ECG abnormalities and myocardial edema showed a parallel time course of development and resolution on initial and follow-up CMR studies.
Conclusions: Our study results show that the ischemic-like Wellens' ECG pattern in TTC coincides and quantitatively correlates with the apicobasal gradient of myocardial edema as evidenced by using CMR. Dynamic negative T waves and QTc prolongation are likely to reflect the edema-induced transient inhomogeneity and dispersion of repolarization between apical and basal left ventricular regions.
Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Comment in
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Ventricular repolarization gradient and electrocardiogram characteristics of Tako-Tsubo cardiomyopathy.Heart Rhythm. 2013 Jan;10(1):78-9. doi: 10.1016/j.hrthm.2012.09.013. Epub 2012 Sep 14. Heart Rhythm. 2013. PMID: 22985661 No abstract available.
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Reply to the letter- electrocardiogram correlates of myocardial edema with takotsubo syndrome.Heart Rhythm. 2013 May;10(5):e67-8. doi: 10.1016/j.hrthm.2013.03.015. Epub 2013 Mar 13. Heart Rhythm. 2013. PMID: 23501510 No abstract available.
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To the Editor- Electrocardiogram correlates of myocardial edema in patients with Takotsubo syndrome.Heart Rhythm. 2013 May;10(5):e67. doi: 10.1016/j.hrthm.2013.03.016. Epub 2013 Mar 14. Heart Rhythm. 2013. PMID: 23501511 No abstract available.
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