| Apico-Basal Gradient Of Left Ventricular Myocardial Edema Underlies Transient T-Wave Inversion And Qt Interval Prolongation (Wellens' Ecg Pattern) In Tako-Tsubo Cardiomyopathy. | |
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MedLine Citation:
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PMID: 22975421 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Tako-Tsubo cardiomyopathy (TTC) presents with chest pain, ST-segment elevation followed by T-waves inversion and QT interval prolongation (Wellens' ECG pattern) and left ventricular (LV) dysfunction, which may mimic an acute coronary syndrome. OBJECTIVE: This study assessed the pathophysiologic basis of the Wellens' ECG pattern in TTC by characterization of underlying myocardial changes using cardiac magnetic resonance (CMR). METHODS: The study population included 20 consecutive patients with TTC (95% females,mean age 65.3±10.4 years) who underwent CMR studies both in the initial phase and after 3-months of follow-up, using a protocol which included cine images, T2-weighted sequences for myocardial edema and post-contrast sequences for late gadolinium enhancement (LGE). Quantitative ECG indexes of repolarization, such as maximal amplitude of negative T-waves (NTWm), sum of the amplitudes of negative T waves (NTWs) and maximum QT interval (QTc max), were correlated to CMR findings. RESULTS: At the time of initial CMR study, there was a significant linear correlation between apico-basal ratio of T2 signal intensity (SI) for myocardial edema and NTWm (ρ=0.498;p=0.02), NTWs (ρ=0.483;p=0.03) and QTc max (ρ=0.520;p=0.02). Repolarization indexes were unrelated to either LGE 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 apico-basal gradient of myocardial edema as evidenced by 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 LV regions. |
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Authors:
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Martina Perazzolo Marra; Alessandro Zorzi; Francesco Corbetti; Manuel De Lazzari; Federico Migliore; Francesco Tona; Giuseppe Tarantini; Sabino Iliceto; Domenico Corrado |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-9-10 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: - ISSN: 1556-3871 ISO Abbreviation: Heart Rhythm Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-9-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012. Published by Elsevier Inc. |
Affiliation:
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Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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