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Apico-Basal Gradient Of Left Ventricular Myocardial Edema Underlies Transient T-Wave Inversion And Qt Interval Prolongation (Wellens' Ecg Pattern) In Tako-Tsubo Cardiomyopathy.
MedLine Citation:
PMID:  22975421     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Martina Perazzolo Marra; Alessandro Zorzi; Francesco Corbetti; Manuel De Lazzari; Federico Migliore; Francesco Tona; Giuseppe Tarantini; Sabino Iliceto; Domenico Corrado
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-10
Journal Detail:
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:
Created Date:  2012-9-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua.
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