Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens’ ECG pattern) in Tako-Tsubo cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

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ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽

10.1093/med/9780198784906.003.0320 ◽

2018 ◽

pp. 1298-1301

Author(s):

Federico Migliore ◽

Sebastiano Gili ◽

Domenico Corrado

Keyword(s):

Left Ventricular ◽

Stunned Myocardium ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

Qt Interval Prolongation ◽

St Segment ◽

Reversible Left Ventricular Dysfunction ◽

Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

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QT interval prolongation and torsade de pointes induced by left ventricular pacing rescued by His bundle pacing

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2020.02.010 ◽

2020 ◽

Vol 6 (6) ◽

pp. 325-328

Author(s):

Adi Lador ◽

Miguel Valderrábano

Keyword(s):

Qt Interval ◽

Torsade De Pointes ◽

Left Ventricular ◽

Ventricular Pacing ◽

Interval Prolongation ◽

His Bundle ◽

His Bundle Pacing ◽

Qt Interval Prolongation ◽

Left Ventricular Pacing

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Mental Stress May Induce QT-Interval Prolongation and T-Wave Notching

Annals of Noninvasive Electrocardiology ◽

10.1111/j.1542-474x.2007.00169.x ◽

2007 ◽

Vol 12 (3) ◽

pp. 251-259 ◽

Cited By ~ 20

Author(s):

Gábor Andrássy ◽

Attila Szabo ◽

Gyöngyvér Ferencz ◽

Zsófia Trummer ◽

Eszter Simon ◽

...

Keyword(s):

Qt Interval ◽

Mental Stress ◽

Interval Prolongation ◽

T Wave ◽

Qt Interval Prolongation

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Myocardial edema underlies dynamic T-wave inversion (Wellens' ECG pattern) in patients with reversible left ventricular dysfunction

Heart Rhythm ◽

10.1016/j.hrthm.2011.04.035 ◽

2011 ◽

Vol 8 (10) ◽

pp. 1629-1634 ◽

Cited By ~ 73

Author(s):

Federico Migliore ◽

Alessandro Zorzi ◽

Martina Perazzolo Marra ◽

Cristina Basso ◽

Francesco Corbetti ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Myocardial Edema ◽

Left Ventricular ◽

T Wave ◽

Wave Inversion ◽

Reversible Left Ventricular Dysfunction

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A Systematic Review of COVID - 19 Induced Myocarditis - Symptomatology, Prognosis, and Clinical Findings

10.1101/2021.05.29.21258059 ◽

2021 ◽

Author(s):

Vikash Jaiswal ◽

Shavy Nagpal ◽

Christine Angela E Labitag ◽

Janelle Tayo ◽

Abhinav Patel ◽

...

Keyword(s):

Systematic Review ◽

Myocardial Edema ◽

Clinical Findings ◽

Left Ventricular ◽

Cardiac Cells ◽

Cardiac Biomarkers ◽

T Wave ◽

Wave Inversion ◽

St Segment ◽

Novel Coronavirus

Objective: With the advent of a novel coronavirus in December 2019, several case studies have reported its adversity on cardiac cells. We conducted a systematic review that describes the symptomatology, prognosis, and clinical findings of patients with COVID-19-related myocarditis. Methods: Search engines including PubMed, Google Scholar, Cochrane Central, and Web of Science were queried for SARS-CoV-2 or COVID 19 and myocarditis. PRISMA guidelines were employed, and peer-reviewed journals in English related to COVID-19 were included. Results: This systematic review included 22 studies and 37 patients. Eight patients (36%) were confirmed myocarditis, while the rest were possible myocarditis. Most patients had elevated cardiac biomarkers, including troponin, CRP, CK, CK-MB, and NT-pro BNP. Electrocardiogram results noted tachycardia (47%), left ventricular hypertrophy (50%), ST-segment alterations (41%), and T wave inversion (18%). Echocardiography presented reduced LVEF (77%), left ventricle abnormalities (34%), right ventricle aberrations (12%), and pericardial effusion (71%). Further, CMR showed reduced myocardial edema (75%), non-ischemic patterns (50%), and hypokinesis (26%). The mortality was significant at 25%. Conclusions: Mortality associated with COVID-19 myocarditis appears significant but underestimated. Further studies are warranted to evaluate and quantify patients actual prognosis and outcomes with COVID-19 myocarditis.

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