Objective: To identify electrocardiographic parameters that predict extent of early improvement in ejection fraction (EF) in patients with stress cardiomyopathy. Methods: We collected baseline clinical, ECG and imaging data and follow up echocardiography data on 30 consecutive patients with stress cardiomyopathy. The relationship between baseline ECG parameters and Delta EF was evaluated by univariate and multivariable analysis. Results: Median EF improved from 35% to 55% (p < 0.0001). Delta EF showed negative correlation with number of leads with T inversion (p = 0.01) and QT interval (p = 0.02). The number of leads with T inversion was independently associated with Delta EF (coefficient ?4.878, p = 0.04). Conclusion: The number of leads with T wave inversion is negatively correlated with and is an independent predictor of the extent of early improvement of EF in patients with stress cardiomyopathy. Hence the ECG at initial presentation can be used as a simple tool to predict LV function recovery.
A. Prasad, A. Lerman and C. S. Rihal, “Apical Ballooning Syndrome (Tako-Tsubo or Stress Cardiomyopathy): A Mimic of Acute Myocardial Infarction,” American Heart Journal, Vol. 155, No. 3, 2008, pp. 408-417. doi:10.1016/j.ahj.2007.11.008
G. S. Wagner, P. Macfarlane, H. Wellens, et al., “AHA/ ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part VI: Acute Ischemia/Infarction: A Scientific Statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology,” Journal of the American College of Cardiology, Vol. 53, No. 11, 2009, pp. 1003-1011. doi:10.1016/j.jacc.2008.12.016
H. C. Bazett, “An Analysis of the Time-Relations of Electrocardiograms,” Annals of Noninvasive Electrocardiology, Vol. 2, No. 2, 1997, pp. 177-194. doi:10.1111/j.1542-474X.1997.tb00325.x
P. M. Rautaharju, B. Surawicz, L. S. Gettes, et al., “AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part IV: The ST Segment, T and U Waves, and the QT Interval: A Scientific Statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology,” Circulation, Vol. 119, No. 10, 2009, pp. e241-e250. doi:10.1161/CIRCULATIONAHA.108.191096
R. M. Lang, M. Bierig, R. B. Devereux, et al., “Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology,” Journal of the American Society of Echocardiography, Vol. 18, No. 12, 2005, pp. 1440-1463. doi:10.1016/j.echo.2005.10.005
M. A. Quinones, C. M. Otto, M. Stoddard, A. Waggoner and W. A. Zoghbi, “Recommendations for Quantification of Doppler Echocardiography: A Report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography,” Journal of the American Society of Echocardiography, Vol. 15, No. 2, 2002, pp. 167-184. doi:10.1067/mje.2002.120202
M. Gianni, F. Dentali, A. M. Grandi, G. Sumner, R. Hiralal and E. Lonn, “Apical Ballooning Syndrome or Takotsubo Cardiomyopathy: A Systematic Review,” European Heart Journal, Vol. 27, No. 13, 2006, pp. 1523- 1529. doi:10.1093/eurheartj/ehl032
S. Kurisu, I. Inoue, T. Kawagoe, et al., “Presentation of TakoTsubo Cardiomyopathy in Men and Women,” Clinical Cardiology, Vol. 33, No. 1, 2010, pp. 42-45. doi:10.1002/clc.20700
S. W. Sharkey, D. C. Windenburg, J. R. Lesser, et al., “Natural History and Expansive Clinical Profile of Stress (Tako-Tsubo) Cardiomyopathy,” Journal of the American College of Cardiology, Vol. 55, No. 4, 2010, pp. 333-341. doi:10.1016/j.jacc.2009.08.057
K. Tsuchihashi, K. Ueshima, T. Uchida, et al., “Transient Left Ventricular Apical Ballooning without Coronary Artery Stenosis: A Novel Heart Syndrome Mimicking Acute Myocardial Infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan,” Journal of the American College of Cardiology, Vol. 38, No. 1, 2001, pp. 11-18. doi:10.1016/S0735-1097(01)01316-X
S. W. Sharkey, J. R. Lesser, A. G. Zenovich, et al., “Acute and Reversible Cardiomyopathy Provoked by Stress in Women from the United States,” Circulation, Vol. 111, 2005, pp. 472-479. doi:10.1161/01.CIR.0000153801.51470.EB
F. Cangella, A. Medolla, G. De Fazio, et al., “Stress Induced Cardiomyopathy Presenting as Acute Coronary Syndrome: Tako-Tsubo in Mercogliano, Southern Italy,” Cardiovasc Ultrasound, Vol. 5, 2007, p. 36. doi:10.1186/1476-7120-5-36
I. S. Wittstein, D. R. Thiemann, J. A. Lima, et al., “Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress,” The New England Journal of Medicine, Vol. 352, 2005, pp. 539-548. doi:10.1056/NEJMoa043046
H. M. Nef, H. Mollmann, S. Kostin, et al., “Tako-Tsubo Cardiomyopathy: Intraindividual Structural Analysis in the Acute Phase and after Functional Recovery,” European Heart Journal, Vol. 28, No. 20, 2007, pp. 2456- 2464. doi:10.1093/eurheartj/ehl570
S. Kurisu, I. Inoue, T. Kawagoe, et al., “Myocardial Perfusion and Fatty Acid Metabolism in Patients with Tako-Tsubo-Like Left Ventricular Dysfunction,” Journal of the American College of Cardiology, Vol. 41, No. 5, 2003, pp. 743-748. doi:10.1016/S0735-1097(02)02924-8
K. Ito, H. Sugihara, T. Kawasaki, et al., “Assessment of Ampulla (Takotsubo) Cardiomyopathy with Coronary Angiography, Two-Dimensional Echocardiography and 99mtc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography,” Annals of Nuclear Medicine, Vol. 15, No. 4, 2001, pp. 351-355. doi:10.1007/BF02988242
J. Ako, K. Takenaka, K. Uno, et al., “Reversible Left Ventricular Systolic Dysfunction-Reversibility of Coronary Microvascular Abnormality,” Japanese Heart Journal, Vol. 42, No. 3, 2001, pp. 355-363. doi:10.1536/jhj.42.355
K. A. Bybee, A. Motiei, I. S. Syed , et al., “Electrocardiography Cannot Reliably Differentiate Transient Left Ventricular Apical Ballooning Syndrome from Anterior ST-Segment Elevation Myocardial Infarction,” Journal of Electrocardiology, Vol. 40, No. 1, 2007, pp. e1-e6.
S. W. Sharkey, “Electrocardiogram Mimics of Acute ST-Segment Elevation Myocardial Infarction: Insights from Cardiac Magnetic Resonance Imaging in Patients with Tako-Tsubo (Stress) Cardiomyopathy,” Journal of Electrocardiology, Vol. 41, No. 6, 2008, pp. 621-625. doi:10.1016/j.jelectrocard.2008.06.015
S. Sclarovsky and K. Nikus, “The Electrocardiographic Paradox of Tako-Tsubo Cardiomyopathy-Comparison with Acute Ischemic Syndromes and Consideration of Molecular Biology and Electrophysiology to Understand the Electrical-Mechanical Mismatching,” Journal of Electrocardiology, Vol. 43, No. 2, 2010, pp. 173-176. doi:10.1016/j.jelectrocard.2009.07.015
R. A. Kloner, “Inverted T waves. An Electrocardiographic Marker of Stunned or Hibernating Myocardium in Man?” Circulation, Vol. 82, No. 3, 1990, pp. 1060-1061. doi:10.1161/01.CIR.82.3.1060
Y. Hirota, Y. Kita, R. Tsuji, et al., “Prominent Negative T Waves with QT Prolongation Indicate Reperfusion Injury and Myocardial Stunning,” Journal of Cardiology, Vol. 22, No. 2-3, 1992, pp. 325-340.
S. Kurisu, I. Inoue, T. Kawagoe, et al., “Time Course of Electrocardiographic Changes in Patients with Tako- Tsubo Syndrome: Comparison with Acute Myocardial Infarction with Minimal Enzymatic Release,” Circulation Journal, Vol. 68, No. 1, 2004, pp. 77-81. doi:10.1253/circj.68.77
R. Ogura, Y. Hiasa, T. Takahashi, et al., “Specific Findings of the Standard 12-Lead ECG in Patients with ‘Takotsubo’ Cardiomyopathy: Comparison with the Findings of Acute Anterior Myocardial Infarction,” Circulation Journal, Vol. 67, No. 8, 2003, pp. 687-690. doi:10.1253/circj.67.687
H. Furushima, M. Chinushi, A. Sanada and Y. Aizawa, “Ventricular Repolarization Gradients in a Patient with Takotsubo Cardiomyopathy,” Europace, Vol. 10, No. 9, 2008, pp. 1112-1115. doi:10.1093/europace/eun166
T. G. Zhu, C. Patel, S. Martin, et al., “Ventricular Transmural Repolarization Sequence: Its Relationship with Ventricular Relaxation and Role in Ventricular Diastolic Function,” European Heart Journal, Vol. 30, No. 3, 2009, pp. 372-380. doi:10.1093/eurheartj/ehn585
P. Ofman, J. R. Cook, L. Navaravong, et al., “T-Wave Inversion and Diastolic Dysfunction in Patients with Electrocardiographic Left Ventricular Hypertrophy,” Journal of Electrocardiology, Vol. 45, No. 6, 2012, pp. 764-769. doi:10.1016/j.jelectrocard.2012.06.001