Tarantino Nicola, Santoro Francesco, Guastafierro Francesca, Di Martino Luigi F M, Scarcia Maria, Ieva Riccardo, Ruggiero Antonio, Cuculo Andrea, Mariano Enrica, Di Biase Matteo, Brunetti Natale Daniele
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy.
Asklepios Klinik - St. Georg, Hamburg, Germany.
Ann Noninvasive Electrocardiol. 2018 Nov;23(6):e12581. doi: 10.1111/anec.12581. Epub 2018 Jul 9.
Persistent ST-segment elevation in acute coronary syndrome is associated with both short and long-term complications. By contrast, there is limited information about ST-elevation and its evolution during takotsubo (stress) cardiomyopathy (TTC).
To evaluate whether persistent downsloping ST-elevation in the early stages of TTC might correlate with short and long-term clinical events.
One-hundred fifty-eight consecutive subjects with TTC were prospectively enrolled and assessed by electrocardiogram. Patients were classified in two groups according to the presence of downsloping ST-elevation ≥5 mm lasting at least 24 hr ("lambda-wave" ST-elevation group vs. without downsloping ST-elevation) in at least one/two contiguous leads.
Five (3.2%) patients, all female with a mean left ventricular ejection fraction 32 ± 5%, were included in the lambda-wave ST-elevation group. These patients were characterized by a higher prevalence of physical stressor (100% vs. 49%, p = 0.04) and higher admission and peak levels of troponin-I levels during hospitalization. Peak of ST-elevation in the lambda-wave ST-elevation group was reached 6 hr after admission and gradually decreased after 24 hr. In-hospital complications were observed in all the patients presenting lambda ST-elevation (100% vs. 23%, p = 0.03, OR: 29.1, p = 0.04); one patient presented endoventricular thrombosis and two died of cardiogenic shock. At long-term follow-up (mean 443 days), adverse events were observed in 80% of patients with lambda-wave ST-elevation (RR of adverse events at follow-up 32, p < 0.01).
Persistent downsloping lambda-wave ST-elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long-term follow-up.
急性冠状动脉综合征中持续性ST段抬高与短期和长期并发症均相关。相比之下，关于应激性心肌病（TTC）时ST段抬高及其演变的信息有限。
评估TTC早期持续性下斜型ST段抬高是否与短期和长期临床事件相关。
前瞻性纳入158例连续的TTC患者，并通过心电图进行评估。根据至少一个/两个相邻导联中是否存在下斜型ST段抬高≥5mm且持续至少24小时（“λ波”ST段抬高组与无下斜型ST段抬高组）将患者分为两组。
λ波ST段抬高组纳入5例（3.2%）患者，均为女性，平均左心室射血分数为32±5%。这些患者的特点是身体应激源的患病率较高（100%对49%，p = 0.04），住院期间肌钙蛋白I水平的入院和峰值较高。λ波ST段抬高组的ST段抬高峰值在入院后6小时达到，并在24小时后逐渐下降。所有出现λ波ST段抬高的患者均观察到院内并发症（100%对23%，p = 0.03，OR：29.1，p = 0.04）；1例患者出现心室内血栓形成，2例死于心源性休克。在长期随访（平均443天）中，80%的λ波ST段抬高患者观察到不良事件（随访时不良事件的相对危险度为32，p < 0.01）。
应激性心肌病急性期持续性下斜型λ波ST段抬高可能与短期和长期随访时不良事件的较高风险相关。
