Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, Madrid, Spain.
Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain.
Curr Probl Cardiol. 2021 Aug;46(8):100841. doi: 10.1016/j.cpcardiol.2021.100841. Epub 2021 Mar 19.
Electrocardiographic disturbances in Takotsubo syndrome have been previously partially described but their consequences remain mostly unknown. Our aim was to describe the prevalence and prognostic significance of different electrocardiographic features in patients with Takotsubo syndrome. Our data come from the Spanish multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with an available 12-lead surface electrocardiogram at admission and 48 hours post-admission were included. A total of 246 patients were studied, mean age was 71.3 ± 11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5% - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T waves in a median of 8 leads with a mean amplitude of 0.7 ± 0.5 mV and 137 (60.9%) had pathological Q waves. The mean corrected QT interval was 520 ± 72 ms. Corrected QT interval was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (P = 0.002) and all-cause death (P = 0.008). A higher heart rate at admission was an independent predictor of the primary endpoint (P = 0.001) and of acute pulmonary edema (P = 0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (P = 0.04). Absence of ST-segment deviation was a protective factor (P = 0.005) for the primary endpoint. Tachyarrhythmias were independently associated with cardiogenic shock (P< 0.001). Takotsubo syndrome patients present with distinct electrocardiographic features. Prolonged corrected QT interval, tachyarrhythmias, heart rate at admission, and more extensive repolarization alterations are associated with poor outcomes.
Takotsubo 综合征的心电图改变先前已部分描述，但它们的后果仍知之甚少。我们的目的是描述 Takotsubo 综合征患者不同心电图特征的发生率和预后意义。我们的数据来自西班牙多中心 Takotsubo 综合征登记研究（RETAKO）。所有纳入患者在入院时和入院后 48 小时均有 12 导联体表心电图。共纳入 246 例患者，平均年龄为 71.3 ± 11.5 岁，215 例（87.4%）为女性。143 例（59.1%）患者出现 ST 段抬高，97 例（39.8%）患者至少 2 个壁导联出现抬高。下壁导联单纯抬高的发生率较低（5%~2.0%）。入院后 48 小时，198 例（88.0%）患者 8 个中位数导联出现负 T 波，平均振幅为 0.7 ± 0.5 mV，137 例（60.9%）患者出现病理性 Q 波。校正 QT 间期平均为 520 ± 72 ms。校正 QT 间期与全因死亡和非致死性心血管事件的主要终点（P = 0.002）以及全因死亡（P = 0.008）独立相关。入院时较高的心率是主要终点（P = 0.001）和急性肺水肿（P = 0.04）的独立预测因子。ST 段抬高伴对应导联 ST 段压低是全因死亡的独立预测因子（P = 0.04）。ST 段无偏移是主要终点的保护因素（P = 0.005）。心动过速与心源性休克独立相关（P<0.001）。Takotsubo 综合征患者存在不同的心电图特征。校正 QT 间期延长、心动过速、入院时心率以及更广泛的复极改变与不良预后相关。
