Margulescu Andrei D, Premawardhana Diluka Amila, Thomas Dewi E
Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
J Electrocardiol. 2025 Jan-Feb;88:153848. doi: 10.1016/j.jelectrocard.2024.153848. Epub 2024 Nov 29.
The prevalence and severity of QT interval prolongation (long QT, LQT) in takotsubo syndrome (TS) is not well described.
This is a retrospective cohort study of all patients admitted in our Centre between January 2019 and December 2023 with confirmed TS. QT interval corrected for heart rate (QTc) (Bazzett formula) was measured manually in all available ECGs. Presence of other ECG abnormalities (T-wave inversion (TWI), ST segment elevation (STE), ST segment depression (STD)) were also recorded.
Fifty-eight patients were included, all women (68 ± 11 years). Fifty-six patients (96.6 %) had classical, apical ballooning form of TS. Symptoms included chest pain (93.1 %), dyspnoea (10.3 %), and others (5.2 %). Triggers were present in 70.7 % of patients. Three-hundred-and-thirty ECGs were analysed. LQT was infrequent in the first 3 h after symptom onset (23.5 % of patients), and was only mild. However, between 24 and 48 h after symptom onset, 90.9 % of patients developed LQT, which was severe (≥500 ms) in 63.6 % of patients. LQT prevalence decreased afterwards but QTc did not return to normal in 40.0 % of patients, and remained severely prolonged in 11.4 % of patients beyond 96 h. ECG was normal in 40.5 % of patients in the first 6 h. TWI was the predominant ECG change, and its prevalence increased from 16.7 % within the first 6 h to 76.9 % after 7 days. STE was present in 31.4 % of patients in the first 96 h, but was rare in isolation. Isolated STD did not occur.
LQT is almost universally seen in patients with TS within the first 96 h after symptom onset, and is severe in the majority. ECGs abnormalities in TS are highly dynamic, but ECGs are frequently normal in the first 6 h after symptom onset. Patients should be monitored for at least 96 h after symptom onset, and until QTc falls below 500 ms.
应激性心肌病（TS）中心电图QT间期延长（长QT，LQT）的发生率和严重程度尚未得到充分描述。
这是一项对2019年1月至2023年12月期间在本中心确诊为TS的所有患者进行的回顾性队列研究。在所有可用的心电图中手动测量校正心率后的QT间期（QTc）（Bazzett公式）。还记录了其他心电图异常情况（T波倒置（TWI）、ST段抬高（STE）、ST段压低（STD））。
共纳入58例患者，均为女性（68±11岁）。56例患者（96.6%）表现为典型的心尖部气球样变型TS。症状包括胸痛（93.1%）、呼吸困难（10.3%）及其他（5.2%）。70.7%的患者存在诱发因素。共分析了330份心电图。症状发作后最初3小时内LQT不常见（23.5%的患者），且仅为轻度。然而，症状发作后24至48小时内，90.9%的患者出现LQT，其中63.6%的患者LQT严重（≥500毫秒）。此后LQT发生率下降，但40.0%的患者QTc未恢复正常，11.4%的患者在96小时后QTc仍严重延长。症状发作后最初6小时内40.5%的患者心电图正常。TWI是主要的心电图改变，其发生率从最初6小时内的16.7%增加至7天后的76.9%。STE在最初96小时内出现在31.4%的患者中，但单独出现的情况罕见。未出现孤立的STD。
TS患者在症状发作后的最初96小时内几乎普遍出现LQT，且大多数患者LQT严重。TS患者的心电图异常具有高度动态性，但症状发作后最初6小时内心电图常正常。症状发作后应至少对患者监测96小时，直至QTc降至500毫秒以下。
