Critical Convex-Type ST Elevation Correlate With Ventricular Tachyarrhythmia in Takotsubo Cardiomyopathy
Jen-Te Hsu1, Ju-Feng Hsiao1, See-Khong Chin1
1Department of Internal Medicine, Divisions of Cardiology, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan County, Taiwan.
Insights
Critical electrocardiogram (ECG) patterns in Takotsubo cardiomyopathy (TC) significantly increase the risk of ventricular tachyarrhythmia (VT) and in-hospital death. Prolonged QRS duration also independently predicts poor prognosis in TC patients.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Ventricular tachyarrhythmia (VT) is an occasional complication of Takotsubo cardiomyopathy (TC).
- Specific ST elevation patterns in coronary artery disease have been linked to VT.
- Understanding ECG predictors in TC is crucial for risk stratification.
Purpose of the Study:
- To assess the correlation between critical ECG patterns and VT occurrence in TC patients.
- To identify independent predictive factors for in-hospital outcomes in TC.
- To evaluate the prognostic role of ECG characteristics in TC.
Main Methods:
- Retrospective analysis of 55 consecutive TC patients meeting Takotsubo Italian Network (TIN) criteria.
- Classification of patients into groups based on critical ECG patterns and VT occurrence.
- Analysis of in-hospital outcomes and influencing factors, including ECG parameters.
Main Results:
- VT incidence was significantly higher in the critical ECG group (43.8%) versus the non-critical ECG group (2.6%).
- In-hospital death and composite endpoints (VT + death) were more frequent in the critical ECG group.
- Critical ECG type (OR=61.8) and prolonged QRS width ≥105 ms (OR=1.06) were independent predictors of VT and poor prognosis.
Conclusions:
- Specific critical ECG types, such as tombstoning and lambda-wave ST elevations, strongly impact short-term outcomes in TC.
- Conduction disturbances, indicated by prolonged QRS duration (≥105 ms), independently predict a worse prognosis in TC.
- These ECG findings are vital for identifying high-risk TC patients requiring closer monitoring and management.
Background:
Ventricular tachyarrhythmia (VT) occasionally occurred in patients with Takotsubo cardiomyopathy (TC). Two convex-type ST elevations were significantly related to VT in coronary artery disease.
Methods:
This study assessed the correlation between VT and critical ECG patterns, as well other independent predictive factors of in-hospital outcome. Fifty-five consecutive patients fulfilled the diagnostic criteria of Takotsubo Italian Network (TIN) were retrospectively enrolled. The patients were classified into two groups according to their critical ECG patterns and VT occurrence. In-hospital outcomes and influencing factors were analyzed.
Results:
The incidence of VT was higher in the critical ECG group than in the Noncritical ECG group (43.8% vs. 2.6%, p < 0.001). In-hospital death was more common in the critical ECG group than in the Noncritical ECG group (25.0% vs. 5.1%, p = 0.032). The composite end-point (combined VT and in-hospital death) revealed significant differences between these two groups (50.0% vs 7.7%, p < 0.001). Multi-variate analysis proved critical ECG type as one independent risk factor of VT (odds ratio [OR] = 61.8, p = 0.009) and the composite end-point (OR = 12.4, p = 0.007). The prolong QRS width ( ≥ 105 ms) was another independent factor for predicting VT (OR = 1.06, p = 0.022) and composite end-point (OR = 1.05, p = 0.017).
Conclusions:
Critical ECG types including tombstoning ST elevation and lambda-wave ST elevation have strong impact on short-term outcomes. Additionally, conduction disturbance with prolong QRS ≥ 105 ms also has independent predicting role for poor prognosis.
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