Transient QRS amplitude attenuation is associated with clinical recovery in patients with takotsubo cardiomyopathy

• Published in: International journal of cardiology Vol. 187; pp. 198 - 205
• Main Authors: Guerra, Federico, Giannini, Irene, Pongetti, Giulia, Fabbrizioli, Azzurra, Rrapaj, Edlira, Aschieri, Daniela, Pelizzoni, Valentina, Villani, Giovanni Q, Madias, John E, Capucci, Alessandro
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 06.05.2015
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - physiopathology; Aged; Biomarkers - blood; Cardiovascular; Coronary Angiography; Creatine Kinase, MB Form - blood; ECG; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; QRS amplitude; QRS voltage; Recovery of Function; Retrospective Studies; Takotsubo cardiomyopathy; Takotsubo Cardiomyopathy - blood; Takotsubo Cardiomyopathy - complications; Takotsubo Cardiomyopathy - physiopathology; Troponin I - blood; Troponin T - blood; ECG; QRS voltage; Takotsubo cardiomyopathy; QRS amplitude; Acute coronary syndrome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2015.03.350

Abstract Background/objectives Low voltage QRS complexes (LQRSV) and amplitude attenuation of QRS voltage (AAQRS) have been described in takotsubo (TC) patients, and postulated as valuable pre-angiographic markers. The aim of this observational study is to evaluate potential diagnostic and prognostic features of QRS amplitude in TC and acute coronary syndrome (ACS) patients. Methods Fifty-eight patients with TC were matched with 58 patients with ACS according to age, gender, and presence or absence of ST elevation at hospital admission. A 12-lead ECG was recorded within 12 h after symptoms onset, the day after coronary angiography (CA) and before hospital discharge. When available, ECGs prior and subsequent to the acute event were also collected. Results QRS amplitude showed a time related trend, with a first phase characterized by an initial decrease in amplitude in both groups and a second phase, with a progressive recovery of QRS amplitude in TC patients up to pre-event levels, while QRS amplitude in ACS patients remained substantially unchanged from admission onwards. Rise in AAQRS during hospitalization showed a positive linear association with systolic function recovery and both troponin I and CK-MB decrease (all p < 0.01) in TC patients. A 20% increase of mean AAQRS from admission is able to predict LVEF recovery and troponin I and CK-MB normalization in TC patients with good sensitivity and specificity. Conclusions LQRSV and AAQRS are not reliable in differentiating ACS from TC. However, QRS amplitude attenuation in TC is transient, and is linearly associated with systolic function recovery and cardiac biomarkers normalization.