“Lambda‐wave” ST‐elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy

• Published in: Annals of noninvasive electrocardiology Vol. 23; no. 6; pp. e12581 - n/a
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.11.2018; John Wiley and Sons Inc
• Subjects: Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - physiopathology; Acute coronary syndromes; Aged; Calcium-binding protein; Cardiomyopathy; Cause of Death; Cohort Studies; Comorbidity; Complications; ECG; Echocardiography, Doppler - methods; EKG; Electrocardiography - methods; Female; follow‐up; Heart; Hospitals, University; Humans; Italy; Kaplan-Meier Estimate; lambda‐wave; Logistic Models; Male; Middle Aged; Multivariate Analysis; Original; Patients; Proportional Hazards Models; Severity of Illness Index; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - epidemiology; Stress; stress cardiomyopathy; Stresses; ST‐elevation; Survival Analysis; takotsubo; Takotsubo Cardiomyopathy - diagnostic imaging; Takotsubo Cardiomyopathy - epidemiology; Thromboembolism; Thrombosis; Troponin; Ventricle; Italy; ECG; ST-elevation; follow-up; lambda-wave; takotsubo; stress cardiomyopathy
• ISSN: 1082-720X; 1542-474X; 1542-474X
• DOI: 10.1111/anec.12581

Background 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). Aim To evaluate whether persistent downsloping ST‐elevation in the early stages of TTC might correlate with short and long‐term clinical events. Methods 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. Results 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). Conclusion 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.