Prevalence and severity of QT prolongation and other ECG abnormalities in takotsubo syndrome

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Andrei D. Margulescu MD, PhD , Diluka Amila Premawardhana , Dewi E. Thomas MD
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引用次数: 0

Abstract

Background

The prevalence and severity of QT interval prolongation (long QT, LQT) in takotsubo syndrome (TS) is not well described.

Methods

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.

Results

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.

Conclusion

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.
takotsubo综合征QT间期延长及其他心电图异常的发生率和严重程度。
背景:takotsubo综合征(TS)中QT间期延长(long QT, LQT)的患病率和严重程度尚未得到很好的描述。方法:这是一项回顾性队列研究,纳入了2019年1月至2023年12月在我们中心确诊为TS的所有患者,在所有可用的心电图中手动测量经心率校正的QT间期(QTc) (Bazzett公式)。同时记录其他心电图异常(t波反转(TWI)、ST段抬高(STE)、ST段下降(STD))。结果:纳入患者58例,均为女性(68±11岁)。56例患者(96.6%)为典型的根尖球囊型TS,症状包括胸痛(93.1%)、呼吸困难(10.3%)和其他(5.2%)。70.7%的患者存在诱发因素。分析了330例心电图。LQT在症状出现后的前3小时不常见(23.5%的患者),且仅为轻度。然而,在症状出现后24 - 48小时,90.9%的患者出现LQT,其中63.6%的患者出现严重LQT(≥500 ms)。术后LQT发生率下降,但QTc未恢复正常的占40.0%,超过96 h后仍严重延长的占11.4%,前6 h心电图正常的占40.5%,TWI是主要的心电图改变,其发生率从前6 h内的16.7%上升到7天后的76.9%。31.4%的患者在最初96小时内出现STE,但孤立的情况很少见。未发生孤立性性病。结论:LQT在TS患者出现症状后96 h内几乎普遍存在,且多数为重度。TS的心电图异常是高度动态的,但在症状发作后的前6小时内,心电图通常是正常的。患者应在症状出现后至少监测96小时,直至QTc降至500 ms以下。
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来源期刊
Journal of electrocardiology
Journal of electrocardiology 医学-心血管系统
CiteScore
2.70
自引率
7.70%
发文量
152
审稿时长
38 days
期刊介绍: The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.
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