Electrocardiographic Characteristics and Associated Outcomes in Patients with Takotsubo Syndrome. Insights from the RETAKO Registry

Miguel, Irene Martín de; Núñez‐Gil, Iván J.; Pérez‐Castellanos, Alberto; Uribarri, Aitor; Durán-Cambra, Albert; Martín-García, Agustín; Corbí-Pascual, Miguel; Marzo, Marta Guillén; Martínez‐Sellés, Manuel; investigators, Retako

doi:10.1016/j.cpcardiol.2021.100841

Cited by 12 publications

(7 citation statements)

References 33 publications

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“…At 48 h, in both groups we observed ECG evolution, as reported in previous studies, with T wave inversion and QTc interval prolongation ( 17 , 18 ). Regarding negative T wave differences, we observed less pronounced T wave inversion extent and depth in MV-TTS compared to typical TTS.…”

Section: Discussionsupporting

confidence: 85%

“…Since TTS clinical presentation is usually very similar to that for acute coronary syndrome, electrocardiogram (ECG) interpretation plays a crucial role in initial evaluation of these patients (12)(13)(14)(15)(16). ECG abnormalities described in TTS mainly include ST-segment elevation at first instance (generally in precordial leads), followed by subsequent T wave inversion and QT interval prolongation in the following hours/days (2,(17)(18)(19)). However, these ECG abnormalities are generally described from the ECGs of patients with typical TTS.…”

Section: Introductionmentioning

confidence: 99%

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Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Padilla-Lopez,

Duran-Cambra,

Belmar-Cliville

et al. 2023

Front. Cardiovasc. Med.

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IntroductionTakotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS.MethodsA retrospective case-control study was conducted where ECGs were reviewed at three time points from symptom onset (within the first 12 h, at 48 h, and at 5–7 days) and compared between patients with typical TTS (n = 33) and those with MV-TTS (n = 27), as classified by ventriculography.Results12-h ECG findings revealed that typical TTS featured ST-segment elevation through anterior leads V3–V6, with maximal deviation in V3 (0.98 ± 0.99 mm) and V4 (0.91 ± 0.91 mm), whereas MV-TTS featured ST-segment depression in inferior leads (−0.24 ± 0.57 mm in II, −0.30 ± 0.52 mm in III, and −0.32 ± 0.47 mm in aVF) and in precordial leads V4–V6. In 48-h ECG findings, the most significant change was T wave inversion, which was more widespread and deeper in typical TTS, with the most pronounced negative T wave depths, exceeding 3 mm, observed in leads V3–V5; in contrast, in MV-TTS, T wave inversion was evident in fewer leads and showed less depth, with the most pronounced negative T waves reaching 1 mm at most in leads I, aVL, and V2. While the QTc interval was prolonged in both groups at 48 h, this prolongation was more pronounced in typical TTS than in MV-TTS (523 ± 52 ms vs. 487 ± 66 ms; p = 0.029). In ECGs at 5–7 days, results essentially returned to baseline.ConclusionPatients with MV-TTS exhibited a distinctive pattern of ECG abnormalities, marked by ST-segment depression in inferolateral leads, less profound and less extensive T wave inversion that mostly affected leads I, aVL and V2, and attenuated QT interval prolongation compared to typical TTS.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Padilla-Lopez,

Duran-Cambra,

Belmar-Cliville

et al. 2023

Front. Cardiovasc. Med.

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“…From the available data, ST-segment elevation is less common in peripartum TTS, with initial T-wave inversion being the most common initial repolarization abnormality between all the compared groups. Better long-term prognosis and an absence of deaths in the peripartum group might be associated with the absence of ST-segment elevation on admission, described as a protective factor in a previous work [14]. All patients were in sinus rhythm in the first admission ECG, except for two cases, in which the initial rhythm was ventricular tachycardia [15] and ventricular fibrillation [16].…”

Section: Discussionmentioning

confidence: 74%

Peripartum Takotsubo Cardiomyopathy: A Review and Insights from a National Registry

Vazirani,

Blanco-Ponce,

Almendro Delia

et al. 2024

JCDD

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Takotsubo syndrome (TTS) during the peripartum period is a relevant cause of morbidity in this population; its clinical course and prognosis, compared to the general TTS population, is yet to be elucidated. Our aim was to analyze the clinical features and prognosis of peripartum TTS in a nationwide prospective specifically oriented registry database and consider the published literature. Peripartum TTS patients from the prospective nationwide RETAKO registry—as well as peripartum TTS patients from the published literature—were included, and multiple comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between the groups. Patients with peripartum TTS exhibit a higher prevalence of secondary forms, dyspnea, atypical symptoms, and echocardiographic patterns, as well as less ST-segment elevation than the general TTS population. In the literature, patients with peripartum TTS had a higher Killip status on admission. TTS during the peripartum period has a higher prevalence of angina and dyspnea, as well as physical triggers, neither of which are related to a worse prognosis. Killip status on admission was higher in the literature for patients with TTS but with excellent mid- and long-term prognoses after the acute phase, despite mostly being secondary forms.

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“…The depth and spread of T-waves and QTc duration provide increased diagnostic confidence in nonobstructive coronary patients [39] . The significantly prolonged precordial T wave is altered by the spatial dispersion of ventricular repolarization [36] , which may be associated with ST segment elevation [30,19] and probable with ST depression in aVR and chest-led PR [36] . In mechanically lengthening cardiac muscle fibers, the cellular membrane depolarizes in a specific pattern, which significantly lasts the decay period of the repolization phase (Figure 2) [40] ; however, the action potential conduction velocity does not significantly change [41] .…”

Section: Mechanical Stress Varied Membrane Potentials Influence On Th...mentioning

confidence: 99%

Mechanical stress concealed force enhancement and ionic transient membrane potential and metabolism in akinesia of stress cardiomyopathy

Chen

Wang

Yang

et al. 2022

Preprint

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Stress cardiomyopathy is a unique heart syndrome that is characterized by reversible left ventricular apical wall motion abnormalities and is commonly known as Takotsubo syndrome. In transient left ventricular apical ballooning, myocardium lengthening stress is in a high energy-demand state. The increased passive tension and force enhancement conducted asynergically are associated with severe hypokinesis on the ventricular wall and reduced the blood ejection fraction. Ventricular myocardial deformation and global longitudinal strain have significant mechanotemporal alteration characteristics. Membrane potential dominant mechanisms related to akinesia are considered from multiple effects of variation of calcium transients, myocardium metabolism, which is relative to the ST segment lift in an ECG, and in the weakness of contraction of the ventricular muscle. Ventricular filling, not pressure,-determine the strengthening from stretching; thus, in stress cardiomyopathy, ventricular apical ballooning (takotsubo-shaped ventricle) strengthens the mechanical stress on the wall. Muscle fiber tolerance of lengthening is a high energy consumption process. Ventricular apical akinesia further aggravates passive tension. Depleted ATP and high inorganic phosphate inhibit Ca 2+-activated development, terminates the crossbridge detachment process in its early stage, and facilitates the occurrence of myogenic force enhancement. Comprehensive analysis of the above mechanisms, in lengthening stress, increased cardiac fibers energy demand, and Ca 2+ transient variation interruption of the diastolic cycle, delayed the onset of systole and aggravated the occurrence of apical ballooning in stress cardiomyopathy.

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Electrocardiographic Characteristics and Associated Outcomes in Patients with Takotsubo Syndrome. Insights from the RETAKO Registry

Cited by 12 publications

References 33 publications

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Peripartum Takotsubo Cardiomyopathy: A Review and Insights from a National Registry

Mechanical stress concealed force enhancement and ionic transient membrane potential and metabolism in akinesia of stress cardiomyopathy

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