Abstract 9111: The Summation of ST-Segment Elevation is a Novel Predictor for Complications in Patients with Stress (Takotsubo) Cardiomyopathy
Background: Although the prognosis of stress (Takotsubo) cardiomyopathy (SC) is relatively favorable, it sometimes leads to serious complications. It is generally accepted that electrocardiogram (ECG) highly suggestive of the characteristics of myocardial damage is essential tool for diagnosis of SC. We assessed the hypothesis that serial change and quantitative analysis of ECG are associated with following adverse events in patients with SC.
Methods and Results: The study patients consisted of 85 patients with SC. A total of 34 patients suffered from 1 or more in-hospital adverse events such as heart failure, intraventricular pressure gradient (>30 mmHg), cardiogenic shock, ventricular tachycardia/fibrillation, and cerebral embolism. Of them, 2 patients died of cardiogenic shock. Patients with adverse events had higher heart rate (96±25 vs. 76±17 bpm, p<0.001) and greater summation of ST-segment elevation in 12 leads (ΣSTE) (10.5 [5.0 to 17.5] mm vs. 3.0 [0 to 7.0] mm; p<0.001) than those with non-adverse event. A multivariate logistic regression analysis showed that heart rate and ΣSTE were independent predictive variables (Table) and the best cutoff level of ΣSTE for prediction of adverse events was 5.5 mm based on a receiver operating characteristic curve. The ST-segment elevation in adverse events group extended up to limb leads as well as precordial leads compared with that in non-adverse evnets group (50% vs. 12%; p<0.001). However, a significant difference was not observed regarding ST resolution <50% at 24 hour after hospital admission clinically suggestive of prognostic impairment of SC between 2 groups (38% vs. 43%; p=0.80).
Conclusions: Electrocardiographic extent and magnitude of ST-segment elevation can predict in-hospital adverse events following SC. Our findings may help to explain the missing link between ECG changes and the severity of catecholamine-induced myocardial damage deeply involved in fatal and non-fatal complications.
- © 2011 by American Heart Association, Inc.