Abstract 17912: Prevalence and Clinical Relevance of Giant Negative T-Waves in Patients With Takotsubo Cardiomyopathy
Purpose: Takotsubo cardiomyopathy (TTC) mimics acute myocardial infarction. Some patients develop giant negative T waves ≥1 mV resembling those in apical hypertrophic cardiomyopathy (AHCM). This study assessed the prevalence and clinical relevance of giant negative T waves in patients with TTC.
Methods: Over a 9-year period, we observed 76 TTC patients (69 f, 7m, age 70±12). By angiography, 45 pts (59%) had apical ballooning and 31 (41%) mid-ventricular ballooning of the left ventricle (LV). ECG on admission, at the time of maximal T-wave inversion and the daily QTc-intervals were compared.
Results: Giant negative T waves ≥1 mV developed in 16/76 pts (21%). All were seen in the precordial leads V2 (n=3), V3 (n=9), V4 (n=10), V5 (n=4) and V6 (n=1). Pts with giant negative T waves were older (75±11 vs 69±12 years, p=0.05) and more frequently had apical ballooning (88% vs 52%, p<0.01). Time from symptom onset to first ECG, heart rate and the number of leads with ST-segment elevation on admission were not different in pts with or without giant negative T waves. Cardiac markers, LV ejection fraction and end-diastolic pressure were comparable in both groups. In pts with giant T there was a trend towards more complications during the acute phase (69% vs 43%, p=0.06).
The maximal QTc interval was longer in pts with giant negative T waves (606±70 vs 559±71 msec, p<0.02), however, the occurrence of ventricular arrhythmias and atrial fibrillation was not different. Time to ECG normalization was similar (59±21 vs 68±82 days, p=ns).
As assessed by echocardiography, 15/16 (94%) pts with giant negative T waves but only 1/60 (2%) without (p<0.0001) developed wall thickening in the apical area within 10 days of presentation with a ratio of apical to posterobasal wall >1.5:1 which is typical for AHCM. Cardiac MRI performed in 6 of these 15 pts disclosed myocardial edema in the apical area. Time to complete normalisation of LV function was longer in pts with giant negative T waves (32±24 vs 20±15 days, p<0.02).
Conclusion: Giant negative T waves ≥1 mV in the precordial leads resembling those in AHCM develop in 21% of pts with TTC. They are associated with apical wall thickening due to myocardial edema, a higher complication rate and a longer time interval to complete normalisation of LV function.
- © 2013 by American Heart Association, Inc.