“Lambda-wave” ST-elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy
Nicola Tarantino
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorCorresponding Author
Francesco Santoro
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Asklepios Klinik - St. Georg, Hamburg, Germany
Correspondence
Francesco Santoro, Department of medical and surgery science, University of Foggia, Viale Pinto, 1, Foggia 71100, Italy.
Email: [email protected]
Search for more papers by this authorFrancesca Guastafierro
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorLuigi F. M. Di Martino
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorMaria Scarcia
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorRiccardo Ieva
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorAntonio Ruggiero
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorAndrea Cuculo
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorEnrica Mariano
Department of Cardiology, University “Tor Vergata”, Rome, Italy
Search for more papers by this authorMatteo Di Biase
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorNatale Daniele Brunetti
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorNicola Tarantino
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorCorresponding Author
Francesco Santoro
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Asklepios Klinik - St. Georg, Hamburg, Germany
Correspondence
Francesco Santoro, Department of medical and surgery science, University of Foggia, Viale Pinto, 1, Foggia 71100, Italy.
Email: [email protected]
Search for more papers by this authorFrancesca Guastafierro
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorLuigi F. M. Di Martino
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorMaria Scarcia
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorRiccardo Ieva
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorAntonio Ruggiero
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorAndrea Cuculo
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorEnrica Mariano
Department of Cardiology, University “Tor Vergata”, Rome, Italy
Search for more papers by this authorMatteo Di Biase
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorNatale Daniele Brunetti
Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
Search for more papers by this authorAbstract
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.
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