Abstract：
OBJECTIVE: The clinical value of electrocardiogram (ECG) repolarization parameters associated with ventricular arrhythmias (VAs) in tako-tsubo syndrome is still under debate. We aimed to evaluate ECG predictors of subacute VAs, defined as those occurring after the first 48hours from admission.
METHODS: This single-center observational study enrolled patients admitted to the cardiology department between 2012 and 2018 with a confirmed diagnosis of tako-tsubo syndrome. Data collection included a 12-lead ECG on admission and at 48hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography, and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥ 2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT, and non-sustained VT.
RESULTS: A total of 87 patients (age 72±12 years) were enrolled. During a median of 8 days of hospitalization, subacute VAs were documented in 22 patients (25%) after a median of 91hours from admission. Subacute VAs were associated with an increase in mortality during hospitalization (P=.030). The corrected global (mean of the 12-lead ECG values) Tpeak-Tend interval at 48hours from admission was an independent predictor of subacute VAs and was statistically superior to the standard corrected QT interval (Z test, P=.040). A cut-off of 108 msec for the corrected global Tpeak-Tend yielded a 71% sensitivity and 72% specificity for subacute VAs.
CONCLUSIONS: In patients with tako-tsubo syndrome, subacute VAs are associated with repolarization alterations that can be identified on conventional ECG using the Tpeak-Tend interval.
METHODS: This single-center observational study enrolled patients admitted to the cardiology department between 2012 and 2018 with a confirmed diagnosis of tako-tsubo syndrome. Data collection included a 12-lead ECG on admission and at 48hours, continuous telemetry monitoring, blood testing, transthoracic echocardiography, and coronary angiography during hospitalization. VAs events were defined as: premature ventricular contractions ≥ 2000 within a 24-hour window of telemetry monitoring, ventricular fibrillation, sustained ventricular tachycardia (VT), polymorphic VT, and non-sustained VT.
RESULTS: A total of 87 patients (age 72±12 years) were enrolled. During a median of 8 days of hospitalization, subacute VAs were documented in 22 patients (25%) after a median of 91hours from admission. Subacute VAs were associated with an increase in mortality during hospitalization (P=.030). The corrected global (mean of the 12-lead ECG values) Tpeak-Tend interval at 48hours from admission was an independent predictor of subacute VAs and was statistically superior to the standard corrected QT interval (Z test, P=.040). A cut-off of 108 msec for the corrected global Tpeak-Tend yielded a 71% sensitivity and 72% specificity for subacute VAs.
CONCLUSIONS: In patients with tako-tsubo syndrome, subacute VAs are associated with repolarization alterations that can be identified on conventional ECG using the Tpeak-Tend interval.
摘要：
目的：与室性心律失常（VAs）相关的心电图（ECG）复极参数在tako-tsubo综合征中的临床价值仍在争论中。我们旨在评估亚急性VAs的心电图预测因子，定义为入院前48小时后发生的事件。
方法：这项单中心观察性研究纳入了2012年至2018年心内科确诊为tako-tsubo综合征的患者。数据收集包括入院时和48小时的12导联心电图，连续遥测监测,验血,经胸超声心动图,住院期间的冠状动脉造影。VA事件定义为：24小时遥测监测窗内室性早搏≥2000，心室纤颤,持续性室性心动过速(VT),多态VT,和非持续性VT。
结果：共纳入87例患者（年龄72±12岁）。在平均住院8天期间，在中位入院时间91小时后,有22例患者(25%)记录了亚急性VAs.亚急性VAs与住院期间死亡率增加相关（P=0.030）。入院后48小时校正的全局（12导联ECG值的平均值）Tpeak-Tend间期是亚急性VAs的独立预测因子，并且在统计学上优于标准校正的QT间期（Z检验，P=.040）。校正的全局Tpeak-Tend的截止时间为108毫秒，对亚急性VAs的灵敏度为71％，特异性为72％。
结论：在tako-tsubo综合征患者中，亚急性VAs与复极化改变相关,可在常规心电图上使用Tpeak-Tend间期进行识别.
方法：这项单中心观察性研究纳入了2012年至2018年心内科确诊为tako-tsubo综合征的患者。数据收集包括入院时和48小时的12导联心电图，连续遥测监测,验血,经胸超声心动图,住院期间的冠状动脉造影。VA事件定义为：24小时遥测监测窗内室性早搏≥2000，心室纤颤,持续性室性心动过速(VT),多态VT,和非持续性VT。
结果：共纳入87例患者（年龄72±12岁）。在平均住院8天期间，在中位入院时间91小时后,有22例患者(25%)记录了亚急性VAs.亚急性VAs与住院期间死亡率增加相关（P=0.030）。入院后48小时校正的全局（12导联ECG值的平均值）Tpeak-Tend间期是亚急性VAs的独立预测因子，并且在统计学上优于标准校正的QT间期（Z检验，P=.040）。校正的全局Tpeak-Tend的截止时间为108毫秒，对亚急性VAs的灵敏度为71％，特异性为72％。
结论：在tako-tsubo综合征患者中，亚急性VAs与复极化改变相关,可在常规心电图上使用Tpeak-Tend间期进行识别.
