Volume 10, Issue 1, Pages (January 2013)

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Volume 10, Issue 1, Pages 70-77 (January 2013) Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens’ ECG pattern) in Tako-Tsubo cardiomyopathy Martina Perazzolo Marra, MD, PhD, Alessandro Zorzi, MD, Francesco Corbetti, MD, Manuel De Lazzari, MD, Federico Migliore, MD, Francesco Tona, MD, PhD, Giuseppe Tarantini, MD, PhD, Sabino Iliceto, MD, Domenico Corrado, MD, PhD Heart Rhythm Volume 10, Issue 1, Pages 70-77 (January 2013) DOI: 10.1016/j.hrthm.2012.09.004 Copyright © 2013 Heart Rhythm Society Terms and Conditions

Figure 1 Dynamics of negative T-wave voltage and corrected QT (QTc) interval in leads V1-V6 over the first week following admission. Heart Rhythm 2013 10, 70-77DOI: (10.1016/j.hrthm.2012.09.004) Copyright © 2013 Heart Rhythm Society Terms and Conditions

Figure 2 Dynamics of tissue characterization and functional cardiac magnetic resonance (CMR) parameters for basal, medium, and apical left ventricular segments. The initial CMR shows a significant apicobasal gradient of signal intensity (SI) both in T2-weighted (A) and in T1-weighted inversion recovery post-contrast sequences (with SI threshold for late gadolinium enhancement [LGE]≥2SD) (B) and a reverse gradient of contractility impairment expressed as systolic wall thickening (SWT) (C). All parameters normalize during follow-up (D-F). Heart Rhythm 2013 10, 70-77DOI: (10.1016/j.hrthm.2012.09.004) Copyright © 2013 Heart Rhythm Society Terms and Conditions

Figure 3 Correlation between T2 apicobasal signal intensity (SI) ratio and electrocardiographic repolarization indices, that is, the maximal amplitude of negative T waves (NTWm) (A) and the sum of amplitudes of negative T waves (NTWs) (B). Heart Rhythm 2013 10, 70-77DOI: (10.1016/j.hrthm.2012.09.004) Copyright © 2013 Heart Rhythm Society Terms and Conditions

Figure 4 Representative cases of Tako-Tsubo cardiomyopathy encompassing the spectrum of electrocardiographic repolarization abnormalities and myocardial edema. Patient 3 (top): Two-chamber view showing mid-apical edema with an apicobasal gradient of 1.72 in T2-weighted sequences (A) and late gadolinium enhancement (LGE)≥2SD with an apicobasal gradient of 1.59 in T1-weighted inversion recovery post-contrast sequences (B). Twelve-lead electrocardiogram showing deep negative T waves (NTWm = 1.3 mV, NTWs = 4.9 mV, QTc max = 590 ms) (C). Patient 18 (bottom): Two-chamber view showing mid-apical edema with an apicobasal gradient of 1.31 in T2-weighted sequences (D) and LGE≥2SD with an apicobasal gradient of 1.20 in T1-weighted inversion recovery post-contrast sequences (E). Twelve-lead electrocardiogram showing small negative T waves (NTWm = 0.2 mV, NTWs = 0.5 mV, QTc max = 510 ms) (F). Heart Rhythm 2013 10, 70-77DOI: (10.1016/j.hrthm.2012.09.004) Copyright © 2013 Heart Rhythm Society Terms and Conditions

Heart Rhythm 2013 10, 70-77DOI: (10.1016/j.hrthm.2012.09.004) Copyright © 2013 Heart Rhythm Society Terms and Conditions

Heart Rhythm 2013 10, 70-77DOI: (10.1016/j.hrthm.2012.09.004) Copyright © 2013 Heart Rhythm Society Terms and Conditions