Association between Tpeak-Tend/QT and major adverse cardiovascular events in patients with Takotsubo syndrome

Electrocardiogram repolarization markers and ventricular arrhythmias in patients with takotsubo syndrome

The predictive value of various ECG repolarization markers for the emergence of VA in patients with TTS was reviewed. The literature reports on QT, more recently on Tpe, and rarely on some more QT-derived metrics, revealing a contribution of these variables for the prediction of VA, complicating the acute, subacute, and follow-up clinical trajectory of patients with TTS. More recent literature reveals that Tpe and some other QT-based metrics, have outperformed the traditionally employed QT marker, although certainty about this awaits confirmation by future carefully designed and implemented studies.

Tpeak-Tend ECG Marker in Obesity and Cardiovascular Diseases: A Comprehensive Review

Globally, cardiovascular diseases are still the leading cause of death. Numerous methods are used to diagnose cardiovascular pathologies; there is still a place for straightforward and noninvasive techniques, such as electrocardiogram (ECG). Depolarization and repolarization parameters, including QT interval and its derivatives, are well studied. However, the Tpeak-Tend interval is a novel and promising ECG marker with growing evidence for its potential role in predicting malignant arrhythmias. In this review, we discuss the association between the Tpeak-Tend interval and several cardiovascular diseases, including long QT syndrome, cardiomyopathies, heart failure, myocardial infarction, and obesity, which constitutes one of the risk factors for cardiovascular diseases.

Evaluation of Tpeak-end interval, Tpeak-end/QT, and Tpeak-end/Qtc ratio during acute migraine attack in the emergency department

INTRODUCTION

During an acute migraine attack, changes in ventricular repolarisation parameters may occur due to an imbalance in the autonomic nervous system. Tpeak-tend (Tp-e) interval, Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio are novel parameters of arrhythmogenesis and can be easily calculated in electrocardiography (ECG). The objective of this study is to demonstrate that novel ventricular repolarisation parameters can anticipate the risk of ventricular dysrhythmia in the migraine attack period.

METHODS

This research was a prospective case-control study, which recruited a total of 144 participants, including 74 migraine patients and 70 healthy volunteers in the control group (CG) who met the criteria for migraine with or without aura. All participants underwent 12-lead ECG recordings, and the study compared the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio with those of the CG.

RESULTS

The average age of patients experiencing migraine attacks was 38.14 ± 10.82, with 58 (76%) of these patients being female. The Tp-e interval mean was higher in the migraine attack group than the CG, with a statistically significant difference discovered (74.22 ± 20.20 ms [ms] compared to 65.39 ± 11.33 ms, p = 0.001). However, there were higher mean Tp-e/QT and Tp-e/QTc ratios in the migraine attack group compared to the CG, and this difference was found to be statistically significant (0.20 ± 0.05 vs. 0.17 ± 0.03, p = 0.001, 0.18 ± 0.52 vs 0.16 ± 0.29, p = 0.003, respectively).

CONCLUSION

Prolonged Tp-e interval and elevated Tp-e/QT and Tp-e/QTc ratios were observed in migraine patients who presented to the emergency department, indicating a potential risk of ventricular dysrhythmia.

QT interval prolongation in Takotsubo syndrome: a frightening feature with no major prognostic impact

Despite the frequent and often severe repolarization abnormalities seen in Takotsubo syndrome (TTS), the underlying mechanism of life-threatening arrhythmias is incompletely understood, and the risk remains uncertain. TTS is considered a potential cause of acquired long QT syndrome; however, there is no robust evidence that QT prolongation has a major prognostic impact on these patients' outcomes. Our aim was to assess the prevalence and clinical implications of acquired long QT during TTS events and compare in-hospital and long-term outcomes between patients with and without corrected QT interval (QTc) prolongation. This is a retrospective cohort study that included 113 patients admitted to our tertiary care hospital with a diagnosis of TTS. The cohort was divided into two groups: a long QTc group (QTc≥460 milliseconds in any electrocardiogram at admission or during hospitalization) and a normal QTc group. Baseline characteristics, occurrences during hospitalization, and outcome data were obtained from the revision of medical registries and hospital visits. Of the 113 patients, 107 (94.7%) were female. The mean age was 67.6±11.7 years. QTc prolongation was found in 38%. Demographic characteristics, relevant chronic medication, prevalence of cardiovascular risk factors, and other comorbidities were similar between the groups, except for history of atrial fibrillation, which was more common in the long QTc group. Syncope was more prevalent in the long QTc group. In-hospital complications were not statistically different between patients with long and normal QTc (48.8% versus 44.2%, p=0.637), including ventricular arrhythmias and complete atrioventricular block (both 4.7% versus 1.4%, p=0.556). In-hospital mortality was 0.9%, corresponding to one patient in the long QTc group. The mean follow-up time was 4.8±3.8 years. 5-year all-cause mortality and the occurrence of the composite endpoint of major adverse cardiac and cerebrovascular events did not differ between the groups (p=0.511 and p=0.538, respectively). Our study found no association between prolonged QTc interval during TTS events and adverse prognosis, since in-hospital and long-term outcomes were similar between the groups. Our findings suggest that, although QT prolongation is usually a frightening feature on ECG, this repolarization abnormality during the acute phase has no major prognostic implications in the TTS population.

A Longer Tpeak-Tend Interval Is Associated with a Higher Risk of Death: A Meta-Analysis

A noninvasive tool for cardiovascular risk stratification has not yet been established in the clinical routine analysis. Previous studies suggest a prolonged Tpeak-Tend interval (the interval from the peak to the end of the T-wave) to be predictive of death. This meta-analysis was designed to systematically evaluate the association of the Tpeak-Tend interval with mortality outcomes. Medline (via PubMed), Embase and the Cochrane Library were searched from 1 January 2008 to 21 July 2020 for articles reporting the ascertainment of the Tpeak-Tend interval and observation of all-cause-mortality. The search yielded 1920 citations, of which 133 full-texts were retrieved and 29 observational studies involving 23,114 patients met the final criteria. All-cause deaths had longer Tpeak-Tend intervals compared to survivors by a standardized mean difference of 0.41 (95% CI 0.23-0.58) and patients with a long Tpeak-Tend interval had a higher risk of all-cause death compared to patients with a short Tpeak-Tend interval by an overall odds ratio of 2.33 (95% CI 1.57-3.45). Heart rate correction, electrocardiographic (ECG) measurement methods and the selection of ECG leads were major sources of heterogeneity. Subgroup analyses revealed that heart rate correction did not affect the association of the Tpeak-Tend interval with mortality outcomes, whereas this finding was not evident in all measurement methods. The Tpeak-Tend interval was found to be significantly associated with all-cause mortality. Further studies are warranted to confirm the prognostic value of the Tpeak-Tend interval.

Prognostic value of the Tpeak-Tend interval for in-hospital subacute ventricular arrhythmias in tako-tsubo syndrome

INTRODUCTION AND OBJECTIVES

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.