PR deviation as a risk marker for cardiac events in patients with Takotsubo syndrome

摘要

Abstract Background PR segment deviation (PRD: defined as PR elevation in aVR and PR depression in lead II/III) on electrocardiography is frequently observed in patients with acute pericarditis; however, there have been few studies that explore the occurrence of PRD in patients with Takotsubo syndrome (TTS). The clinical significance of PRD in TTS is not clearly elucidated. Methods & results A total of 52 consecutive patients with TTS in sinus rhythm (73.9 ± 13.8 years, nine males) were enrolled in the study. The major cardiac events were defined as sustained ventricular tachycardia or ventricular fibrillation, Killip class 4 heart failure, and cardiac death within 30 days. PRD in the hyperacute phase (within 48 h from the onset of TTS) was observed in 15 patients (29%), and all PRDs disappeared or diminished at 1 week later. The PRD (+) group had a higher value of C‐reactive protein level (median: 1.80?mg/dL [0.31‐3.26] vs 0.20?mg/dL [0.06‐0.81], P ??=??0.013) and creatine kinase‐muscle/brain isoenzyme (median: 60?IU/L [28‐75] vs 17?IU/L [13‐26], P? ?0.001) and a lower level of left ventricular ejection fraction (42.7 ± 7.2% vs 48.8 ± 9.4%, P ??=??0.041) than the PRD (?) group. Multivariate analysis showed that PRD was a significant and independent predictor for major cardiac events (odds ratio??=??21.0, 95% confidence interval??=??1.18‐273). Conclusions TTS patients with PRD in the hyperacute phase showed a high incidence of major cardiac events. Therefore, PRD may help to identify TTS patients at high risk for cardiac event.