title: Myocardial edema underlies dynamic T-wave inversion (Wellens' ECG pattern) in patients with reversible left ventricular dysfunction.
abstract: BACKGROUND
  The Wellens' electrocardiogram (ECG) pattern of dynamic T-wave inversion in the anterior leads is observed in clinical conditions characterized by reversible left ventricular (LV) dysfunction (stunned myocardium), either ischemic or nonischemic. The pathophysiologic basis of this ECG pattern remains to be elucidated.
  
  
  OBJECTIVE
  The purpose of this study was to report the contrast-enhanced cardiac magnetic resonance (CE-CMR) findings in 4 cases of Wellens' ECG pattern associated with transient LV dysfunction from a variety of clinical conditions such as myocardial bridge, coronary artery dissection, cholecystitis, and takotsubo syndrome.
  
  
  METHODS
  All patients underwent CE-CMR at the time of acute clinical manifestations and after 6 to 8 weeks of follow-up to assess the presence and dynamics of LV myocardial changes.
  
  
  RESULTS
  In all patients, the Wellens' ECG abnormalities were associated with increased signal intensity of the LV myocardium on T2-weighted sequences suggesting myocardial edema, in the absence of late enhancement on postcontrast sequences. Repolarization abnormalities and myocardial edema had a parallel time course with persistence beyond recovery of mechanical abnormalities. T-wave inversion was associated with transient prolongation of the QTc interval in all cases.
  
  
  CONCLUSIONS
  The study results suggest that myocardial edema rather than systolic dysfunction underlies the Wellens' ECG pattern, regardless of the causative mechanism.
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.forename: Cristina
authors.initials: C
authors.lastname: Basso
authors.forename: Francesco
authors.initials: F
authors.lastname: Corbetti
authors.forename: Manuel
authors.initials: M
authors.lastname: De Lazzari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.forename: Carmelo
authors.initials: C
authors.lastname: Lacognata
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D004489:Edema, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
chemical_list: D003287:Contrast Media