Инверсия зубца Т в грудных отведениях: дифференциальный диагноз при сердечных и внесердечных заболеваниях

Инверсия зубца Т (ИЗТ) – распространенная находка на электрокардиограмме. Причины ИЗТ многочисленны, в ряде случаев ИЗТ может возникать при угрожающих жизни состояниях. Цель обзора литературы – представить современный анализ ИЗТ: (1) определение и распространенность, (2) причины возникновения и (3) дифференциальный диагноз при доброкачественной ИЗТ, обратимой ишемии миокарда передней стенки левого желудочка, кардиомиопатии такоцубо, субарахноидальном кровоизлиянии, тромбоэмболии легочной артерии, аритмогенной кардиомиопатии правого желудочка и «памяти сердца». В обзоре представлены практические электрокардиографические критерии, позволяющие вовремя заподозрить угрожающие жизни состояния для выбора своевременного метода лечения.

1. Malhotra A, Dhutia H, Gati S, Yeo T-J, Dores H, Bastiaenen R et al. Anterior T-Wave Inversion in Young White Athletes and Nonathletes: Prevalence and Significance. Journal of the American College of Cardiology. 2017;69(1):1–9. DOI: 10.1016/j.jacc.2016.10.044

2. Aro AL, Anttonen O, Tikkanen JT, Junttila MJ, Kerola T, Rissanen HA et al. Prevalence and Prognostic Significance of T-Wave Inversions in Right Precordial Leads of a 12-Lead Electrocardiogram in the Middle-Aged Subjects. Circulation. 2012;125(21):2572–7. DOI: 10.1161/CIRCULATIONAHA.112.098681

3. Pelliccia A, Culasso F, Di Paolo FM, Accettura D, Cantore R, Castagna W et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. European Heart Journal. 2007;28(16):2006–10. DOI: 10.1093/eurheartj/ehm219

4. Jacobson D, Schrire V. Giant T wave inversion. Heart. 1966;28(6):768–75. DOI: 10.1136/hrt.28.6.768

5. Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens’ syndrome. The American Journal of Emergency Medicine. 2002;20(7):638–43. DOI: 10.1053/ajem.2002.34800

6. Byer E, Ashman R, Toth LA. Electrocardiograms with large, upright T waves and long Q-T intervals. American Heart Journal. 1947;33(6):796–806. DOI: 10.1016/0002-8703(47)90025-2

7. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Journal of the American College of Cardiology. 2001;38(1):11–8. DOI: 10.1016/S0735-1097(01)01316-X

8. Cheng TO, Bashour TT. Striking Electrocardiographic Changes Associated with Pheochromocytome. Chest. 1976;70(3):397–9. DOI: 10.1378/chest.70.3.397

9. Pelkonen R, Pitkänen E. Unusual Electrocardiographic Changes in Pheochromocytoma. Acta Medica Scandinavica. 2009;173(1):41– 4. DOI: 10.1111/j.0954-6820.1963.tb16503.x

10. Littmann L. Large T wave inversion and QT prolongation associated with pulmonary edema: a report of nine cases. Journal of the American College of Cardiology. 1999;34(4):1106–10. DOI: 10.1016/S0735-1097(99)00311-3

11. Said SAM, Somer ST, Oude Luttikhuis HA. Flecainide-induced JT prolongation, T wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation. International Journal of Cardiology. 1994;44(3):285–7. DOI: 10.1016/0167-5273(94)90293-3

12. Pillarisetti J, Gupta K. Giant Inverted T waves in the emergency department: case report and review of differential diagnoses. Journal of Electrocardiology. 2010;43(1):40–2. DOI: 10.1016/j.jelectrocard.2009.08.048

13. Littmann L. Large T-Wave Inversion in a Patient with a Pacemaker. Archives of Internal Medicine. 2011;171(15):1314. DOI: 10.1001/archinternmed.2011.358

14. Corbella F, Dragonetti L, Rivas C, Eyheremendy E, Acunzo R. Giant negative T waves of indeterminate origin. Revista Argentina Cardiologia. 2009;77(2):131–4. [Av. at: https://pdfs.semanticscholar.org/d8d0/1e472be0b06212e94cdfbee9275556c60194.pdf?_ga=2.112624580.1986970897.1584445994-898496954.1576661036]

15. Dhawan SS. Pseudo-Wellens’ syndrome after crack cocaine use. Canadian Journal of Cardiology. 2008;24(5):404. DOI: 10.1016/S0828-282X(08)70608-1

16. Said SA. Coronary-cameral fistulas in adults (first of two parts). World Journal of Cardiology. 2013;5(9):329–36. DOI: 10.4330/wjc.v5.i9.329

17. Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S et al. Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. European Heart Journal. 2009;30(14):1728–35. DOI: 10.1093/eurheartj/ehp164

18. Papadakis M, Carre F, Kervio G, Rawlins J, Panoulas VF, Chandra N et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. European Heart Journal. 2011;32(18):2304–13. DOI: 10.1093/eurheartj/ehr140

19. Zaidi A, Sheikh N, Jongman JK, Gati S, Panoulas VF, Carr-White G et al. Clinical Differentiation Between Physiological Remodeling and Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes with Marked Electrocardiographic Repolarization Anomalies. Journal of the American College of Cardiology. 2015;65(25):2702–11. DOI: 10.1016/j.jacc.2015.04.035

20. Macfarlane PW, Antzelevitch C, Haissaguerre M, Huikuri HV, Potse M, Rosso R et al. The Early Repolarization Pattern. Journal of the American College of Cardiology. 2015;66(4):470–7. DOI: 10.1016/j.jacc.2015.05.033

21. Calore C, Zorzi A, Sheikh N, Nese A, Facci M, Malhotra A et al. Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete’s heart and cardiomyopathy. European Heart Journal. 2016;37(32):2515–27. DOI: 10.1093/eurheartj/ehv591

22. Wehrens XHT, Doevendans PA, Oude Ophuis TJ, Wellens HJJ. A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. American Heart Journal. 2000;139(3):430–6. DOI: 10.1016/S0002-8703(00)90086-3

23. De Zwaan C, Bär FWHM, Wellens HJJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. American Heart Journal. 1982;103(4):730–6. DOI: 10.1016/0002-8703(82)90480-X

24. Kojuri J, Vosoughi A, Khosropanah S, Aslani A. Electrocardiographic predictors of proximal left anterior descending coronary artery occlusion. Open Medicine. 2008;3(3):294–9. DOI: 10.2478/s11536-007-0060-0

25. Canpolat U, Kaya EB, Aytemir K, Oto A. Delayed therapy for Wellens’ syndrome resulted in acute myocardial infarction. Kardiologia Polska. 2012;70(12):1316. PMID: 23264258

26. Hollar L, Hartness O, Doering T. Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction. Journal of Community Hospital Internal Medicine Perspectives. 2015;5(5):29384. DOI: 10.3402/jchimp.v5.29384

27. Okada M, Yotsukura M, Shimada T, Ishikawa K. Clinical implications of isolated T wave inversion in adults: Electrocardiographic differentiation of the underlying cause of this phenomenon. Journal of the American College of Cardiology. 1994;24(3):739–45. DOI: 10.1016/0735-1097(94)90023-X

28. Kosuge M, Ebina T, Hibi K, Tsukahara K, Iwahashi N, Gohbara M et al. Differences in negative T waves among acute coronary syndrome, acute pulmonary embolism, and Takotsubo cardiomyopathy. European Heart Journal: Acute Cardiovascular Care. 2012;1(4):349–57. DOI: 10.1177/2048872612466790

29. Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW. The electrocardiogram in acute pulmonary embolism. Progress in Cardiovascular Diseases. 1975;17(4):247–57. DOI: 10.1016/S0033-0620(75)80016-8

30. Daniel KR, Courtney DM, Kline JA. Assessment of Cardiac Stress from Massive Pulmonary Embolism With 12-Lead ECG. Chest. 2001;120(2):474–81. DOI: 10.1378/chest.120.2.474

31. Walder LA, Spodick DH. Global T wave inversion. Journal of the American College of Cardiology. 1991;17(7):1479–85. DOI: 10.1016/0735-1097(91)90635-M

32. Kosuge M, Ebina T, Hibi K, Tsukahara K, Iwahashi N, Umemura S et al. Differences in Negative T Waves Between Acute Pulmonary Embolism and Acute Coronary Syndrome. Circulation Journal. 2014;78(2):483–9. DOI: 10.1253/circj.CJ-13-1064

33. Punukollu G, Gowda RM, Khan IA, Wilbur SL, Vasavada BC, Sacchi TJ. QT Interval Prolongation with Global T-Wave Inversion: A Novel ECG Finding in Acute Pulmonary Embolism. Annals of Noninvasive Electrocardiology. 2004;9(1):94–8. DOI: 10.1111/j.1542-474X.2004.91528.x

34. Rencuzogullari I, Çağdaş M, Karabağ Y, Karakoyun S, Çiftçi H, Gürsoy MO et al. A novel ECG parameter for diagnosis of acute pulmonary embolism: RS time. The American Journal of Emergency Medicine. 2019;37(7):1230–6. DOI: 10.1016/j.ajem.2018.09.010

35. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS et al. Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction. Annals of Internal Medicine. 2004;141(11):858. DOI: 10.7326/0003-4819-141-11-200412070-00010

36. Prasad A, Dangas G, Srinivasan M, Yu J, Gersh BJ, Mehran R et al. Incidence and angiographic characteristics of patients With apical ballooning syndrome (takotsubo/stress cardiomyopathy) in the HORIZONS-AMI trial: An analysis from a multicenter, international study of ST-elevation myocardial infarction. Catheterization and Cardiovascular Interventions. 2014;83(3):343–8. DOI: 10.1002/ccd.23441

37. Redfors B, Vedad R, Angerås O, Råmunddal T, Petursson P, Haraldsson I et al. Mortality in takotsubo syndrome is similar to mortality in myocardial infarction — A report from the SWEDEHEART registry. International Journal of Cardiology. 2015;185:282–9. DOI: 10.1016/j.ijcard.2015.03.162

38. Frangieh AH, Obeid S, Ghadri J, Imori Y, D’Ascenzo F, Kovac M et al. ECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction. Journal of the American Heart Association. 2016;5(6):e003418. DOI: 10.1161/JAHA.116.003418

39. Imran TF, Rahman I, Dikdan S, Shah R, Niazi OT, Thirunahari N et al. QT Prolongation and Clinical Outcomes in Patients with Takotsubo Cardiomyopathy. Pacing and Clinical Electrophysiology. 2016;39(6):607–11. DOI: 10.1111/pace.12864

40. Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. The Lancet. 2007;369(9558):306–18. DOI: 10.1016/S0140-6736(07)60153-6

41. Lee VH, Oh JK, Mulvagh SL, Wijdicks EFM. Mechanisms in Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage. Neurocritical Care. 2006;5(3):243–9. DOI: 10.1385/NCC:5:3:243

42. Malik AN, Gross BA, Rosalind Lai PM, Moses ZB, Du R. Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery. 2015;83(6):880–5. DOI: 10.1016/j.wneu.2015.01.013

43. Khechinashvili G, Asplund K. Electrocardiographic Changes in Patients with Acute Stroke: A Systematic Review. Cerebrovascular Diseases. 2002;14(2):67–76. DOI: 10.1159/000064733

44. Kumai T, Inamasu J, Watanabe E, Sugimoto K, Hirose Y. Differences between Takotsubo cardiomyopathy and reverse Takotsubo cardiomyopathy associated with subarachnoid hemorrhage. IJC Heart & Vasculature. 2016;11:99–103. DOI: 10.1016/j.ijcha.2016.05.010

45. Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right Ventricular Cardiomyopathy and Sudden Death in Young People. New England Journal of Medicine. 1988;318(3):129–33. DOI: 10.1056/NEJM198801213180301

46. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: Proposed Modification of the Task Force Criteria. European Heart Journal. 2010;31(7):806–14. DOI: 10.1093/eurheartj/ehq025

47. Corrado D, Link MS, Calkins H. Arrhythmogenic Right Ventricular Cardiomyopathy. New England Journal of Medicine. 2017;376(1):61–72. DOI: 10.1056/NEJMra1509267

48. Shvilkin A, Ho KKL, Rosen MR, Josephson ME. T-Vector Direction Differentiates Postpacing From Ischemic T-Wave Inversion in Precordial Leads. Circulation. 2005;111(8):969–74. DOI: 10.1161/01.CIR.0000156463.51021.07

49. Nakagawa T, Yagi T, Ishida A, Mibiki Y, Yamashina Y, Sato H et al. Differences between cardiac memory T wave changes after idiopathic left ventricular tachycardia and ischemic T wave inversion induced by acute coronary syndrome. Journal of Electrocardiology. 2016;49(4):596–602. DOI: 10.1016/j.jelectrocard.2016.04.001