Vol.:(0123456789) 1 3 Int J Cardiovasc Imaging DOI 10.1007/s10554-017-1181-4 ORIGINAL PAPER T-wave changes in patients with Wellens syndrome are associated with increased myocardial mechanical and electrical dispersion Ivan Stankovic 1  · Srdjan Kafedzic 1  · Aleksandra Janicijevic 1  · Radosava Cvjetan 1  · Tijana Vulovic 1  · Milica Jankovic 1  · Ivan Ilic 1  · Biljana Putnikovic 1  · Aleksandar N. Neskovic 1   Received: 7 March 2017 / Accepted: 24 May 2017 © Springer Science+Business Media Dordrecht 2017 stenosis and normal ECG, and control subjects (P < 0.05). T-wave changes in patients with WS are associated with more profound regional myocardial dysfunction and increased QTc and myocardial mechanical dispersion. Sim- ilar angiographic characteristics of the LAD lesion were seen in patients with WS and normal ECG. Keywords Wellens syndrome · QT dispersion · Mechanical dispersion · Strain imaging Introduction Wellens syndrome refers to a subtype of unstable angina with negative or minimally elevated markers of myocar- dial necrosis, biphasic or inverted T-waves in the precordial leads V2 and V3 and a critical stenosis of the left anterior descending coronary artery (LAD) [1, 2]. However, only some symptomatic patients with a critical narrowing of LAD exhibit a typical Wellens pattern, while the major- ity presents with ST-segment depression or normal resting electrocardiogram (ECG). After the original description of the syndrome in 1982 [1, 2] and a series of case reports [3–7], emergency physicians have become increasingly aware of this high risk subset of patients, but the etiology of the Wellens’ T-waves remains undetermined. In the present study, we hypothesize that the presence of ischemic myocardium is associated with characteristic ECG changes in Wellens syndrome. Previous studies have shown that ischemic memory could be assessed by detect- ing post-systolic shortening (PSS), i.e., prolongation of myocardial contraction beyond end-systole [8]. In line with this, we have recently reported that there is a correlation between myocardial contraction and QTc interval duration in patients with chest pain and critical LAD stenosis [9]. Abstract Some patients with unstable angina and criti- cal stenosis of the left anterior descending coronary artery (LAD) present with Wellens syndrome (WS), i.e., inverted or biphasic T-waves in the anterior precordial leads. We assessed clinical, angiographic, electro- and echocardio- graphic characteristic of patients with WS. In this retro- spective study, clinical, angiographic, electro- and echo- cardiographic characteristic of 35 patients with WS were compared to 57 patients with critical LAD stenosis and normal resting electrocardiogram (ECG), and 45 subjects with normal coronary angiogram. QTc dispersion was measured from the 12-lead ECG as the diference between longest and shortest QTc intervals. Mechanical dispersion was defned as the time diference between the longest and shortest contraction durations which were measured as the time from the frst defection of the QRS complex to maximum myocardial shortening of each 18 segmental longitudinal strain curves derived by speckle tracking echo- cardiography. There were no signifcant diferences in the complexity and location of the LAD lesion, anterograde and collateral fow in LAD and coronary artery dominance between patients with WS and normal ECG (P > 0.05, for all). Patients with WS had lower global longitudinal strain (GLS) and more pronounced both QTc and myocardial mechanical dispersion than patients with critical LAD Electronic supplementary material The online version of this article (doi:10.1007/s10554-017-1181-4) contains supplementary material, which is available to authorized users. * Ivan Stankovic future.ivan@gmail.com 1 Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Vukova 9, 11070 Belgrade, Serbia