Myocardial edema the cause of Wellens’ ECG pattern?

Myocardial edema the cause of Wellens’ ECG pattern?

Dynamic T-wave inversion in the anterior leads known as Wellens’ ECG pattern can be seen in conditions with reversible left ventricular dysfunction (stunned myocardium) of either ischemic or nonischemic etiology. Cardiac magnetic resonance (CMR) imaging was done by Federico Migliore, Alessandro Zorzi, Martina Perazzolo Marra, Cristina Basso, Francesco Corbetti, Manuel De Lazzari, Giuseppe Tarantini, Paolo Buja, Carmelo Lacognata, Gaetano Thiene, Domenico Corrado and Sabino Iliceto [1] in four cases of the ECG pattern associated with myocardial bridge, coronary artery dissection, cholecystitis, and takotsubo syndrome. CMR studies were also repeated after six to eight weeks. The authors noted increased signal intensity of the left ventricular myocardium on T2-weighted sequences suggesting myocardial edema in all the four cases. There was no late gadolinium enhancement (LGE) in these cases. They found that the occurrence of repolarization abnormalities paralleled the time course of edema rather than the left ventricular mechanical dysfunction, persisting beyond the recovery of left ventricular dysfunction. The authors concluded that Wellens’ ECG pattern suggests myocardial edema rather than systolic dysfunction, regardless of the etiology.

Reference

  1. Federico Migliore, Alessandro Zorzi, Martina Perazzolo Marra, Cristina Basso, Francesco Corbetti, Manuel De Lazzari, Giuseppe Tarantini, Paolo Buja, Carmelo Lacognata, Gaetano Thiene, Domenico Corrado, Sabino Iliceto. Heart Rhythm. 2011 Oct;8(10):1629-34.