Clinical analysis on Wellens syndrome in 68 cases

QIU Jing-wei; WANG Cui-zhen; PU Kui; GUO Feng; CHENG Yan-hui

doi:10.3969/j.issn.1674-4055.2017.04.25

Abstract：Objective To investigate the clinical symptoms, features of electrocardiogram (ECG) and misdiagnosis causes of Wellens syndrome (WS).Methods ECG, ultrasonic cardiogram and myocardial biochemical markers were retrospectively analyzed, and types and quantity of misdiagnosis diseases were counted in 68 WS patients undergone coronary angiography (CAG) in the Department of Cardiology of Chinese PLA 254th Hospital from Jan. 2013 to Jul. 2015.Results ①Clinical situation: there 47 male patients and 21 female ones, 58 received percutaneous coronary intervention (PCI), 6, coronary artery bypass grafting (CABG) and 4, medication therapy, and 3 evolved to anterior myocardial infarction (AMI). ②The lesions were located at proximal-middle segments of left anterior descending branch (LAD), and there was 0 with stenosis<50%, 4 (5.9%) with stenosis from50% to70%, 12 (17.6%) with stenosis from 70% to 90%, and 52 (76.5%) with stenosis>90%. ③Myocardial biochemical markers: cardiac troponin I (cTnI) increased in 24 cases and average peak value was 0.72±0.26 ng/mL, and average peak value of NT-proBNP was 384.02±192.89 pg/mL. ④ECG: there were 52 cases (76.5%) with inversed T-wave, 30 (44.1%) with bidirectional T-wave and 14 (20.6%) with both. ⑤Ultrasonic cardiogram: there were 37 with ventricular wall motion abnormalities (RWMA). ⑥Misdiagnosis: there were 5 cases misdiagnosed with cardiac neurosis, 4, with stress cardiomyopathy, and one each with pericarditis, pulmonary infarction, gastroesophageal reflux disease or pharyngitis respectively.Conclusion ECG shows as isolated T-wave changes in WS patients, and the locations of lesions are at the proximal-middle segments of LAD. The levels of cTnI and NT-proBNP have increased in part of patients. The lack of understanding on ECG features is the main cause of misdiagnosis.