alexa Differences in ST-elevation and T-wave amplitudes do not reliably differentiate takotsubo cardiomyopathy from acute anterior myocardial infarction.


Emergency Medicine: Open Access

Author(s): Parkkonen O, Allonen J, Vaara S, Viitasalo M, Nieminen MS,

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Abstract BACKGROUND: Previous efforts to distinguish acute anterior ST-elevation myocardial infarction (anterior-STEMI) from various forms of takotsubo cardiomyopathy (TTC) by electrocardiography (ECG) have produced differing results. METHODS: We performed a retrospective comparison of acute ECGs between 48 apical and 9 mid-ventricular TTC patients, with 96 anterior-STEMI patients. ECG was recorded in acute phase (<24h from onset of pain), and analyzed for ST-changes, negative T-waves, abnormal Q-waves and QT-interval duration. Time from onset of pain to ECG was gathered from patient records. RESULTS: Anterior-STEMI patients had ST-elevation in lead V1 more frequently than apical (70\% vs 15\%, p<0.0001) or mid-ventricular TTC patients (70\% vs 0\%, p<0.0001), and higher ST-elevation amplitudes in leads V2-V5 (p<0.02). Lack of ST-elevation in lead V1 and ST-elevation amplitude <2mm in lead V2 distinguished TTC from anterior-STEMI patients with 63\% sensitivity and 93\% specificity, with 79\% predictive value. CONCLUSIONS: In patients with anterior ST-elevation and acute chest pain, lack of ST-elevation in lead V1 and ST-elevation amplitude <2mm in lead V2 suggests a TTC diagnosis. However, this criterion is not reliable enough in clinical practice to distinguish between TTC and anterior-STEMI patients. Copyright © 2014 Elsevier Inc. All rights reserved. This article was published in J Electrocardiol and referenced in Emergency Medicine: Open Access

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