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Performance of electrocardiographic criteria to differentiate Takotsubo cardiomyopathy from acute anterior ST elevation myocardial infarction.
MedLine Citation:
PMID:  21802749     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The initial electrocardiogram (ECG) in Takotsubo cardiomyopathy (TC) can mimic an acute, anterior ST-segment elevation myocardial infarction (STEMI). Given the profound and immediate treatment differences between TC and STEMI, it would be clinically valuable to distinguish them using ECG criteria. METHODS: Presenting ECGs for proven cases of TC and acute, anterior STEMI were retrospectively collected. QRS onset and J-point were manually identified using custom software to compute median ST deviation for each lead. Six published ECG criteria were examined for diagnostic accuracy using the clinical diagnosis as the gold standard. RESULTS: 33 TC and 263 acute, anterior STEMI cases were identified. ST-segment deviation differed significantly between groups for all leads except aVR, I, V5, and V6. All six published ECG criteria showed a marked reduction in diagnostic accuracy in our validation cohort, except for a combination of ST-elevation in leads V2<1.75mm and V3<2.5mm (sensitivity 79%, specificity 73% for TC). CONCLUSION: Our study demonstrates the limited diagnostic accuracy of published ECG rules to distinguish TC from acute, anterior STEMI. Given the rarity of TC and the clinical consequences of a "false positive" TC diagnosis based on ECG criteria alone, such rules should not be used in practice. TC remains a diagnosis of exclusion after emergent angiography in patients with an acute coronary syndrome and significant ST-segment elevation.
Authors:
Nils P Johnson; Jose F Chavez; William J Mosley; James D Flaherty; Justin M Fox
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-28
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-8-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States; Weatherhead P.E.T. Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas, United States.
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