title: Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The presentation and electrocardiographic (ECG) characteristics of transient left ventricular apical ballooning syndrome (TLVABS) can be similar to that of anterior ST-segment elevation myocardial infarction (STEMI). We tested the hypothesis that the ECG on presentation could reliably differentiate these syndromes.
  
  
  METHODS
  Between January 1, 2002 and July 31, 2004, we identified 18 consecutive patients with TLVABS who were matched with 36 subjects presenting with acute anterior STEMI due to atherothrombotic left anterior descending coronary artery occlusion.
  
  
  RESULTS
  All patients with TLVABS were women (mean age, 72.0 +/- 13.1 years). The heart rate, PR interval, QRS duration, and corrected QT interval were similar between groups. Distribution of ST elevation was similar, but patients with anterior STEMI exhibited greater ST elevation. Regressive partitioning analysis indicated that the combination of ST elevation in lead V2 of less than 1.75 mm and ST-segment elevation in lead V3 of less than 2.5 mm was a suggestive predictor of TLVABS (sensitivity, 67%; specificity, 94%). Conditional logistic regression indicated that the formula: (3 x ST-elevation lead V2) + (ST-elevation V3) + (2 x ST-elevation V5) allowed possible discrimination between TLVABS and anterior STEMI with an optimal cutoff level of less than 11.5 mm for TLVABS (sensitivity, 94%; specificity, 72%). Patients with TLVABS were less likely to have concurrent ST-segment depression (6% vs 44%; P = .003).
  
  
  CONCLUSIONS
  Women presenting with TLVABS have similar ECG findings to patients with anterior infarct but with less-prominent ST-segment elevation in the anterior precordial ECG leads. These ECG findings are relatively subtle and do not have sufficient predictive value to allow reliable emergency differentiation of these syndromes.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Bybee
authors.forename: Arashk
authors.initials: A
authors.lastname: Motiei
authors.forename: Imran S
authors.initials: IS
authors.lastname: Syed
authors.forename: Tomas
authors.initials: T
authors.lastname: Kara
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Murphy
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: R Scott
authors.initials: RS
authors.lastname: Wright
mesh_terms: D000368:Aged; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis*; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis*