title: A new electrocardiographic criterion to differentiate between Takotsubo cardiomyopathy and anterior wall ST-segment elevation acute myocardial infarction.
abstract: Several studies have examined the ability of electrocardiography to differentiate between takotsubo cardiomyopathy (TC) and anterior wall acute ST-segment elevation myocardial infarction (AA-STEMI). In those studies, the magnitude of ST-segment elevation was not measured at the J point. The American Heart Association, American College of Cardiology Foundation, and Heart Rhythm Society guidelines recommend that the magnitude of ST-segment elevation should be measured at the J point. Accordingly, the aim of this study was to retrospectively examine whether electrocardiography, using the magnitude of ST-segment elevation measured at the J point, could differentiate 62 patients with TC from 280 with AA-STEMI. Patients with AA-STEMI were divided into following subgroups: 140 with left anterior descending coronary artery occlusions proximal to the first diagonal branch (AA-STEMI-P), 120 with left anterior descending occlusions distal to the first diagonal branch and proximal to the second diagonal branch (AA-STEMI-M), and 20 with left anterior descending occlusions distal to the second diagonal branch (AA-STEMI-D). TC had a much lower prevalence of ST-segment elevation ≥1 mm in lead V(1) (19.4%) compared to AA-STEMI (80.4%, p <0.01), AA-STEMI-P (80.7%, p <0.01), AA-STEMI-M (80%, p <0.01), and AA-STEMI-D (80%, p <0.01). ST-segment elevation ≥1 mm in ≥1 of leads V(3) to V(5) without ST-segment elevation ≥1 mm in lead V(1) identified TC with sensitivity of 74.2% and specificity of 80.6%. Furthermore, this criterion could differentiate TC from each AA-STEMI subgroup, with similar diagnostic values. In conclusion, using the magnitude of ST-segment elevation measured at the J point, a new electrocardiographic criterion is proposed with an acceptable ability to differentiate TC from AA-STEMI.
authors.affiliation: Internal Medicine, Faculty of Medicine, Oita University, Yufu, Japan. akira@oita-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Tamura
authors.forename: Toru
authors.initials: T
authors.lastname: Watanabe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ando
authors.forename: Shigeru
authors.initials: S
authors.lastname: Naono
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Zaizen
authors.forename: Yusei
authors.initials: Y
authors.lastname: Abe
authors.forename: Shoji
authors.initials: S
authors.lastname: Yano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shinozaki
authors.forename: Munenori
authors.initials: M
authors.lastname: Kotoku
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Momii
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kadokami
authors.forename: Junichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000503:physiopathology