title: Differences in ST-elevation and T-wave amplitudes do not reliably differentiate takotsubo cardiomyopathy from acute anterior myocardial infarction.
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.
authors.affiliation: HUCH Heart and Lung Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland. Electronic address: olavi.parkkonen@helsinki.fi.
authors.forename: Olavi
authors.initials: O
authors.lastname: Parkkonen
authors.affiliation: HUCH Heart and Lung Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Allonen
authors.affiliation: HUCH Heart and Lung Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Vaara
authors.affiliation: HUCH Heart and Lung Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Viitasalo
authors.affiliation: HUCH Heart and Lung Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland.
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.affiliation: HUCH Heart and Lung Center, Helsinki University Central Hospital (HUCH), Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Sinisalo
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000503:physiopathology
keywords: Acute myocardial infarction; Electrocardiography; Takotsubo cardiomyopathy