title: Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) typically affects postmenopausal women and clinically presents with chest pain, ST-segment elevation, elevated cardiac enzymes and apical left ventricular (LV) wall motion abnormalities that mimic 'apical-anterior' acute myocardial infarction (AMI). This study assessed whether at-admission clinical evaluation helps in differential diagnosis between the two conditions.
  
  
  METHODS
  The study compared at-admission clinical, electrocardiographic (ECG) and echocardiographic findings of 31 women (median age 67 years, interquartile range (IQR) 62-76) with typical TTC and 30 women (median age 73 years, IQR 61-81) with apical-anterior AMI due to acute occlusion of the mid/distal left anterior descending coronary artery.
  
  
  RESULTS
  Women with TTC significantly more often showed PR-segment depression (62% versus 3%, p<0.001), J-waves (26% versus 3%, p=0.03), maximum ST-segment elevation ⩽2 mm (84% versus 37%, p<0.001) and ST-segment elevation in lead II (42% versus 10%, p=0.01) than those with AMI. At multivariate analysis, PR-segment depression (odds ratio (OR)=37.2, 95% confidence interval (CI)=3.4-424, p=0.002) and maximum ST-segment elevation ⩽2 mm (OR=11.1, 95% CI=1.7-99.4, p=0.01) remained the only independent predictors of TTC and the co-existence of both parameters excluded AMI with a 100% specificity. The two groups did not differ with regard to age, first troponin-I value, echocardiographic LV ejection fraction and distribution of hypo/akinetic LV segments.
  
  
  CONCLUSIONS
  At-admission electrocardiogram (but no clinical, laboratory and echocardiographic features) allows differential diagnosis between TTC and apical-anterior AMI in postmenopausal women. The combination of PR-segment depression and mild (⩽2 mm) ST-segment elevation predicted TTC with greater accuracy than traditional parameters such as localisation of ST-segment elevation and reciprocal ST-segment depression.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Baritussio
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy Department of Cardiology, Aswan Heart Center, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: ElMaghawry
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Siciliano
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Perazzolo Marra
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy domenico.corrado@unipd.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission; D017698:Postmenopause; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging*
keywords: Electrocardiogram; PR-segment depression; acute coronary syndrome; apical ballooning; gender medicine; myocardial infarction; pericarditis; troponin