title: ECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction.
abstract: ECG criteria differentiating Takotsubo cardiomyopathy (TTC) from mainly anterior myocardial infarction (MI) have been suggested; however, this was in small patient populations.
  
  
  
  Twelve-lead admission ECGs of consecutive 200 TTC and 200 MI patients were compared in dichotomized groups based on the presence or absence of ST-elevation MI (STEMI versus STE-TTC and non-ST elevation MI versus non ST-elevation-TTC). When comparing STEMI and STE-TTC, ST-elevation in -aVR was characteristic of STE-TTC with a sensitivity/specificity of 43% and 95%, positive predictive value (PPV) 91%, and a negative predictive value (NPV) 62% (P<0.001); when ST-elevation in -aVR is accompanied by ST-elevation in inferior leads, sensitivity/specificity were 14% and 98% (PPV was 89% and NPV 52%) (P=0.001), and 12% and 100% when associated with ST-elevation in anteroseptal leads (PPV 100%, NPV 52%) (P<0.001). On the other hand, STEMI was characterized by ST-elevation in aVR (sensitivity/specificity of 31% and 95% P<0.001, PPV 85% and NPV 59%) and ST-depression in V2-V3-V4 (sensitivity/specificity of 24% and 100% P<0.001, PPV 100% and NPV 76%). When comparing non-ST elevation MI and non ST-elevation-TTC, T-inversion in leads I-aVL-V5-V6 had a sensitivity/specificity of 17% and 97% for non ST-elevation-TTC (PPV 83% and NPV 55%) (P<0.001), and ST-elevation in -aVR with T-inversion in any lead was also specific for non ST-elevation-TTC (sensitivity/specificity of 8% and 100%, PPV 100% and NPV 53%) (P=0.006). In non-ST elevation MI patients, the presence of ST-depression in V2-V3 was specific (sensitivity/specificity of 11% and 99%, PPV 91% and NPV 51%) (P=0.01).
  
  
  
  ECG on admission can differentiate between TTC and acute MI, with high specificity and positive predictive value.
  
  
  
  URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01947621.
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Antonio H
authors.initials: AH
authors.lastname: Frangieh
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Slayman
authors.initials: S
authors.lastname: Obeid
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Jelena-Rima
authors.initials: JR
authors.lastname: Ghadri
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Imori
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Kovac
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Firat
authors.initials: F
authors.lastname: Duru
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland christian.templin@usz.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis*; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*
keywords: Takotsubo cardiomyopathy; differential diagnosis; electrocardiogram; myocardial infarction; stress‐induced cardiomyopathy