Specific Findings of the Standard 12-Lead ECG in Patients With `Takotsubo' Cardiomyopathy

Comparison With the Findings of Acute Anterior Myocardial Infarction

Abstract

The clinical course of `Takotsubo' cardiomyopathy closely resembles that of acute myocardial infarction (AMI) and coronary angiography (CAG) is usually performed to distinguish the 2 conditions during the acute phase. The present study was designed to determine whether the standard 12-lead electrocardiogram (ECG) findings could help to distinguish `Takotsubo' cardiomyopathy from anterior AMI. The study group comprised 13 patients with `Takotsubo' cardiomyopathy and 13 consecutive patients with anterior AMI. Patients with `Takotsubo' cardiomyopathy had abnormal Q waves less frequently than patients with anterior AMI (15% vs 69%, p=0.008). No reciprocal changes were seen in the inferior leads in patients with `Takotsubo' cardiomyopathy (p=0.0003). The ratio of ST-segment elevation in leads V<sub>4-6</sub> to V<sub>1-3</sub> (ΣSTeV<sub>4-6</sub>/V<sub>1-3</sub>) was significantly higher in patients with `Takotsubo' cardiomyopathy (1.55±0.53 vs 0.57±0.58, p=0.0004). The QTc interval was significantly longer in patients with `Takotsubo' cardiomyopathy. The absence of reciprocal changes, absence of abnormal Q waves, and a ΣSTeV<sub>4-6</sub>/V<sub>1-3</sub> ≥1 all showed a high sensitivity and specificity for diagnosing `Takotsubo' cardiomyopathy. Furthermore, the combination of the absence of reciprocal changes and a ΣSTeV_4-6/V _1-3 ≥1 had a greater specificity (100%) and overall accuracy (91%) than either criteria. Therefore, the standard 12-lead ECG on admission can help to distinguish `Takotsubo' cardiomyopathy from anterior AMI. (Circ J 2003; 67: 687 - 690)