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Circulation Journal
Vol. 67 (2003) No. 8 p. 687-690



Clinical Investigation

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 V4-6 to V1-3 (ΣSTeV4-6/V1-3) 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 ΣSTeV4-6/V1-3 ≥1 all showed a high sensitivity and specificity for diagnosing `Takotsubo' cardiomyopathy. Furthermore, the combination of the absence of reciprocal changes and a ΣSTeV4-6/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)


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