Takotsubo syndrome vs anterior STEMI electrocardiography; a meta-analysis and systematic review (original) (raw)
Related papers
GET QT': Clinical Criteria to Differentiate Takotsubo Cardiomyopathy from STEMI
International Cardiovascular Forum Journal, 2016
Background Introduction: Presentation of Takotsubo cardiomyopathy (TCM) may closely mimic ST-elevation myocardial infarction (STEMI) and clinicians are often faced with a dilemma when cardiac catheterization is unavailable or contraindicated. Methods Age-matched 42 TCM and 55 STEMI patients admitted in SUNY Upstate Hospital, Syracuse, NY were retrospectively compared for characteristics at presentation. Results Results: 12 TCM patients (26%) had ST elevation in the initial EKG. Mean QTc interval was significantly prolonged in TCM (469ms vs 443ms,p=0.001). The peak Troponin T (TnTp) level in TCM was significantly less (1.15ng/ml vs 6.04ng/ml; p=0.001) and the time to peak troponin T (Tp) was lower (3.7 hours versus 12.4 hours,p=0.001). Mean LV ejection fraction (EF) was 36% in TCM versus 47.4% in STEMI (p=0.001). Significance (p<0.05) was noted for 5 predictors on multiple regression namely: Gender, EF, TnTp, QTc interval and Tp. A prediction model was then developed, giving a score of one for each positive finding: female gender, EF< 40%, TnTp< 2ng/ ml, QTc> 470ms in the initial EKG and Tp< 6 hours (GET QT criteria). The presence of 3 or more predictors had a sensitivity of 88.8%, specificity of 95.1% and negative predictive value of 90.9% to diagnose TCM. Though there have been recent publications proposing various criteria to distinguish the two diseases, this is the first proposing highly specific and all-inclusive combined laboratory, EKG and echocardiography criteria. Conclusions Females with early and low peaking troponins prolonged QTc; low EF were likely to have TCM. With the proposed prediction modelpresence of 3 or more factors is highly specific to diagnose TCM.
Differentiating Takotsubo cardiomyopathy from ST-segment elevation myocardial infarction
Hong Kong Journal of Emergency Medicine
Background: Takotsubo cardiomyopathy affects between 1.7% and 2.2% of patients hospitalized with suspected acute coronary syndromes. Characterized by chest pain, electrocardiogram changes, and transient left ventricular apical wall motion abnormality, it is under-recognized and often misdiagnosed. Objectives: In order to better differentiate between St-segment myocardial infarction and Takotsubo cardiomyopathy, we developed a scoring system. Methods: Of the 82 patients enrolled with Takotsubo cardiomyopathy, 67 had ST-segment elevation on electrocardiogram and were compared with 79 ST-elevation myocardial infarction patients. A multi-variant logistic regression model was used to find factors independently associated with Takotsubo cardiomyopathy. The Platelets and Thrombosis in Sheba (PLATIS)-Takotsubo cardiomyopathy is based on a 10-point scoring system: stressful events (3), females (2), no history of diabetes mellitus (2), estimated left ventricular ejection fraction ≤ 40% on adm...
“Takotsubo effect” in patients with ST segment elevation myocardial infarction
European Heart Journal: Acute Cardiovascular Care, 2020
Background Myocardial infarction can be a trigger of Takotsubo syndrome. We recently characterized imaging features of acute myocardial infarction-induced Takotsubo syndrome (“Takotsubo effect”). In this study, we investigate diagnostic and prognostic implications of Takotsubo effect in patients with anterior wall ST-segment elevation myocardial infarction. Methods We enrolled 111 consecutive patients who developed anterior wall ST-segment elevation myocardial infarction and received percutaneous coronary intervention, and studied systolic/diastolic function, hemodynamic consequences, adverse cardiac events, as well as 30-day and five-year outcomes in patients with and without Takotsubo effect. Results Patients with Takotsubo effect showed significantly worse average peak systolic longitudinal strain (–9.5 ± 2.6% vs –11.1 ± 3.6%, p = 0.038), left ventricular ejection fraction (38.5 ± 6.8% vs 47.7 ± 8.7%, p = 0.000) and myocardial performance index (0.54 ± 0.17 vs 0.37 ± 0.15, p = 0....
The American Journal of Cardiology, 2018
No previous study has examined the differences in patient characteristics and initial electrocardiographic findings of Takotsubo syndrome (TTS) according to the time from onset to electrocardiography. Using the Tokyo Cardiovascular Care Unit network registry 2011-2012, we retrospectively identified 106 apical TTS patients in whom symptom onset time was specified, and classified the patients into 5 groups according to the time from onset to the initial electrocardiography: <3h (n=45), 3-6h (n=20), 6-12h (n=12), 12-24h (n=13), and ≥24h (n=16). There was no significant difference across the groups in age, sex, symptoms, triggers, vital signs, blood tests, or in-hospital outcomes. In the electrocardiographic findings, ST-elevation was more frequent in leads V2-V4 than in the other leads, especially in the <24h groups, but did not differ significantly across groups. T-wave inversion was more frequent in leads V3-V6, especially in the ≥24h group, and differed significantly across groups. The total number of leads with T-wave inversion was significantly higher in the ≥24h group than in the <24h groups (mean, 5.9 leads vs 1.5-2.9 leads; P<0.001). Isolated ST-elevation was the most frequent pattern of ST-T change in precordial leads (42%-56%) in the <24h groups, while isolated T-wave inversion was the most frequent (44%) in the ≥24h group (P=0.018). Neither ST-elevation nor T-wave inversion was observed in precordial leads in 10 (9%) patients. In conclusion, our results suggest that the initial electrocardiographic findings of apical TTS are affected by the time from onset to electrocardiography and display a wide variation in ST-T changes.
Takotsubo cardiomyopathy and arrhythmic risk: the dark side of the moon
2013
BACKGROUND: "Takotsubo" cardiomyopathy (TTC) is a clinical disorder usually triggered by intense emotional and/or physical stress, characterized by reversible severe localized left ventricular wall dyskinesia, transient changes of ST segment, without significant coronary artery stenoses, that can mimic acute myocardial infarction. STATE OF THE ART: Although TTC is well known to have a good mid-and long-term prognosis, arrhythmic risk is increasingly recognized and we could provide, in view of the available literature, a mean for a prognostic stratification and some practical suggestions for management of these "vulnerable" patients. PERSPECTIVES: Further studies with randomized trials will be needed to prove the optimal treatment of TTC CONCLUSIONS: TTC, generally considered a benign syndrome, should be reconsidered as a clinical condition at high risk for lethal arrhythmias in a subpopulation with QTc > 500 msec in acute phase. The studies about arrhythmias and TTC are based on case reports. TTC may present with sudden cardiac death: this results in a probable underestimate of the real arrhythmic risk. TTC is one of the causes of acquired long QT syndrome and could be a trigger able to unmask latent silent or inapparent congenital long QT syndrome. All factors that can exacerbate QT prolongation should be promptly removed. In the case of marked bradycardia and/or TdP should be implant a temporary pacemaker. In most cases, due to the transient nature of the syndrome, it is reasonable to recommend only beta-blocker therapy at discharge, despite the absence of randomized trials. If there are high-risk factor for long QT syndrome (QTc post-TCM > 500 ms, prior syncope, previous cardiac arrests) thought should be given an indication to ICD implant.
Journal of the American Heart Association, 2021
Background Takotsubo syndrome (TS) is a potentially life‐threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short‐term mortality risk of TS, ST‐segment–elevation myocardial infarction (STEMI), and non‐STEMI (NSTEMI) and to identify predictors of in‐hospital complications and poor prognosis in patients with TS. Methods and Results This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all‐cause mortality at 30 days. Secondary outcomes were acute heart ...