Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction.

摘要

Because clinical features of Takotsubo cardiomyop-athy (TC) mimic those of anterior acute myocardial infarction (AMI) (1), the differential diagnosis is important in selecting the appropriate treatment strategy, especially in the acute phase. This study assessed the value of the electrocardiogram (ECG) for discriminating TC from anterior AMI. We retrospectively compared admission ECGs of 33 patients with TC with those of 342 patients with a first anterior AMI who had ST-segment elevation of >1.0 mm in at least 2 contiguous precordial leads. All patients were admitted within 6 h of symptom onset. Patients with left or right bundle branch block, left ventricular hypertrophy, or atrial fibrillation were excluded. All patients with TC fulfilled the Mayo Clinic diagnosis criteria for TC (2); emergency coronary angiog-raphy was performed in 25 patients (76%) and emergency left ventriculography in 23 (70%). The diagnosis of anterior AMI was based on typical chest pain lasting for at least 30 min and a typical increase in serum creatine kinase levels to more than twice the upper limit of normal, as well as precordial ST-segment elevation on the admission ECG, as described previously. All patients with anterior AMI underwent emergency coronary angiography, and the presence of obstruction, severe stenosis, or intracoronary thrombus in the left anterior descending coronary artery was documented.