Performance of electrocardiographic criteria to differentiate Takotsubo cardiomyopathy from acute anterior ST elevation myocardial infarction

Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

“…The existing ECG criterion [6] analyzed in this study was compared to the original study [6] and a recent study performed by Johnson et al [13]. The sensitivity found in the original study was 91%, while in both our study and the study performed by Johnson et al the sensitivity was markedly lower (26% and 0% respectively), while the specificity was similar.…”

Diagnosis of Takotsubo Cardiomyopathy

“…Indeed, the condition closely resembles the entity previously known as neurologic stunned myocardium, which is now commonly considered to be a manifestation of TTC. 36 Many case series have included exhaustive lists of specific stressful 50 The criteria showed a marked reduction in diagnostic accuracy in their cohort except for STe V2 <1.75 mm plus STe V3 <2.5 mm (79% sensitivity and 73% specificity). SCANTLEBURY DC et al…”

“…The criteria all have less than perfect diagnostic accuracy and given the consequences of a missed diagnosis, do not allow for reliable differentiation between the 2 conditions in the emergency setting to guide management (eg, decision to undergo emergency coronary angiography). 50 worth noting that a stressor is not identified in up to one-third of individuals. 37 MI may also be precipitated by specific stressors.…”

Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis

“…These include lack or rarity of reciprocal ST depression, widespread T wave inversion, low QRS voltage on presentation, attenuation of QRS voltage in serial EKGs, QTc prolongation, frontal plane ST vector, ST segment elevation (STE) in aVR without STE in V1, lower rate of Q-waves, more frequent STE in the inferior leads, higher ratio of the sums of STEs in leads V4-V6 to the sums of STEs in leads in V1-V3, lower amplitude of STE (< 1.5 mm) and a summated amplitude of the S-wave in V1 plus the R-wave in V6 < 1.5 mV[47,48]. While these EKG findings could have additive value in diagnosis of TC, their diagnostic accuracy for TC diagnosis have been found wanting in some studies[49,50]. …”