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Cited by 171Takotsubo Cardiomyopathy and Associated PhenomenaAcute Myocardial Infarction ResearchCardiac Imaging and Diagnostics

Spectrum and Significance of Electrocardiographic Patterns, Troponin Levels, and Thrombolysis in Myocardial Infarction Frame Count in Patients With Stress (Tako-tsubo) Cardiomyopathy and Comparison to Those in Patients With ST-Elevation Anterior Wall Myocardial Infarction

Sharkey, Scott W., Lesser, John R., Menon, Madhav, Parpart, Mary, Maron, Martin S., Maron, Barry J.·2008·The American Journal of Cardiology
DOI 10.1016/j.amjcard.2008.02.062
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Abstract

Stress (takotsubo) cardiomyopathy (SC) is a recently recognized syndrome with clinical and electrocardiographic (ECG) presentation resembling ST elevation anterior myocardial infarction. As experience with this condition has evolved, a more diverse spectrum of 12-lead ECG patterns has emerged that may affect differential diagnosis. Fifty-nine consecutive patients with SC were prospectively identified at a large community-based cardiology practice. All were women aged 32 to 90 years (mean 66+/-13) with acute chest pain triggered by emotional or physical incidents and with akinesia of the mid-distal left ventricle; each patient recovered and was discharged within a median of 4 days. On electrocardiography, anterior ST elevation was most common (33 [56%]), with magnitudes less than in controls with left anterior descending coronary artery occlusions (1.4+/-1.5 vs 2.4+/-2.2 mm, p<0.001), with considerable overlap. ECG findings in 26 other patients (44%) without ST elevation revealed diffuse T-wave inversion (10 [17%]) and healed anterior infarctions (6 [10%]) or were nonspecific (5 [8.5%]) or normal (5 [8.5%]). Troponin elevations occurred in 56 patients with SC (95%). The mean peak troponin T level was significantly lower in patients with SC (0.64+/-0.86 ng/ml) than in those with left anterior descending coronary artery occlusions (3.88+/-4.9 ng/ml) (p<0.0001). Patients with SC with or without ST elevation did not differ with respect to the ejection fraction (29+/-9% vs 34+/-9%, respectively, p=NS) or Thrombolysis In Myocardial Infarction (TIMI) frame counts. During recovery, diffuse T-wave inversion evolved in 49 patients with SC (83%). In conclusion, patients with SC present with diverse ECG findings, and no single pattern alone can reliably distinguish this condition from acute coronary syndromes. The diagnosis of SC requires heightened awareness of its unique clinical profile as well as coronary arteriography and left ventriculography.

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  • In 59 female patients with stress (takotsubo) cardiomyopathy, 56% had anterior ST-elevation with magnitudes less than in controls with left anterior descending coronary artery occlusions; other patients without ST-elevation had diffuse T-wave inversion, healed anterior infarctions or nonspecific changes; 8.5% had a normal ECG.

    “Scrutinizing the ECG findings in 59 female patients with stress (takotsubo) cardiomyopathy showed in 56% of the patients anterior STelevation, with magnitudes less than in controls with left anterior descending coronary artery occlusions; in other patients without ST-elevation, the ECG revealed diffuse T-wave inversion, healed anterior infarctions or nonspecific changes; in 8.5% the ECG was normal”

    From The Year of 2008 in Electrocardiology (2010) · cites this paper as [29]

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Authors
Sharkey, S. W., Lesser, J. R., Menon, M., Parpart, M., Maron, M. S., & Maron, B. J.
Affiliations
  • Minneapolis Heart Institute Foundation (US)
  • Tufts Medical Center (US)
Corresponding author
Maron, Barry J.
ORCID
Venue
The American Journal of Cardiology
Publisher
Elsevier BV
Published
2008-06
Volume
101
Issue
12
Pages
1723-1728
ISSN
0002-9149 (ISSN-L)
DOI
10.1016/j.amjcard.2008.02.062
OpenAlex
W1992921450
Cited by
171
References
24
Citations by year
2026: 1 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 8 · 2019: 5 · 2018: 4 · 2017: 11 · 2016: 16 · 2015: 20 · 2014: 19 · 2013: 17 · 2012: 13
FWCI
8.49
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The American Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
takotsubo cardiomyopathy, ST-elevation myocardial infarction, electrocardiographic pattern, troponin T, TIMI frame count, T-wave inversion, differential diagnosis, acute coronary syndrome, left anterior descending artery occlusion, ejection fraction, women, emotional stress, physical stress, chest pain, coronary angiography
MeSH terms
Adult, Aged, Aged, 80 and over, Electrocardiography, Female, Follow-Up Studies, Humans, Middle Aged, Myocardial Infarction, Prognosis, Prospective Studies, Severity of Illness Index, Thrombolytic Therapy, Troponin T, Takotsubo Cardiomyopathy

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