The DOI matches its Crossref record; 23 of the 24 references it cites were found in a registry or an index.
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
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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“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]
Citations
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Items 101–171 of 171
Emotional Stress and Tako-Tsubo Cardiomyopathy: Observations on 2 Distinct Clinical Phenotypes
Yaqub, Y., Jenkins, L. A., Suarez, J., Sutthiwan, P., Phy, M. P., NUGENT, K. M., & Kumar, A. (2010) · Journal of Investigative Medicine · doi:10.2310/jim.0b013e3181c9b2b8 · Cited by 6
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“In a systematic review of 14 series, the main findings were; ST elevations were present in 34 − 56% of patients [14,18,19].”
BackgroundCharacteristics of coronary microcirculatory function in patients with Takotsubo syndrome
Novo, G., Quagliana, A., Buccheri, D., Rizzo, S. C., Giambanco, S., Giambanco, F., Evola, S., Geraci, G., & Novo, S. (2017) · Journal of Thoracic Disease · doi:10.21037/jtd.2017.10.93 · Cited by 6
“Some studies recorded alterations of the coronary microcirculation, at TFC analysis observing the coronary angiograms during the acute phases of the TS (13-18).”
BackgroundTroponins in Tako-tsubo Cardiomyopathy
Chadha, S., Lodha, A., Shetty, V., Sadiq, A., Hollander, G. M., Frankel, R. A., & Shani, J. (2013) · Heart Lung and Circulation · doi:10.1016/j.hlc.2012.12.010 · Cited by 6
Animal models of Takotsubo syndrome: bridging the gap to the human condition
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Self-citationTransient Cardiac Ballooning—The Syndrome
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Electromechanical Window and Spontaneous Ventricular Tachyarrhythmias in Takotsubo Syndrome
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“from STEMI based solely on the ECG findings [7,8].”
MethodMicrovascular Dysfunction in Takotsubo Cardiomyopathy
Gowdar, S. D., & Chhabra, L. (2016) · International Cardiovascular Forum Journal · doi:10.17987/icfj.v5i0.222 · Cited by 4
Takotsubo Syndrome in the Emergency Room — Diagnostic Challenges and Suggested Algorithm
Moady, G., Rubinstein, G., Mobarki, L., & Atar, S. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2304131 · Cited by 4
Mishra, T., Saha, R., & Paramasivam, G. (2024) · The Egyptian Heart Journal · doi:10.1186/s43044-024-00453-x · Cited by 4
“Therefore, some studies state that a detailed clinical profile along with coronary angiography is a better way for TCM identification [43].”
BackgroundSáez, F. D. N., García-Sípido, E. M., Molina, M. V., Navalpotro, M. A. B., Abad, R., & Ingelmo, J. M. G. (2011) · Medicina Intensiva · doi:10.1016/j.medin.2010.09.010 · Cited by 4
Madias, J. E. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.10.155 · Cited by 4
Varghese, J. G., Jelani, Q., ZARICH, S. W., & Walsh, B. (2017) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2017.01.024 · Cited by 4
Looi, J., Chan, C., Pemberton, J., Nankivell, A. W., McLeod, P. J., Webster, M. W. I., To, A. C. Y., Lee, M., & Kerr, A. (2023) · Heart Lung and Circulation · doi:10.1016/j.hlc.2023.04.002 · Cited by 3
Takotsubo Cardiomyopathy Induced Intraoperative and Postoperative Cardiac Arrests
Pittard, M. (2014) · Journal of Anesthesia & Clinical Research · doi:10.4172/2155-6148.1000454 · Cited by 3
“One study showed that compared with an acute myocardial infarction due to coronary artery occlusion, the rise in troponins in a patient with TC is only mildly elevated [4], as was the case with our patient.”
ResultA Unique Case Of Recurrent Takotsubo Cardiomyopathy- Atypical Followed By Typical Variant.
(2012) · The Internet Journal of Cardiology · doi:10.5580/2c03 · Cited by 3
Does this patient have takotsubo syndrome?
McLean, A. S., Slama, M., & Chew, M. S. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5189-6 · Cited by 3
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Bayón, J., Santás‐Álvarez, M., Ocaranza‐Sánchez, R., & González‐Juanatey, C. (2019) · Revista Portuguesa de Cardiologia (English Edition) · doi:10.1016/j.repce.2017.08.013 · Cited by 3
Recurrencia de miocardiopatía por estrés posterior a terremoto en Chile: Reporte de un caso clínico
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Takotsubo syndrome in New Zealand: current knowledge and future challenges
Looi, J., Chan, C., Bridgman, P. G., & Kerr, A. (2022) · Internal Medicine Journal · doi:10.1111/imj.15749 · Cited by 2
Rethinking Tako-tsubo Cardiomyopathy: The Contribution of Myocardial Pathology and Molecular Imaging
Sestini, S., Coppola, A., Dona, M., Martini, A. L., Tardelli, E., Montelatici, G., Laghai, I., Arena, A., Carli, G., Pestelli, F., et al. (2023) · Current Radiopharmaceuticals · doi:10.2174/1874471016666230515142106 · Cited by 2
Protean Electrocardiographic Patterns of ST-Segment Elevation in Patients With Takotsubo Syndrome
Xenogiannis, I., Nikolakopoulos, I., Vemmou, E., Brilakis, E. S., Herman, R., & Sharkey, S. W. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.08.149 · Cited by 2
Self-citationCardiomiopatia de Takotsubo da patogênese ao diagnóstico: estado da arte
Brito, J. D. S., Castro, M. S., Zambianco, P. D. S., Cavalcante, M. R., Silva, V. A., de Souza, N. B., & Caputo, L. R. G. (2020) · Revista de Medicina · doi:10.11606/issn.1679-9836.v99i5p491-502 · Cited by 2
Tako-Tsubo Cardiomyopathy: A Recent Clinical Syndrome Mimicking an Acute Coronary Syndrome
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Isolated deep T‐wave inversion on an electrocardiogram with normal wall motion
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Cori, A. D., Gemignani, C., Lazzari, M., Lorenzoni, R., Boni, A., Cortigiani, L., & Bovenzi, F. (2010) · PubMed · Cited by 2
Wittstein, I. S. (2016) · Springer eBooks · doi:10.1007/978-981-287-206-7_44 · Cited by 2
Cardiovascular Disease in Women
Rosenbaum, L. R., Shah, S. V., & Wood, M. J. (2013) · Springer eBooks · doi:10.1007/978-1-4471-4441-0_18 · Cited by 2
The Authors Reply: further consideration in evaluation of right ventricular infarction
Smer, A. M., Haddad, T. M., & Alla, V. M. (2015) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2015.02.037 · Cited by 2
“Ramaraj et al, in a systematic review of 114 patients with stress cardiomyopathy, demonstrated that peak troponin I ranged between 3 - 13 ng/ml (mean: 6.5 ng/ml) and peak troponin T ranged between 3 - 7 ng/ml (mean: 3.6 ng/ml).2 This finding was corroborated in a prospective study of 59 patients with stress cardiomyop…”
ResultInfluentialTako-Tsubo (stress) cardiomyopathy: pathophysiology and natural history.
Neil, C. (2014) · Adelaide Research & Scholarship (AR&S) (University of Adelaide) · Cited by 2
The Year of 2008 in Electrocardiology
Stern, S. (2010) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2009.00347.x · Cited by 1
Hakansson, F. H. K., Bodin, E., Dutordoir, V., Gemvik, A., Olsson, T., Nilsson, I., Andersson, M., Spaak, J., Ekenbäck, C., Henareh, L., et al. (2025) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztaf073 · Cited by 2
“7 The most common type of TTS is the apical TTS, however, other forms such as the midventricular, basal, and focal forms occur.”
Dynamic LVOT Obstruction as a Cause of Hemodynamic Instability in Takotsubo Syndrome
Tanna, S., Sangha, G., Singh, S., Patel, N., Suleman, U., Kutcher, J., Thannir, S., & Siddiqui, S. (2026) · Journal of Investigative Medicine High Impact Case Reports · doi:10.1177/23247096261475113 · Cited by 1
“When basal segments remain hypercontractile in the setting of apical or inferoseptal dysfunction, the resulting ventricular geometry and flow dynamics may promote systolic anterior motion of the mitral valve and dynamic LVOT obstruction (Video 2).”
Stress Induced Cardiomyopathy with Midventricular Ballooning: A Rare Variant
Siddiqui, M. U., Desiderio, M. C., Ricculli, N., & Rusovici, A. (2015) · Case Reports in Medicine · doi:10.1155/2015/154678 · Cited by 1
Devenir à moyen terme de 70 syndromes de Tako-Tsubo
Réglat, C., Chevalier, J. M., Coste, P., Godon, P., Renault, L., Roudaut, R., Séguy, B., & Gerbaud, É. (2014) · Annales de Cardiologie et d Angéiologie · doi:10.1016/j.ancard.2014.01.008 · Cited by 1
Broken heart in elderly patients: two clinical observations
Saller, A., Stefano, F. D., Allemand, E., Bigolin, P., Realdi, G., & Fabris, F. (2012) · Aging Clinical and Experimental Research · doi:10.1007/bf03325357 · Cited by 1
“ponin I were typically much lower than would be expected on the basis of wall-motion abnormalities (27).”
BackgroundThe role of invasive coronary physiology in Takotsubo Syndrome
Bayón, J., Reyes, M.-Á., Santás‐Álvarez, M., Abellás-Sequeiros, R. A., Ocaranza‐Sánchez, R., & González‐Juanatey, C. (2021) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2204141 · Cited by 1
Wittstein, I. S. (2011) · Springer eBooks · doi:10.1007/978-1-84882-419-5_10 · Cited by 1
Repolarization Injury and Occurrence of Torsades de Pointes During Acute Takotsubo Syndrome
Vemmou, E., Basala, T. R., Witt, D., Nikolakopoulos, I., Bergstedt, S., Xenogiannis, I., Brilakis, E. S., Hauser, R. G., & Sharkey, S. W. (2024) · JACC Advances · doi:10.1016/j.jacadv.2024.101263 · Cited by 1
Self-citationValidation of Takotsubo Syndrome Scoring System
Deeb, D., Loutati, R., Taha, L., Karmi, M., Brin, A., Rabi, O., Levi, N., Fink, N., Sabouret, P. F., Manassra, M., et al. (2025) · Diagnostics · doi:10.3390/diagnostics15111314 · Cited by 1
“Some studies have suggested that the prevalence of ST-segment elevation on ECG is less than half in TS patients [13,14], while diffuse T-wave inversions (I, II, V2–V6) and QTc prolongation (>500 ms) are a more characteristic feature of TS [9].”
La vulnerabilità cardiaca della donna agli stressor acuti: La sindrome Tako-tsubo
Compare, A., Grossi, E., Vanoli, E., Germani, E., Carniato, S., Covelli, V., & Leonardi, M. (2012) · Springer eBooks · doi:10.1007/978-88-470-2080-1_16 · Cited by 1
EKG bei Patienten mit Tako-Tsubo-Kardiomyopathie
Bonnemeier, H. (2015) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-015-0382-6
Unusual Causes of Myocardial Ischemia
Naples, R., & Harrigan, R. A. (2011) · doi:10.1002/9781119959809.ch4
Takotsubo cardiomyopathy: diagnosis in an emergency department
Mancini, M., Bartolini, D., & Zanna, M. (2014) · Emergency Care Journal · doi:10.4081/ecj.2014.1188
30-Year-Old Man With Chest Pain and Nausea
Kupsky, D. F., Tweet, M. S., & Anavekar, N. S. (2014) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2014.03.020
Takotsubo Cardiomyopathy with a Dramatically Rapid Resolution
Alichaudhry, M., Dib, C., & Lazzara, R. (2011) · International Journal of Clinical Medicine · doi:10.4236/ijcm.2011.22025
“In a comparison study of takotsubo cardiomyopathy and acute myocardial infarction (MI) 34% to 56% of takotsubo patients showed ST elevation in anterior leads [9,10], with absence of reciprocal changes, prolongation of QTc interval, and deep T wave inversion [9,10].”
BackgroundResultTakotsubo cardiomyopathy associated with serotonin syndrome: A disease that we should be aware of
Miyasaka, Y. (2012) · Journal of Cardiology Cases · doi:10.1016/j.jccase.2012.09.007
“[4] Sharkey SW, Lesser JR, Menon M, Parpart M, Maron MS, Maron BJ.”
BackgroundCoronary artery vasospasm after atrial septal defect surgery
Yoon, J. W., Lee, Y. S., Kim, D. K., Choi, Y. H., Kim, D.-J., Lee, J. J., Ahn, H. S., & Cho, W. H. (2014) · Journal of Yeungnam Medical Science · doi:10.12701/yujm.2014.31.2.122
“during the acute episodes within 1 to 4 weeks after the onset of stress-induced cardiomyopathy [25].”
BackgroundStreso sukelta kardiomiopatija (tako-tsubo kardiomiopatija)
Šerpytis, P., & Juknevičius, V. (2012) · Sveikatos mokslai · doi:10.5200/sm-hs.2012.104
Torres, S. (2014) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) · doi:10.34626/ep8r-5e76
Troponin Elevation Beyond Coronary Arteries
Vavuranakis, M., Kariori, M. G., Papaioannou, T. G., & Tousoulis, D. M. (2015) · Springer eBooks · doi:10.1007/978-94-007-7741-5_41-1
Ventricular Arrhythmias in Takotsubo Cardiomyopathy
Madias, C. A., & Trohman, R. G. (2013) · Elsevier eBooks · doi:10.1016/b978-1-4557-2856-5.00091-1
Bovenzi, F., Borelli, L., & Cortigiani, L. (2016) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000476
Ventricular Arrhythmias in Takotsubo Cardiomyopathy
Prasad, A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-44733-1.00091-2
Parkkonen, O. (2017) · Työväentutkimus Vuosikirja
Clinical and Diagnostic Aspects of Takotsubo Cardiomyopathy
Akashi, Y. J., Bárbaro, G., & Miyake, F. (2011) · Asia Pacific Cardiology · doi:10.15420/apc.2011:3:1:60
Takotsubo syndrome and hyperthyroidism: a case report
Echarri, A. I., Lorea, A. E., Esparza, N. E., Errea, A. S. D. L. T., Artajo, J. D. C., & Chacón, P. B. (2019) · Anales del Sistema Sanitario de Navarra · doi:10.23938/assn.0713
Schneider, B. (2020) · Sex and Cardiac Electrophysiology · doi:10.1016/b978-0-12-817728-0.00035-8
Wittstein, I. S. (2015) · Springer eBooks · doi:10.1007/978-981-4560-53-5_44-1
Troponin Elevation Beyond Coronary Arteries
Vavuranakis, M., Kariori, M. G., Papaioannou, T. G., & Tousoulis, D. M. (2016) · Springer eBooks · doi:10.1007/978-94-007-7678-4_41
Ghobrial, M., Karan, A., Omar, M. B., & Velarde, G. (2023) · Cureus · doi:10.7759/cureus.36277
“A comparative study found that the most common acute ECG changes in TCM are ST segment elevations in the anterior leads (56%), ECGs without ST segment elevations (44%), 17% were non-specific or normal, 17% revealed diffuse T-wave inversions, and 10% with healed anterior infarctions [4].”
BackgroundTakotsubo cardiomyopathy in athletes
Петрова, М. В., Spassky, A. A., Polyaev, B. A., & Mihaylov, A. (2024) · Sports medicine research and practice · doi:10.47529/2223-2524.2024.2.2
An Unusual Presentation of Takotsubo Syndrome in a Young Female of Middle Eastern Origin
Lal, D., Almohdar, S. M., Elsayed, M. O. K., & Heena, H. (2025) · Clinical Case Reports · doi:10.1002/ccr3.70166
Синдром разбитого сердца или кардиомиопатия Такоцубо
Доронина, А. Ю. (2014) · APRIORI. Серия: Естественные и технические науки
Metadata
- 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.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 101
- Issue
- 12
- Pages
- 1723-1728
- ISSN
- 0002-9149 (ISSN-L)
- 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
- 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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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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