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
Cites
Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress
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Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States
Sharkey, S. W., Lesser, J. R., Zenovich, A. G., Maron, M. S., Lindberg, J. L., Longe, T. F., & Maron, B. J. (2005) · Circulation · doi:10.1161/01.cir.0000153801.51470.eb · Cited by 1,043
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Cited by
Sorted by citations
Natural History and Expansive Clinical Profile of Stress (Tako-Tsubo) Cardiomyopathy
Sharkey, S. W., Windenburg, D. C., Lesser, J. R., Maron, M. S., Hauser, R. G., Lesser, J. N., Haas, T. S., Hodges, J. S., & Maron, B. J. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.08.057 · Cited by 903
Self-citationTroponin elevation in coronary vs. non-coronary disease
Agewall, S., Giannitsis, E., Jernberg, T., & Katus, H. A. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq456 · Cited by 606
“Most patients with Tako-tsubo cardiomyopathy have a modest rise in cTn that peaks within 24 h.(58,60) The magnitude of increase in the biomarkers is less than that observed with a STEMI and disproportionately low for the extensive acute regional wall motion abnormalities that characterize Tako-tsubo cardiomyopathy.”
BackgroundStress Cardiomyopathy Diagnosis and Treatment
de Chazal, H. M., Buono, M. G. D., Keyser‐Marcus, L., Ma, L., Moeller, F. G., Berrocal, D. H., & Abbate, A. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.07.072 · Cited by 554
Januzzi, J. L., Filippatos, G. S., Nieminen, M. S., & Gheorghiade, M. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs191 · Cited by 315
“Despite being strongly linked to spontaneous (Type I) acute myocardial infarction (MI)—a common cause of acute HF syndromes—it is well recognized that concentrations of circulating troponins above the 99th percentile of a normal population in the context of both acute and chronic HF are highly prevalent, and frequentl…”
BackgroundInfluentialDiagnosis of Takotsubo Cardiomyopathy
Scantlebury, D. C., & Prasad, A. (2014) · Circulation Journal · doi:10.1253/circj.cj-14-0859 · Cited by 288
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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