The early dynamic of ECG in takotsubo syndrome presenting with ST-elevation: A comparison with age and gender-matched ST-elevation myocardial infarction

Abstract Background Electrocardiographic (ECG) features on acute phase of Takotsubo syndrome (TTS) is recognized to mimic that of acute anterior myocardial infarction (ant AMI). However, the difference of synthesized 18-leads ECG of both diseases was not elucidated. Purpose To elucidate diagnostic performance of 18-leads ECG to distinguish TTS and acute anterior AMI. Methods We firstly enrolled consecutive 40 patients of TTS, and among 500 ant AMI patients, one to two matching was done by their age and gender. Finally, 40+80 patients (74.5±11.2 years, 87 females) were enrolled, and ECG at onset of both group was estimated. Because of multicollinearity, all significant differences were compared by machine learning (Random Forest method). Results Prevalence of Q wave had no difference. Conversely, ST depression in TTS and ST elevation in ant AMI were significant differences in V7–9 leads. T-wave polarity of V3R-V9 leads were significantly different (flat T-wave in TTS and positive in ant AMI). Machine learning revealed T wave polarity in V7 lead had the highest feature importance. Conclusion 18-leads ECG at onset had powerful diagnostic performance to distinguish the two diseases. Funding Acknowledgement Type of funding source: None

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Abstract 13718: Automatic Microvolt-level Measurement of ST Level at J-point on 12-lead Electrocardiography Can Distinguish Takotsubo Syndrome and Acute Anterior Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.13718 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Masato Shimizu ◽

shummo cho ◽

Yoshiki Misu ◽

Mari Ohmori ◽

Ryo Tateishi ◽

...

Keyword(s):

Myocardial Infarction ◽

Automated System ◽

P Value ◽

Takotsubo Syndrome ◽

Random Matching ◽

Anterior Myocardial Infarction ◽

St Depression ◽

Level Measurement ◽

St Elevation ◽

And Gender

Introduction: ST elevation/depression on 12-leads electrocardiography (ECG) at onset was recognized difficult to distinguish Takotsubo syndrome (TTS) and acute anterior myocardial infarction (ant AMI). Diagnostic performance of automatic microvolt-level measurement of the ST levels was not elucidated. Hypothesis: Microvolt-level differences of ST level at J-point on ECG can distinguish TTS and ant AMI in acute phase. Methods: We firstly enrolled consecutive 40 patients of TTS, and among 500 ant AMI patients, one to two random matching was done by their age and gender. Finally, 40+80 patients (74.5±11.2 years, 87 females) were enrolled. ECG at onset of both group was measured by automated system (ECAPs12c: Nihon-Koden). Results: ST level of TTS at J-point in I/II/V4-6 lead was significantly elevated comparing to that of ant AMI. Conversely, Conversely, significant ST depression in aVR and no ST elevation in V1 of TTS was observed in TTS. Logistic regression analysis revealed that ST elevation in I lead and no ST elevation in V1 lead showed high odds ratio and low P value. Conclusions: Automated measurement of microvolt-level difference of ST level at J-point was a powerful tool to distinguish TTS and ant AMI at onset.

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Differences of ST level at J-point on 12-lead electrocardiography can distinguish takotsubo syndrome and acute anterior myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.2152 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Shimizu ◽

S Cho ◽

K Hara ◽

M Ohmori ◽

T Kaneda ◽

...

Keyword(s):

Myocardial Infarction ◽

Quantitative Difference ◽

Qualitative Difference ◽

Automated System ◽

P Value ◽

Takotsubo Syndrome ◽

Anterior Myocardial Infarction ◽

St Depression ◽

St Elevation ◽

And Gender

Abstract Background Qualitative difference of ST elevation/depression on 12-leads electrocardiography (ECG) at onset was reported in patients with Takotsubo syndrome (TTS) and acute anterior myocardial infarction (ant AMI). However, quantitative difference of those was not elucidated. Purpose To investigate differences of ST level at J point on ECG between TTS and ant AMI by automated calculating system. Methods We firstly enrolled consecutive 40 patients of TTS, and among 500 ant AMI patients, one to two random matching was done by their age and gender. Finally, 40+80 patients (74.5±11.2 years, 87 females) were enrolled. ECG at onset of both group was measured by automated system (ECAPs12c: Nihon-Koden). Results ST level of TTS at J-point in I/II/V4–6 lead was significantly elevated comparing to that of ant AMI. Conversely, Conversely, significant ST depression in aVR and no ST elevation in V1 of TTS was observed in TTS. Logistic regression analysis revealed that ST elevation in I lead and no ST elevation in V1 lead showed high odds ratio and low P value. Conclusion Automated measured ST level at J-point was a powerful tool to distinguish TTS and ant AMI at onset. Funding Acknowledgement Type of funding source: None

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