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

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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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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Diagnostic performance of 18-leads electrocardiography to distinguish takotsubo syndrome and acute anterior myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3445 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Shimizu ◽

S Cho ◽

K Hara ◽

M Ohmori ◽

T Kaneda ◽

...

Keyword(s):

Machine Learning ◽

Myocardial Infarction ◽

Diagnostic Performance ◽

Takotsubo Syndrome ◽

Anterior Myocardial Infarction ◽

T Wave ◽

St Depression ◽

St Elevation ◽

The Difference ◽

And Gender

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 15414: Diagnostic Performance of Deep Learning on 12-lead Electrocardiography to Distinguish Takotsubo Syndrome and Acute Anterior Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.15414 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Masato Shimizu ◽

shummo cho ◽

Yoshiki Misu ◽

Mari Ohmori ◽

Ryo Tateishi ◽

...

Keyword(s):

Myocardial Infarction ◽

Deep Learning ◽

Diagnostic Performance ◽

P Wave ◽

Takotsubo Syndrome ◽

Anterior Myocardial Infarction ◽

Color Mapping ◽

Lead Avr ◽

The Difference ◽

And Gender

Introduction: Takotsubo syndrome (TTS) and acute anterior myocardial infarction (ant-AMI) show very similar 12-lead electrocardiography (ECG) featured at onset, and it is often difficult to distinguish them without cardiac catheterization. The difference of ECG between them was studied, but the diagnostic performance of machine learning (deep learning) for them had not been investigated. Hypothesis: Deep learning on 12-leads ECG has high diagnostic performance to diagnose TTS and ant-AMI at onset. Methods: Consecutive 50 patients of TTS were one-to-one matched to ant-AMI randomly by their age and gender, and total 100 patients were enrolled. No sinus rhythm patients were excluded. All ECGs were divided into each 12-lead, and 5 heart beats from one lead were extracted. For each lead, 250 ECG waves of TTS/AMI were sampled as 24bit bitmap image, and prediction model construction by convolutional neural network (CNN: transfer learning, using VGG16 architecture) underwent to distinguish the two diseases in each lead. Next, gradient weighted class activation color mapping (GradCam) was performed to detect the degree and position of convolutional importance in the leads. Results: Lead aVR (mean accuracy 0.748), I (0.733), and V1 (0.678) were the top 3 leads with high accuracy. In aVR lead, GradCam showed strong convolution of negative T wave in TTS, and sharp R wave in ant-AMI. In I lead, it spotlighted several parts of ECG wave in ant-AMI. However in TTS, whole shape of the wave, P wave onset, and negative T were invertedly convoluted in TTS. Conclusions: Deep learning was a powerful tool to distinguish TTS and ant-AMI at onset, and GradCam method gave us new insight of the difference on ECG between the two diseases.

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ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Cardiology ◽

10.1159/000481814 ◽

2017 ◽

Vol 139 (1) ◽

pp. 53-61

Author(s):

Mert İlker Hayıroğlu ◽

Ahmet Okan Uzun ◽

Ceyhan Türkkan ◽

Muhammed Keskin ◽

Edibe Betül Börklü ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Death ◽

Anterior Myocardial Infarction ◽

St Depression ◽

St Segment ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Group 1

Objective: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). Results: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). Conclusion: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

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