Why the study?
Takotsubo syndrome and anterior ST-elevation myocardial infarction with apical involvement have overlapping features that make early bedside differential diagnosis challenging.
Do the novel echocardiographic indices IAR and ILAR accurately distinguish typical Takotsubo syndrome from anterior STEMI in patients with apical akinesis?
Do the novel echocardiographic indices IAR and ILAR accurately distinguish typical Takotsubo syndrome from anterior STEMI in patients with apical akinesis?
IAR and ILAR are simple, reproducible echocardiographic markers that provide excellent diagnostic accuracy for differentiating Takotsubo syndrome from anterior STEMI at the bedside.
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May aid rapid bedside differentiation of TTS from AMI; first RCT validation of novel echocardiographic ratios.
AIMS: Takotsubo syndrome (TTS) and anterior ST-elevation myocardial infarction (AMI) with apical involvement often present with overlapping clinical and echocardiographic features, making early differential diagnosis challenging. Novel echocardiographic indices may aid rapid, bedside discrimination. The objective of the study was to evaluate the diagnostic accuracy and reproducibility of two new echocardiographic indices - inferior-apex ratio (IAR) and infero-lateral-apex ratio (ILAR) - in distinguishing typical TTS from anterior STEMI. Secondary objectives included comparison with segmental strain values and inter-observer reproducibility. METHODS AND RESULTS: This retrospective study analyzed 2D and speckle-tracking echocardiography of 50 patients with confirmed TTS and 50 with AMI and apical akinesis. IAR and ILAR were calculated from standard apical views. Diagnostic performance was assessed via receiver-operating characteristic analysis. Longitudinal strain was evaluated in all myocardial segments. Inter-observer reproducibility was tested. ILAR and IAR were significantly lower in TTS vs. AMI (ILAR: 0.78 ± 0.32 vs. 1.99 ± 0.85; IAR: 0.86 ± 0.42 vs. 1.71 ± 0.71; P < 0.001). Both indices showed excellent diagnostic accuracy [area under the curve (AUC) = 0.90 for IAR and 0.94 for ILAR], with optimal cutoffs of 1.01 (ILAR) and 0.95 (IAR). Mid-inferior (MI) and infero-lateral (MIL) strain were more impaired in TTS but had slightly lower AUCs (MI: 0.84; MIL: 0.82). ILAR and IAR remained independently associated with TTS in multivariable analysis. Inter-observer correlation was strong (ICC: 0.81-0.82). CONCLUSIONS: IAR and ILAR are simple, reproducible, and accurate echocardiographic markers for differentiating TTS from AMI at the bedside. Their use may improve early diagnostic confidence and guide appropriate clinical management.
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Pernigo et al. (2026) studied this question.
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