Why the study?
The electrocardiographic differentiation between Takotsubo syndrome and anterior wall ST-elevation myocardial infarction has been a matter of debate.
Do specific ECG findings (reciprocal changes, Q-waves, QT-interval) differentiate Takotsubo syndrome from anterior wall STEMI?
Do specific ECG findings (reciprocal changes, Q-waves, QT-interval) differentiate Takotsubo syndrome from anterior wall STEMI?
Reciprocal changes on ECG are significantly less common in Takotsubo syndrome compared to anterior STEMI, aiding in their differentiation, whereas Q-waves and QT interval do not differ significantly.
ECG features may not reliably differentiate TTS from AW-STEMI; leaves open need for prospective multimodal validation.
BACKGROUND: Takotsubo syndrome (TTS) and its differentiation from anterior wall ST-elevation myocardial infarction on electrocardiography (ECG) has been a debate. METHODS: Six studies comparing ECG changes in TTS and AW-STEMI were identified. The primary endpoint was reciprocal changes, presence of Q-waves, and QT-interval. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated using Review Manager (RevMan) 5.3. RESULTS: Six studies consisting of 1090 patients (TTS = 220, AW-STEMI = 870) were included. Reciprocal changes on ECG were less commonly associated with TTS than AW STEMI with OR of 0.05 and 95%CI- 0.02-0.11 (P-<0.00001). Q-wave presence on ECG was comparable between the groups with OR-0.68, 95%CI-0.08-5.63 (p-0.72). QT interval on ECG was comparable between the two groups with OR-1.09, 95%CI-0.63-1.54 (p-<0.00001). There was minimal publication bias among the studies. CONCLUSION: AW STEMI is associated with reciprocal changes. Q-waves and QT interval has no differentiating significance between AW STEMI and TTS.
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Mir et al. (2020) studied this question.
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