Zorzi Alessandro, Baritussio Anna, ElMaghawry Mohamed, Siciliano Mariachiara, Migliore Federico, Perazzolo Marra Martina, Iliceto Sabino, Corrado Domenico
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy Department of Cardiology, Aswan Heart Center, Egypt.
Eur Heart J Acute Cardiovasc Care. 2016 Aug;5(4):298-307. doi: 10.1177/2048872615585515. Epub 2015 May 11.
Takotsubo cardiomyopathy (TTC) typically affects postmenopausal women and clinically presents with chest pain, ST-segment elevation, elevated cardiac enzymes and apical left ventricular (LV) wall motion abnormalities that mimic 'apical-anterior' acute myocardial infarction (AMI). This study assessed whether at-admission clinical evaluation helps in differential diagnosis between the two conditions.
The study compared at-admission clinical, electrocardiographic (ECG) and echocardiographic findings of 31 women (median age 67 years, interquartile range (IQR) 62-76) with typical TTC and 30 women (median age 73 years, IQR 61-81) with apical-anterior AMI due to acute occlusion of the mid/distal left anterior descending coronary artery.
Women with TTC significantly more often showed PR-segment depression (62% versus 3%, p<0.001), J-waves (26% versus 3%, p=0.03), maximum ST-segment elevation ⩽2 mm (84% versus 37%, p<0.001) and ST-segment elevation in lead II (42% versus 10%, p=0.01) than those with AMI. At multivariate analysis, PR-segment depression (odds ratio (OR)=37.2, 95% confidence interval (CI)=3.4-424, p=0.002) and maximum ST-segment elevation ⩽2 mm (OR=11.1, 95% CI=1.7-99.4, p=0.01) remained the only independent predictors of TTC and the co-existence of both parameters excluded AMI with a 100% specificity. The two groups did not differ with regard to age, first troponin-I value, echocardiographic LV ejection fraction and distribution of hypo/akinetic LV segments.
At-admission electrocardiogram (but no clinical, laboratory and echocardiographic features) allows differential diagnosis between TTC and apical-anterior AMI in postmenopausal women. The combination of PR-segment depression and mild (⩽2 mm) ST-segment elevation predicted TTC with greater accuracy than traditional parameters such as localisation of ST-segment elevation and reciprocal ST-segment depression.
应激性心肌病（TTC）通常影响绝经后女性，临床上表现为胸痛、ST段抬高、心肌酶升高以及左心室（LV）心尖部壁运动异常，酷似“心尖 - 前壁”急性心肌梗死（AMI）。本研究评估入院时的临床评估是否有助于鉴别这两种情况。
本研究比较了31名典型TTC女性（中位年龄67岁，四分位间距（IQR）62 - 76）与30名因左前降支冠状动脉中/远端急性闭塞导致心尖 - 前壁AMI的女性（中位年龄73岁，IQR 61 - 81）入院时的临床、心电图（ECG）和超声心动图检查结果。
与AMI女性相比，TTC女性更常出现PR段压低（62% 对3%，p < 0.001）、J波（26% 对3%，p = 0.03）、最大ST段抬高≤2 mm（84% 对37%，p < 0.001）以及II导联ST段抬高（42% 对10%，p = 0.01）。多因素分析显示，PR段压低（比值比（OR）= 37.2，95%置信区间（CI）= 3.4 - 424，p = 0.002）和最大ST段抬高≤2 mm（OR = 11.1，95% CI = 1.7 - 99.4，p = 0.01）仍然是TTC的唯一独立预测因素，且这两个参数同时存在时可100%特异性排除AMI。两组在年龄、首次肌钙蛋白I值、超声心动图左心室射血分数以及左心室运动减弱/运动不能节段分布方面无差异。
入院时的心电图（而非临床、实验室和超声心动图特征）可用于鉴别绝经后女性的TTC和心尖 - 前壁AMI。PR段压低和轻度（≤2 mm）ST段抬高相结合预测TTC的准确性高于ST段抬高部位和ST段压低等传统参数。
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