Abstract
Introduction: In both takotsubo cardiomyopathy (TC) and reperfused non-Q-wave anterior acute myocardial infarction (AMI), giant negative T waves (Neg T) commonly appear after the resolution of ST-segment elevation (ST elevation) in precordial leads, reflecting viable but sympathetically denervated myocardium. Hypothesis: ST-T changes may differ between between TC and reperfused non-Q-wave anterior AMI, reflecting the differences in underlying electrophysiologic mechanisms between these 2 diseases. Methods: We studied 38 patients with TC and 253 with a first non-Q-wave anterior AMI who were admitted within 6 hours after symptom onset. All patients with anterior AMI underwent emergency coronary angiography, and the occlusion of the left anterior descending coronary artery was documanted and successful reperfusion (TIMI grade 3) was obtained. ECGs on admission and those with the greatest amplitude of subsequent Neg T (mean 2 days later) were studied. Results: As compared with patients with anterior AMI, those with TC were older (70 ± 11 vs 62 ± 11 years, p < 0.01), more likely to be women (84% vs 20%, p<0.01) and had a lower peak creatine kinase (461 ± 493 vs 1506 ± 934 mU/ml, p<0.01) despite lower left ventricular ejection fraction on admission (40 ± 9 vs 51 ± 10%, p < 0.01), respectively. TC was associated with a smaller maximal ST elevation on admission (4.6 ± 4.7 vs 5.9 ± 3.1 mm, p<0.01), a greater maximal amplitude of Neg T (10.0 ± 4.1 vs 8.0 ± 4.8 mm, p < 0.01), a greater number of leads with Neg T (9 ± 1 vs 6 ± 2, p < 0.01) and a longer maximal QTc interval (643 ± 99 vs 586 ± 79 ms, p < 0.01) in subacute phase, respectively. The prevalences of initial ST elevation and subsequent Neg T differed between TC and anterior AMI (Figure). Conclusions: ST-T changes in the acute and subacute phases clearly differed between TC and reperfused non-Q-wave anterior AMI. In TC, deeper NegT were more broadly distributed, suggesting that TC might be associated with more extensive viable but denervated myocardium.
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