Author + information
- Iván J. Núñez-Gil, MD, PhD⁎ (, )
- Maria Luaces, MD, PhD,
- Juan Carlos Garcia-Rubira, MD, PhD and
- Jose Zamorano, MD, PhD
- ↵⁎Cardiovascular Institute, Hospital Clinico San Carlos, Avda. Prof Martin Lagos, 28040 Madrid, Spain
Recently, Kosuge et al. (1) reported an interesting set of electrocardiographic criteria in order to differentiate Takotsubo cardiomyopathy (TC) from anterior myocardial infarction (AMI), with its consequent prognostic implications. ST-segment depression in aVR together with the absence of ST-segment elevation in V1clearly helped to differentiate TC from anterior AMI in their Asian population and was superior to any other electrocardiographic finding (1). However, we feel it is worthy to point out that in TC there are some race electrocardiographic differences that could make the widespread use of this criteria in Caucasians challenging (2). Thus, Caucasians more frequently have T-wave inversion, whereas Asians more frequently have ST-segment elevation (2,3). In our experience, including only patients within 6 h of symptom onset as well (1) and taking account only the first admission electrocardiogram, we found 51 TC patients and compared them with 135 anterior AMI patients randomly selected (age 65.25 ± 13 years vs. 63.84 years, p = 0.5; women 78.8% vs. 25.9%, p < 0.001, respectively). In our TC series, onset persistent ST-segment elevation was barely displayed in 50%, and negative T waves were shown in 26.9%. When we tested the Kosuge score (1), we only found 3 TC patients fulfilling together both lead criteria (vs. 1 in the AMI group, p = 0.007). Therefore, the area under the curve was small (0.529). We conclude that race and epidemiologic differences should be strongly considered when a TC suspicion is made. In our opinion, until further studies report more evidence, invasive regular AMI management is warranted, at least in all Caucasian patients.
- American College of Cardiology Foundation