Abstract 14176: Frequency and Clinical Correlates of ST-segment Elevation on the Electrocardiogram at Presentation in Apical Ballooning Syndrome (Takotsubo/Stress Cardiomyopathy)
Background: Apical ballooning syndrome (ABS) is characterized by transient left ventricular systolic dysfunction that often mimics an acute myocardial infarction. The aim of this study was to assess the incidence and clinical correlates of ST-segment elevation (STE) on the electrocardiogram at presentation in patients with ABS.
Methods: We prospectively identified 165 ABS patients, median age (IQR) 72 years (61.1, 80.0), 96.3% females between January 2002 and December 2010 in accordance with the Mayo Clinic diagnostic criteria. Clinical and hemodynamic characteristics were compared between patients with and without STE of > 1 mm in 2 or more contiguous leads.
Results: Eighty-one (49%) patients exhibited STE on the initial ECG at presentation (Table). These patients had a lower left ventricular ejection fraction and higher levels of cardiac troponin T suggestive of greater myocardial injury compared to those without STE. Accordingly, patients with STE had a higher incidence of heart failure, cardiogenic shock, and requirement for hemodynamic and ventilatory support. STE was also associated with a longer hospital stay. ST segment depression was seen in 1.2% of patients on presentation.
Conclusions: ABS can mimic either STE or non-STE myocardial infarction at presentation. STE is present in approximately half of ABS patients and is a marker of greater myocardial injury, hemodynamic instability and adverse hospital outcomes.
- © 2011 by American Heart Association, Inc.