Abstract 8950: Simple and Accurate Electrocardiographic Criteria for Differentiation Among Acute Coronary Syndrome, Acute Pulmonary Embolism, and Takotsubo Cardiomyopathy
Background: Negative T waves (Neg T) in precordial leads are often seen in acute coronary syndrome (ACS), but also occur in acute pulmonary embolism (APE) and takotsubo cardiomyopathy (TC). Differentiating these 3 diseases is important with regard to selecting the appropriate treatment strategy.
Methods: We studied 278 patients (178 patients with ACS, 80 with APE, and 20 with TC) who were admitted within 48 h from symptom onset and had Neg T ≥1.0 mm in ≥2 contiguous precordial leads (V1-4) without ST-segment elevation on admission ECG. In all patients with ACS, the culprit lesion was confirmed to be located in the left anterior descending coronary artery by angiography during hospitalization. Baseline characteristics and ECG findings on admission were analyzed.
Results: In patients with ACS, APE, and TC, age was 67±10, 64±14, and 69±12 years (p=0.10); the rates of women were 38%, 69%, and 75% (p<0.01); positive troponin T was 46%, 49%, and 85% (p<0.01); S1Q3T3 pattern was 0%, 25%, 0% (p<0.01); right axis deviation was 0%, 8%, and 0% (p<0.01); ST-segment depression ≥0.5 mm was 40%, 18%, and 25% (p<0.01), and the amplitude of maximal Neg T was 5±3, 3±2, and 7±3 mm (p<0.01). The prevalence of Neg T is shown in Figure, in which the anatomically contiguous Cabrera sequence was used to display limb leads, and it significantly differed in all 12 leads among the 3 groups (p<0.001, respectively). Neg T in both leads III and V1 identified APE with 86% sensitivity, 98% specificity, and 95% predictive accuracy, and Neg T in lead -aVR (ie, positive T wave in lead aVR) combined with no Neg T in lead V1 identified TC with 95% sensitivity, 99% specificity, and 99% predictive accuracy, representing the highest diagnostic accuracies.
Conclusions: The distribution of Neg T obviously differed among ACS, APE, and TC, suggesting the differences in underlying electrophysiologic mechanisms. These differences were useful for differential diagnosis of these 3 diseases.
- © 2012 by American Heart Association, Inc.