'GET QT': Clinical Criteria to Differentiate Takotsubo Cardiomyopathy from STEMI
DOI:
https://doi.org/10.17987/icfj.v5i0.324Keywords:
Myocardial infarction, Takotsubo cardiomyopathy, ST-elevation, EKG, cardiac biomarkers, echocardiographyAbstract
Introduction: Presentation of Takotsubo cardiomyopathy (TCM) may closely mimic ST-elevation myocardial infarction (STEMI) and clinicians are often faced with a dilemma when cardiac catheterization is unavailable or contraindicated.
Methods: Age-matched 42 TCM and 55 STEMI patients admitted in SUNY Upstate Hospital, Syracuse, NY were retrospectively compared for characteristics at presentation.
Results: 12 TCM patients (26%) had ST elevations in the initial EKG. Mean QTc interval was significantly prolonged in TCM (469ms vs 443ms,p=0.001). The peak Troponin T (TnTp) level in TCM was significantly less(1.15ng/ml vs 6.04ng/ml;p=0.001) and the time to peak troponin T (Tp) was lower(3.7 hours versus 12.4 hours,p=0.001). Mean LV ejection fraction(EF) was 36% in TCM versus 47.4% in STEMI (p=0.001).
Significance (p<0.05) was noted for 5 predictors on multiple regression namely: Gender, EF, TnTp, QTc interval and Tp. A prediction model was then developed, giving a score of one for each positive finding: female gender, EF< 40%, TnTp< 2ng/ml, QTc> 470ms in the initial EKG and Tp< 6 hours (GET QT criteria). The presence of 3 or more predictors had a sensitivity of 88.8%, specificity of 95.1% and negative predictive value of 90.9% to diagnose TCM. Though there have been recent publications proposing various criteria to distinguish the two diseases, this is the first proposing highly specific and all-inclusive combined laboratory, EKG and echocardiography criteria.
Conclusion: Females with early and low peaking troponins; prolonged QTc; low EF were likely to have TCM. With the proposed prediction model- presence of 3 or more factors is highly specific to diagnose TCM.
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