'GET QT': Clinical Criteria to Differentiate Takotsubo Cardiomyopathy from STEMI

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 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.