AUTHOR=Padilla-Lopez Mireia , Duran-Cambra Albert , Belmar-Cliville David , Soriano-Amores Marc , Arakama-Goikoetxea Sabiñe , Vila-Perales Montserrat , Bragagnini Walter , Rodríguez-Sotelo Laura , Peña-Ortega Pedro , Sánchez-Vega Jesús , Carreras-Mora Jose , Sionis Alessandro 

TITLE=Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1286975

DOI=10.3389/fcvm.2023.1286975

ISSN=2297-055X

ABSTRACT=Takotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS. In our comprehensive comparative ECG analysis, ECGs were reviewed at three time points from symptom onset (within the first 12 hours, at 48 hours, and at 5-7 days) and compared for patients with typical TTS (n=33) and with MV-TTS (n=27) as classified by ventriculography. 12-hour ECG findings revealed that typical TTS featured ST-segment elevation through anterior leads V3 to V6, with maximal deviation in V3 (0.98±0.99 mm) and V4 (0.91±0.91 mm), whereas MV-TTS featured ST-segment depression in inferior leads (-0.24±0.57 mm in II, -0.30±0.52 mm in III, and -0.32±0.47 mm in aVF) and in precordial leads V4 to V6. In 48-hour ECG findings, the most significant change was T wave inversion, which was more widespread and deeper in typical TTS, with the most pronounced negative T wave depths, exceeding 3 mm, observed in leads V3 to V5; in contrast, in MV-TTS, T wave inversion was evident in fewer leads and showed less depth, with the most pronounced negative T waves reaching 1 mm at most in leads I, aVL, and V2. While the QTc interval was prolonged in both groups at 48 hours, this prolongation was more pronounced in typical TTS than in MV-TTS (523±52 ms vs 487±66 ms; p=0.029). In ECGs at 5-7 days, results essentially returned to baseline. Patients with MV-TTS exhibited a distinctive pattern of ECG abnormalities, marked by ST-segment depression in inferolateral leads, less profound and less extensive T wave inversion that mostly affected leads I, aVL and V2, and attenuated QT interval prolongation after 48 hours compared to typical TTS.