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Comparative Study
. 2016 Sep;21(5):486-92.
doi: 10.1111/anec.12337. Epub 2016 Jan 18.

Distinctive Electrocardiographic Features in African Americans Diagnosed with Takotsubo Cardiomyopathy

Emiliana Franco  1 , Andre Dias  1 , Nikoloz Koshkelashvili  1 , Gregg S Pressman  1 , Kathy Hebert  2 , Vincent M Figueredo  1   3
Affiliations
Comparative Study

Distinctive Electrocardiographic Features in African Americans Diagnosed with Takotsubo Cardiomyopathy

Emiliana Franco et al. Ann Noninvasive Electrocardiol. 2016 Sep.

Abstract

Background: Takotsubo cardiomyopathy (TC) can resemble acute anterior ST-elevation myocardial infarction. Most studies have examined TC in Asians and Caucasians (non-African Americans [AA]), while very few cases have been reported in AA. We aimed to assess the electrocardiographic features of TC in AA patients and compare them to non-AA TC patients.

Methods: We retrospectively compared electrocardiograms of 52 AA and 47 non-AA patients diagnosed with TC. All patients met the modified Mayo Clinic criteria for the diagnosis of TC. Information collected included PR interval, QRS duration and amplitude, QT interval in milliseconds (msec) adjusted for heart rate (QTc), ST-segment deviation at the J point in limb and precordial leads (≥1 mm), ST elevation (≥1 mm), and T-wave inversion (≥0.5 mm).

Results: T-wave inversion was more prevalent on presentation among AA patients (82% vs 48% in non-AA; P < 0.01), whereas ST depression was more common among non-AA (21% vs 7% in AA; P = 0.05). T-wave inversions in AA patients were frequent in both limb and precordial leads, whereas T-wave inversions in non-AA were limited to precordial leads. The average QTc upon presentation in AA was longer than non-AA (491 msec in AA vs 456 msec in non-AA; P < 0.01) as was the maximum average QTc during index hospitalization (527 msec in AA vs 497 msec in non-AA, P = 0.03).

Conclusion: In patients presenting with TC, AA patients more frequently present with diffuse T-wave inversions and a more prolonged QTc, whereas non-AA patients more often present with ST depressions. AA patients also more frequently present with T-wave inversions diffusely, whereas non-AA patients present with T-wave inversions more limited to the precordial leads.

Keywords: African American; apical ballooning; cardiomyopathy; electrocardiography; takotsubo.

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Figures

Figure 1
Figure 1
Representative ECG in an AA patient: (A) ECG on admission showing sinus rhythm with diffuse T‐wave inversions, (B) ECG at 48 hours with deeper T‐wave inversions, and (C) ECG at follow‐up with resolution of T‐wave inversions.
Figure 2
Figure 2
Representative ECG in a non‐AA patient: (A) ECG on admission showing sinus tachycardia with diffuse ST depressions and T‐wave inversions in V1–V3, (B) ECG at 48 hours with persistent T‐wave inversions in V1–V3 and mild improvement of diffuse ST depressions, and (C) ECG at follow‐up with resolution of ST‐depressions and T‐wave inversions.
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