IJCS | Volume 33, Nº1, January / February 2019

DOI: 10.5935/2359-4802.20190080 94 BRIEF COMMUNICATION International Journal of Cardiovascular Sciences. 2020;33(1):94-97 Mailing Address: Luiz Eduardo Ritt Centro de Estudos Clínicos - Hospital Cárdio Pulmonar - Av. Anita Garibaldi, 2199. Postal Code: 40170-130, Ondina, Salvador, BA - Brazil. E-mail: luizritt@hotmail.com Takotsubo Syndrome in the Context of Transmural Acute Myocardial Infarction: Prevalence and How to Differentiate? João Paulo Soares Costa, 1 L uiz Eduardo Fonteles Ritt, 1, 2 R afael Modesto Fernandes, 1 F elipe Alvarenga Duarte Campos, 1 Q ueila Borges, 2 E duardo Sahade Darzé 1, 2 Escola Bahiana de Medicina e Saúde Pública, 1 Salvador, BA - Brazil Hospital Cárdio Pulmonar, 2 Salvador, BA - Brazil Manuscript received on September 19, 2018, revised manuscript on December 08, 2018, accepted on January 30, 2019. ST Elevation Myocardial Infarction; Takotsubo Cardiomyopathy; Stress, Psychological; Stress, Physiological; Ventricular Function Left; Acute Coronary Syndrome/diagnosis. Keywords Takotsubo syndrome (TTS) is characterized by acute and reversible cardiac dysfunction. Because of clinical similarities between TTS and acute coronary syndrome, their differential diagnosis is a challenge. To describe the prevalence of TTS among patients suspected of ST-elevation myocardial infarction (STEMI) and compare the clinical profile of TTS with that of STEMI. A retrospective analysis of medical records was performed on patients diagnosed with TTS with ST elevation (cases) and patients diagnosed with STEMI (controls) at Cárdio Pulmonar Hospital, Bahia, Brazil, between 2011 and 2017. For each case, four controls were randomly selected. Categorical data were compared using Pearson’s chi-square and Mann–Whitney tests. Six patients had a confirmed diagnosis of TTS, corresponding to 3.2% of the patients suspected of STEMI. All TTS cases were female; ejection fraction was lower in TTS than in STEMI (35.5 vs. 56.0%; p = 0.018); patients with STEMI had higher peak troponin levels (9.4 vs. 2.2 ng/mL; p = 0.033), and neuropsychiatric disorders were more common in the TTS group (50.0 vs. 12.5%; p = 0.04). The median InterTAK diagnostic score was 60.5 (interquartile range 43.0 67.0) in cases and 24 (interquartile range 18.0–39.5) in controls (p < 0.001). TTS differed fromSTEMI in that it was more prevalent in females andwas associatedwith emotional or physical stress, neuropsychiatric disorders, lower ejection fraction, and lower peak troponin levels. Introduction Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction culminating in acute cardiac dysfunction. It is frequently preceded by emotional or physical stress. 1,2 The most common symptoms at presentation are chest painanddyspnea. Because thepresentationof TTS is similar to that of acute coronary syndrome (ACS), the differential diagnosis is difficult, especially from ST-elevation myocardial infarction (STEMI).Absence of coronary artery disease in the affected area must be confirmed to establish the diagnosis of TTS. 2 To facilitate the diagnosis of TTS, the European Society of Cardiologyhas recentlydeveloped the InterTAK diagnostic score, a promising tool that estimates the probability of a TTS event. 3,4 The aim of this study was to analyze the prevalence of TTS among patients suspected of STEMI and to compare the clinical profiles of TTS and STEMI patients. Methods Study design and sample This was a nested case-control study. We evaluated the medical records of patients with ST-elevation ACS admitted to Cárdio Pulmonar Hospital , Salvador, BA, Brazil, between 2011 and 2017, who received a final diagnosis of TTS (cases) or STEMI (controls). For each case, four controls were randomly selected.