Association Between ECG Findings on Presentation and Outcomes in Patients with Takotsubo Syndrome

<b>Background</b>: Takotsubo syndrome (TTS) may mimic acute coronary syndrome (ACS) by sharing a similar presentation, electrocardiogram (ECG) findings, and elevated troponin. Different ECG abnormalities may be encountered on presentation in patients with TTS, with ST elevation being the most common. In the current study, we aimed to evaluate the association of different ECG patterns on outcomes of patients with TTS. <b>Methods</b>: Patients hospitalized for TTS between 2018 and 2024 were included in the study. Demographic, echocardiographic, electrocardiographic, and laboratory parameters were obtained. Patients were classified according to ECG into two main groups, with and without ST segment elevation. We compared echocardiographic parameters and clinical outcomes between the two groups. <b>Results</b>: A total of 119 patients (mean age 70, 97% females) were included in the final analysis. The mean left ventricular ejection fraction (LVEF) was 45%, and 59 (50%) of the patients had ST segment elevation on ECG. Patients with ST elevation had lower LVEF, higher troponin levels, and a higher rate of complications related to heart failure (HF) and arrhythmia. After adjusting for potential confounders, only reduced LVEF was associated with an increased rate of complications. There was no difference in readmission rate between patients with or without ST elevation. <b>Conclusions</b>: Patients with TTS presenting with ST segment elevation exhibit more severe disease, reflected by lower LVEF and higher troponin levels, albeit without increased risk for readmission.