Tako-tsubo cardiomyopathy is an increasingly recognised phenomenon characterised by chest pain, ECG abnormalities, cardiac biomarker elevation and transient left ventricular dysfunction without significant coronary artery obstruction.
To report the clinical and echocardiographic characteristics from a large single-centre Australian series of patients with Tako-tsubo syndrome.
We prospectively collected data on 23 consecutive patients presenting between November 2005 and November 2007. Baseline demographics, ECG, echocardiography and coronary angiography were performed on nearly all patients.
All patients presented with chest pain; 87% were female. Various stressors were noted and cardiac Troponin-T was elevated in 91% of patients. All patients had non-obstructive coronary disease at angiography. 19/23 patients had initial and subsequent echocardiography. Mean ejection fraction was 50% at baseline and 64% at follow-up (p < 0.0001). Right ventricular dysfunction was present in eight, dynamic left ventricular outflow tract obstruction in two, diastolic dysfunction in seven and two patients had the mid-cavity variant.
This large prospective single-centre Australian series of Tako-tsubo syndrome is in concert with previous published series. Complete recovery of left ventricular function on echocardiographic follow-up was typical. Although its pathogenesis remains unclear, early distinction from acute coronary syndromes is important and the prognosis is reassuringly good.
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- Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases.J Cardiol. 1991; 21: 203-214
- Kodama K. Haze K. Hon M. Takotsubo-type cardiomyopathy due to multivessel spasm. Kagakuhyouronsya Co., Tokyo1990
- Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina pectoris-myocardial infarction investigations in Japan.J Am Coll Cardiol. 2001; 38: 11-18
- Assessment of clinical features in transient left ventricular apical ballooning.J Am Coll Cardiol. 2003; 41: 737-742
- Apical ballooning of the left ventricle: first series in white patients.Heart. 2003; 89: 1027-1031
- Acute and reversible cardiomyopathy provoked by stress in women from the United States.Circulation. 2005; 111: 472-479
- Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction.Ann Intern Med. 2004; 141: 858-865
- ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography).Circulation. 2003; 108: 1146-1162
- Images in cardiovascular medicine. Atypical transient left ventricular ballooning without involvement of apical segment.Circulation. 2006; 113: e686-e688
- Images in cardiovascular medicine. A rare form of midventricular Tako-Tsubo after emotional stress followed up with magnetic resonance imaging.Circulation. 2006; 114: e248
- Braunwald E. Zipes D.P. Libby P. Bonow R.O. Heart disease—a textbook of cardiovascular medicine. 7th ed. Elsevier Suanders, Philadelphia, Pennsylvania2005: 132-133
- Increased precordial QTc dispersion predicts ventricular fibrillation during acute myocardial infarction.Am J Cardiol. 1996; 78: 706-708
- Correlation between QTc interval duration and left ventricular systolic dysfunction in patients with acute myocardial infarction.J Electrocardiol. 1993; 26: 333-340
- Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review.JAMA. 2000; 283: 1183-1188
- Ventricular arrhythmias during Tako-tsubo syndrome.Int J Cardiol. 2008; 128: e50-e53
- Apical thrombus associated with left ventricular apical ballooning.Heart. 2003; 89: 927
- Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome).Am J Cardiol. 2007; 100: 296-301
- Left ventricular rupture associated with Takotsubo cardiomyopathy.Mayo Clin Proc. 2004; 79: 821-824
- Prevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndrome.Am Heart J. 2008; 156: 543-548
- Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement.J Am Coll Cardiol. 2006; 47: 1082-1083
- Right ventricular involvement in Takotsubo cardiomyopathy.Eur Heart J. 2006; 27: 2433-2439
- The clinical features of takotsubo cardiomyopathy.QJM. 2003; 96: 563-573
- Two cases of transient left ventricular apical ballooning syndrome associated with subarachnoid hemorrhage.Anesth Analg. 2006; 103: 583-586
- The brain–heart connection.Circulation. 2007; 116: 77-84
- Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury.J Am Soc Echocardiogr. 2000; 13: 774-779
- Neurohumoral features of myocardial stunning due to sudden emotional stress.N Engl J Med. 2005; 352: 539-548
- A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography.Eur Heart J. 2007; 28: 2598-2604
- Apical ballooning of the left ventricle: a distinct entity?.Heart. 2003; 89: 974-976
- Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction.Am Heart J. 2002; 143: 448-455
- Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome.Am J Cardiol. 2004; 94: 343-346
- Transient left ventricular apical ballooning: magnetic resonance imaging evaluation.J Comput Assist Tomogr. 2005; 29: 34-36
- Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli.Cardiovasc Res. 1993; 27: 192-198
- Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning.Nat Clin Pract Cardiovasc Med. 2008; 5: 22-29
- Estrogen attenuates the emotional stress-induced cardiac responses in the animal model of Tako-tsubo (Ampulla) cardiomyopathy.J Cardiovasc Pharmacol. 2003; 42: S117-S119
- Early diagnosis of stress-induced apical ballooning syndrome based on classic echocardiographic findings and correlation with cardiac catheterization.J Am Soc Echocardiogr. 2005; 18: 1423
- Extent of right and left ventricular focal wall-motion abnormalities in differentiating transient apical ballooning syndrome from apical dysfunction as a result of coronary artery disease.J Am Soc Echocardiogr. 2007; 20: 144-150
Accepted: October 10, 2009
Received in revised form: October 6, 2009
Received: March 21, 2009
© 2009 Published by Elsevier Inc. All rights reserved.