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Citro R, Rigo F, Ciampi Q, D'Andrea A, Provenza G, Mirra M, Giudice R, Silvestri F, Di Benedetto G, Bossone E. Echocardiographic assessment of regional left ventricular wall motion abnormalities in patients with tako-tsubo cardiomyopathy: comparison with anterior myocardial infarction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:542-9. [PMID: 21606046 DOI: 10.1093/ejechocard/jer059] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The aim of this study was to assess the echocardiographic distribution of regional wall motion abnormalities (RWMA) in patients with tako-tsubo cardiomyopathy (TTC) compared with anterior ST-elevation myocardial infarction (ant-STEMI). METHODS AND RESULTS Thirty-seven TTC and 37 ant-STEMI patients underwent standard echocardiographic examination at the time of hospital admission. RWMA and the involvement of the left ventricular territories supplied by each coronary artery according to the American Society of Echocardiography classification were reported. TTC patients showed a lower left ventricular ejection fraction (37.6 ± 5.1 vs. 40.9 ± 3.7%; P = 0.002) and a higher wall motion score index (WMSI; 1.98 ± 0.2 vs. 1.51 ± 0.14; P < 0.001) compared with ant-STEMI patients. No significant differences were observed between groups with regard to detection of RWMA in the territory supplied by the left anterior descending coronary artery (LAD) (37 vs. 37; P = 1). Conversely, in TTC patients, the territories supplied by the LAD/left circumflex coronary artery (LCX) (37 vs. 31; P = 0.011), LAD/right coronary artery (RCA) (34 vs. 13; P < 0.001), RCA (33 vs. 5; P < 0.001), and RCA/LCX (31 vs. 2; P < 0.001) were more frequently involved. A cut-off value of WMSI ≥1.75 (area under the curve 0.956) and for the number of territories with RWMA ≥4 (AUC = 0.928) predicted TTC with a sensitivity of 83 and 84% and a specificity of 100 and 97%, respectively. CONCLUSION Echocardiography revealed a distinctive pattern of contractility in TTC patients, characterized by symmetrical RWMA extending equally into the territory of distribution of all coronary arteries.
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Affiliation(s)
- Rodolfo Citro
- Department of Cardiology and Cardiac Surgery, University Hospital Scuola Medica Salernitana, Largo Città di Ippocrate, Salerno, Italy.
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Paixao ARM, Balaji N, Ryzhikov A, Ghafourian K, Collins S, Suddath WO, Satler LF, Kent KM, Pichard AD, Waksman R, Lindsay J. Left ventricular contraction patterns in patients with suspected acute coronary syndrome and normal coronary angiograms: a new look at the takotsubo syndrome. Clin Cardiol 2011; 34:45-50. [PMID: 21259278 DOI: 10.1002/clc.20833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Original descriptions of the takotsubo syndrome (TS) included a characteristic left ventricular (LV) contraction pattern, "apical ballooning." Recently, several reports have associated contraction patterns not strictly conforming to the original description with TS. The specifics of the contraction pattern seem to set TS apart from the much larger population of patients with acute coronary syndrome (ACS) but no obstructive coronary artery disease (OCAD). This study was undertaken to compare patients with midventricular and apical dysfunction with those with other LV contraction patterns. HYPOTHESIS If TS can present with a variety of patterns of LV dysfunction, then both those with and those without the pattern should have the clinical components previously assigned to the syndrome. METHODS We studied LV contraction patterns in consecutive ACS patients referred for consideration of emergent or urgent percutaneous coronary intervention. RESULTS Of the 893 patients evaluated in 2008, we excluded 862 on the basis of OCAD, preexisting LV dysfunction, or an obvious alternative cause of symptoms. The remaining 31 (3.5%) also had no OCAD but manifested an LV contraction abnormality. We compared the 15 patients (1.7%) whose ventriculograms met criteria for TS with the 16 patients (1.8%) whose did not. The most common alternative pattern was global hypokinesis, followed by a variety of segmental contraction abnormalities. Patients with the TS pattern were older and had evidence of greater myocardial injury. More than 85% were women. CONCLUSIONS The TS pattern identifies a distinct subset of ACS patients with a remarkable predominance of postmenopausal women and is therefore fundamental to the definition of this entity. This distinctive facet of the syndrome is likely to be an important clue to its pathogenesis. We did not encounter patients with other patterns of LV dysfunction that could be thought to represent stress-induced cardiomyopathy. Copyright © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Affiliation(s)
- Andre R M Paixao
- Division of Cardiology, Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA.
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Heggemann F, Hamm K, Kaelsch T, Sueselbeck T, Papavassiliu T, Borggrefe M, Haghi D. Global and Regional Myocardial Function Quantification in Takotsubo Cardiomyopathy in Comparison to Acute Anterior Myocardial Infarction Using Two-Dimensional (2D) Strain Echocardiography. Echocardiography 2011; 28:715-9. [DOI: 10.1111/j.1540-8175.2011.01430.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Schwitter J, Arai AE. Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonance. Eur Heart J 2011; 32:799-809. [PMID: 21398645 PMCID: PMC3069387 DOI: 10.1093/eurheartj/ehq481] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 12/05/2010] [Accepted: 12/09/2010] [Indexed: 11/26/2022] Open
Abstract
Over the past years, cardiovascular magnetic resonance (CMR) has proven its efficacy in large clinical trials, and consequently, the assessment of function, viability, and ischaemia by CMR is now an integrated part of the diagnostic armamentarium in cardiology. By combining these CMR applications, coronary artery disease (CAD) can be detected in its early stages and this allows for interventions with the goal to reduce complications of CAD such as infarcts and subsequently chronic heart failure (CHF). As the CMR examinations are robust and reproducible and do not expose patients to radiation, they are ideally suited for repetitive studies without harm to the patients. Since CAD is a chronic disease, the option to monitor CAD regularly by CMR over many decades is highly valuable. Cardiovascular magnetic resonance also progressed recently in the setting of acute coronary syndromes. In this situation, CMR allows for important differential diagnoses. Cardiovascular magnetic resonance also delineates precisely the different tissue components in acute myocardial infarction such as necrosis, microvascular obstruction (MVO), haemorrhage, and oedema, i.e. area at risk. With these features, CMR might also become the preferred tool to investigate novel treatment strategies in clinical research. Finally, in CHF patients, the versatility of CMR to assess function, flow, perfusion, and viability and to characterize tissue is helpful to narrow the differential diagnosis and to monitor treatment.
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Affiliation(s)
- Juerg Schwitter
- Department of Cardiology, University Hospital Lausanne-CHUV, Rue du Bugnon 46, Lausanne, Switzerland.
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55
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Pheochromocytoma-induced ventricular tachycardia and reversible cardiomyopathy. Int J Cardiol 2011; 147:145-6. [DOI: 10.1016/j.ijcard.2009.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 11/15/2009] [Indexed: 11/23/2022]
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A rare case report of mid cavitary takotsubo: the role of magnetic resonance imaging. Case Rep Cardiol 2011; 2011:481394. [PMID: 24826219 PMCID: PMC4008476 DOI: 10.1155/2011/481394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/19/2011] [Indexed: 12/02/2022] Open
Abstract
This is a case report of a female presenting originally with clinical picture of acute coronary syndrome and depressed left ventricular function with no angiographic evidence of coronary artery disease with mid cavitary akinesis and basal as well as apical hyperkinesis after emotional stresses identified by multi-imaging modalities to be mid cavitary Takotsubo. The Incidence and the prevalence of apical ballooning syndrome (Takotsubo) is on the rise with more reports in the literature; however, mid cavitary Takotsubo remains rare and raises questions more than answers as to the reason behind the mid cavitary localization in some patients versus apical involvement.
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Loiske K, Waldenborg M, Fröbert O, Rask P, Emilsson K. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy. Clin Physiol Funct Imaging 2010; 31:203-8. [PMID: 21138516 DOI: 10.1111/j.1475-097x.2010.01001.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. Limited information is available on the genesis of the underlying reversible contractile disorder. Our objective in this prospective study was to investigate biventricular changes in systolic long-axis function and diastolic parameters in the acute phase and after recovery. METHODS AND RESULTS Thirteen consecutive patients were examined by echocardiography and coronary angiography at admission and again by echocardiography after 3 months. Amplitudes, systolic and diastolic velocities of the mitral and tricuspid annuli and conventional diastolic parameters were measured. Systolic long-axis shortening of the left ventricle (LV) and right ventricle (RV) improved from 9.6 ± 2.2 mm to 11.2 ± 1.9 mm (P = 0.02) and from 21.3 ± 3.6 mm to 24.1 ± 2.8 mm (P = 0·02), respectively. LV systolic, early and late diastolic velocities measured by pulsed-wave tissue Doppler also improved, while additional conventional diastolic parameters of the LV and RV diastolic function were unchanged. CONCLUSIONS Takotsubo cardiomyopathy temporarily affects systolic LV and RV function, while most diastolic parameters remain unchanged.
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Affiliation(s)
- K Loiske
- Departments of Clinical Physiology, Örebro University Hospital, Örebro, Sweden
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A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings. Int J Cardiovasc Imaging 2010; 26:345-51. [PMID: 20857201 DOI: 10.1007/s10554-010-9685-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 02/01/2023]
Abstract
Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac disease that is characterized by transient left ventricular systolic dysfunction involving the apical region. The symptoms and electrocardiographic changes of TLVABS mimic those observed in acute myocardial infarction while obstructive coronary arterial lesions are not seen in patients with TLVABS. TLVABS usually occurs in elderly women after physical or emotional stress. However, it is very rare in children and so it not well known to pediatricians. Accordingly, TLVABS in children can be misdiagnosed as myocarditis or cardiomyopathy. We report here on a case of child who showed the typical findings of TLVABS in association with pericarditis. He presented with dyspnea and pericardial effusion, which required pericardiocentesis. After pericardiocentesis, he showed the typical echocardiographic and electrocardiographic findings of TLVABS. The MRI findings at 14 days after the initial symptoms showed normal coronary arteries and normal left ventricular function without any wall motion abnormalities. In addition, no delayed hyper enhancement was found on delayed-enhanced (DE)-MRI. We also reviewed the other reported cases of TLVABS in patients who were under the age of 40.
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Singh NK, Rumman S, Mikell FL, Nallamothu N, Rangaswamy C. Stress cardiomyopathy: Clinical and ventriculographic characteristics in 107 North American subjects. Int J Cardiol 2010; 141:297-303. [DOI: 10.1016/j.ijcard.2008.12.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Accepted: 12/04/2008] [Indexed: 01/06/2023]
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Coronary Artery Anatomy and Apical Sparing in Apical Ballooning Syndrome: Implications for Diagnosis and Aetiology. Heart Lung Circ 2010; 19:219-24. [DOI: 10.1016/j.hlc.2010.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 11/20/2022]
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Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol 2010; 55:333-41. [PMID: 20117439 DOI: 10.1016/j.jacc.2009.08.057] [Citation(s) in RCA: 657] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 07/24/2009] [Accepted: 08/20/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event. BACKGROUND Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning. METHODS Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients. RESULTS Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were <or=50 years of age. In 121 patients (89%), SC was precipitated by intensely stressful emotional (n = 64) or physical (n = 57) events, including 22 associated with sympathomimetic drugs or medical/surgical procedures; 15 other patients (11%) had no evident stress trigger. Twenty-five patients (18%) were taking beta-blockers at the time of SC events. Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance (CMR) imaging, usually with rapid return to normal systolic function, although delayed >2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year. CONCLUSIONS In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male, <or=50 years of age, without a stress trigger, or with in-hospital death, nonfatal recurrence, embolic stroke, or delayed normalization of ejection fraction. Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality. These data support expanded management and surveillance strategies including CMR imaging and consideration for anticoagulation.
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Affiliation(s)
- Scott W Sharkey
- Hypertrophic Cardiomyopathy Center and Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA
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Bohl S, Schulz-Menger J. Cardiovascular magnetic resonance imaging of non-ischaemic heart disease: established and emerging applications. Heart Lung Circ 2010; 19:117-32. [PMID: 20138807 DOI: 10.1016/j.hlc.2009.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 11/24/2009] [Indexed: 01/19/2023]
Abstract
This review aims to summarise state-of-the-art CMR-methodology, established applications, future directions and potentials in the assessment of patients with NonIschaemic-Heart Disease. CMR offers the unique possibility to differentiate myocardial tissue changes. One of the most challenging tasks in cardiology is the differentiation of the underlying cause of a wall motion abnormality in case of unclear or conflicting results of conventional clinical assessment CMR offers the unique chance to fill that gap. Most of the presented data are ready for use in clinical routine.
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Affiliation(s)
- Steffen Bohl
- British Heart Foundation Experimental MR Unit, Wellcome Trust Centre for Human Genetics, Department of Cardiovascular Medicine, University of Oxford, United Kingdom
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Vizzardi E, D'Aloia A, Zanini G, Fiorina C, Chiari E, Nodari S, Dei Cas L. Tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome. Int J Clin Pract 2010; 64:67-74. [PMID: 18803556 DOI: 10.1111/j.1742-1241.2008.01833.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIMS/OBJECTIVES This review examines the 'tako-tsubo-like' syndrome or transient left ventricular apical ballooning. The aim of this review is a complete evaluation of epidemiology, clinical and instrumental features, pathophysiological mechanisms, therapy and prognosis of this syndrome. METHODS We have evaluated the data from literature for a comprehensive consideration of multiple aspects of this syndrome. RESULTS/FINDINGS Transient left ventricular apical ballooning typically affects women, and the clinical presentation is comparable to acute coronary syndrome with chest pain or sudden dyspnoea, changes in ECG and elevated cardiac enzymes in the absence of significant coronary stenosis, with complete resolution of wall-motion abnormalities in a period of days or weeks. This syndrome is triggered by marked psychological or physiological stress. Several pathophysiological mechanisms have been proposed, such as cathecolamine-mediated cardiotoxicity, abnormalities in coronary microvascular function and multivessel coronary vasospasm. The highest incidence of transient left ventricular apical ballooning is in the Japanese population, but it has been recently identified also in the USA and Europe. Treatment is empirical and supportive. The prognosis is generally favourable, although some deaths have been reported, usually the result of irreversible cardiogenic shock, refractory ventricular arrhythmias, or other catastrophic cardiovascular event. CONCLUSIONS/INTERPRETATIONS We conclude by emphasising the importance of a more deeper knowledge of this syndrome for general physicians and cardiologists and it should be often considered as a possible diagnosis occurring in emergency department and in patients admitted in the Chest Pain Units with a diagnosis of coronary acute syndrome.
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Affiliation(s)
- E Vizzardi
- Section of Cardiovascular Disease, Department of Applied Experimental Medicine, Department of Cardiology, University Study of Brescia, Brescia, Italy.
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Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 2009; 54:1407-24. [PMID: 19796734 DOI: 10.1016/j.jacc.2009.04.094] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 04/14/2009] [Accepted: 04/28/2009] [Indexed: 01/08/2023]
Abstract
Noninvasive imaging plays a central role in the diagnosis of heart failure, assessment of prognosis, and monitoring of therapy. Cardiovascular magnetic resonance (CMR) offers a comprehensive assessment of heart failure patients and is now the gold standard imaging technique to assess myocardial anatomy, regional and global function, and viability. Furthermore, it allows assessment of perfusion and acute tissue injury (edema and necrosis), whereas in nonischemic heart failure, fibrosis, infiltration, and iron overload can be detected. The information derived from CMR often reveals the underlying etiology of heart failure, and its high measurement accuracy makes it an ideal technique for monitoring disease progression and the effects of treatment. Evidence on the prognostic value of CMR-derived parameters in heart failure is rapidly emerging. This review summarizes the advantages of CMR for patients with heart failure and its important role in key areas.
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Affiliation(s)
- Theodoros D Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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65
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Ballonisation médioventriculaire au cours d’un syndrome de sevrage médicamenteux. Presse Med 2009; 38:1374-7. [DOI: 10.1016/j.lpm.2008.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 06/27/2008] [Accepted: 08/27/2008] [Indexed: 11/20/2022] Open
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Silva C, Gonçalves A, Almeida R, Dias P, Araújo V, Gavina C, Maciel MJ. Transient left ventricular ballooning syndrome. Eur J Intern Med 2009; 20:454-6. [PMID: 19712842 DOI: 10.1016/j.ejim.2008.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 10/29/2008] [Accepted: 12/17/2008] [Indexed: 11/18/2022]
Abstract
The transient left ventricular apical ballooning syndrome or takotsubo-like left ventricular dysfunction refers to the ventricular morphological features present in the heart of these patients. It resembles the Japanese Takotsubo, which means a "fishing pot for trapping octopuses". This syndrome is characterized by transient left ventricular dysfunction, electrocardiographic changes and minimal release of myocardial enzymes that mimic acute anterior myocardial infarction, in patients without angiographic coronary artery disease. Several pathophysiological mechanisms have been proposed to explain it; however the precise aetiology remains unknown. This condition is transient and has a good prognosis, however Takotsubo cardiomyopathy as a new entity of acute heart failure, should be noted and thought of as a cause of sudden cardiac death. Its proper diagnosis and management greatly depends on our initial suspicion.
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Affiliation(s)
- Carla Silva
- Department of Cardiology, Hospital S. João, Porto, Portugal.
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Eitel I, Lücke C, Grothoff M, Sareban M, Schuler G, Thiele H, Gutberlet M. Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging. Eur Radiol 2009; 20:422-31. [PMID: 19705125 DOI: 10.1007/s00330-009-1549-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/18/2009] [Accepted: 07/05/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Takotsubo cardiomyopathy (TTC) is an increasingly recognised acute cardiac syndrome, whose underlying pathophysiological mechanisms remain unknown. Inflammation might play a role as this has been shown in endomyocardial biopsies. The aim of this study was to assess inflammatory parameters in patients with TTC using a comprehensive cardiovascular magnetic resonance imaging (CMR) approach. METHODS Thirty-seven patients with the suspected diagnosis of TTC underwent CMR. T2-weighted imaging to calculate the oedema ratio, T1-weighted imaging before and after contrast agent administration to calculate the global relative enhancement (gRE), and late gadolinium enhancement (LGE) imaging were performed. RESULTS In 11 patients CMR revealed the diagnosis of myocardial infarction (n = 7; 19%) or myocarditis (n = 4; 11%) with typical patterns of LGE. In all other patients (n = 26; 70%), no LGE was detected consistent with the diagnosis of TTC. Of these, in 16 patients (62%) both inflammatory markers (oedema ratio and gRE) were elevated with concomitant pericardial effusion, indicating acute inflammation. Follow-up CMR after 3 months showed complete normalisation of left ventricular function and inflammatory parameters in the absence of LGE and pericardial effusion. CONCLUSION This CMR study provides further insights into the pathophysiological mechanisms in TTC, supporting the contribution of an inflammatory process in the acute setting.
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Affiliation(s)
- Ingo Eitel
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre, Strümpellstr. 39, 04289 Leipzig, Germany.
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Clinical characteristics of tako-tsubo cardiomyopathy. Am J Cardiol 2009; 104:578-82. [PMID: 19660615 DOI: 10.1016/j.amjcard.2009.04.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 04/02/2009] [Accepted: 04/02/2009] [Indexed: 01/22/2023]
Abstract
Tako-tsubo cardiomyopathy (TTC) is increasingly diagnosed in the United States, especially in the Caucasian population. To evaluate the clinical features and outcome of patients with TTC, we evaluated 34 patients (32 women and 2 men) 22 to 88 years of age (mean 66 +/- 14) who fulfilled the following criteria: (1) akinesia or dyskinesia of the apical and/or midventricular segments of the left ventricle with regional wall motion abnormalities that extended beyond the distribution of a single epicardial vessel and (2) absence of obstructive coronary artery disease. Twenty-five patients (74%) presented with chest pain, 20 patients (59%) presented with dyspnea, and 8 patients (24%) presented with cardiogenic shock. Twenty-two patients (65%) had ST-segment elevation and 14 patients (41%) had T-wave inversion on presentation. Twenty-five patients (74%) reported a preceding stressful event. Cardiac biomarkers were often mildly increased, with a mean troponin I (peak) of 13.9 +/- 24. Mean +/- SD left ventricular ejection fractions were 28 +/- 10% at time of presentation and 51 +/- 14 at time of follow-up (p <0.0001). Two patients (6%) died during the hospital stay. Average duration of hospital stay was 6.6 +/- 6.2 days. In conclusion, TTC is common in postmenopausal women with preceding physical or emotional stress. It predominantly involves the apical portion of the left ventricle and patients with this condition have a favorable outcome with appropriate medical management. The precise cause remains unclear.
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Park SM, Prasad A, Rihal C, Bell MR, Oh JK. Left ventricular systolic and diastolic function in patients with apical ballooning syndrome compared with patients with acute anterior ST-segment elevation myocardial infarction: a functional paradox. Mayo Clin Proc 2009; 84:514-21. [PMID: 19483168 PMCID: PMC2688625 DOI: 10.4065/84.6.514] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To compare left ventricular (LV) systolic and diastolic function in patients with apical ballooning syndrome (ABS) and those with acute myocardial infarction (AMI) using 2-dimensional Doppler echocardiography and strain rate imaging (SRI). PATIENTS AND METHODS We prospectively enrolled patients with newly diagnosed AMI and ABS who had akinetic apical walls. Both 2-dimensional Doppler echocardiography and SRI were performed on hospital day 1 or within 24 hours of primary percutaneous coronary intervention. RESULTS Twenty-four patients with AMI and 13 patients with ABS (mean +/- SD age, 63+/-15 vs 73+/-12 years; P=.03) were prospectively enrolled in the study from October 3, 2005 through July 12, 2006. The mean +/- SD LV end-diastolic volume was larger (58.1+/-9.1 vs 45.2+/-10.6 mL/m(2); P<.001) and the mean +/- SD LV ejection fraction was lower (35%+/-6% vs 43%+/-9%; P=.006) in patients with ABS compared with patients with AMI. The early diastolic mitral annular velocity was similar (0.06+/-0.02 vs 0.06+/-0.02 m/s; P=.85) in both groups, but the ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was higher in patients with AMI than in patients with ABS (16.3+/-6.9 vs 12.2+/-3.2; P=.05). The systolic strain rate was decreased at the apex in both groups (P=.98). Both the early diastolic strain rate of the apex (0.64+/-0.24 vs 0.48+/-0.30 s(-1); P=.04) and the postsystolic shortening index of the apex (61%+/-15% vs 45%+/-23%; P=.006) were higher in the patients with ABS than in those with AMI. However, early diastolic SR was higher in the akinetic apical walls of patients with AMI with recovery than those with no recovery (0.64+/-0.35 vs 0.43+/-0.25 s(-1); P=.04) and was similar between akinetic apical walls of patients with AMI with recovery and the akinetic apical walls of ABS. CONCLUSION Compared with patients with AMI, those with ABS showed the functional paradox of worse initial LV systolic function with larger LV size but better LV diastolic function. The early systolic strain rate and postsystolic shortening were greater in patients with ABS than in those with AMI; hence, these measurements can be helpful in distinguishing ABS from AMI and in detecting myocardial viability.
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Affiliation(s)
| | | | | | | | - Jae K. Oh
- From the Division of Cardiology, Korea University College of Medicine, South Korea (S.-M.P.), and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (A.P., C.R., M.R.B., J.K.O.)
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Eitel I, Behrendt F, Schindler K, Gutberlet M, Schuler G, Thiele H. Takotsubo cardiomyopathy or myocardial infarction? Answers from delayed enhancement magnetic resonance imaging. Int J Cardiol 2009; 135:e9-12. [DOI: 10.1016/j.ijcard.2008.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 03/01/2008] [Indexed: 11/16/2022]
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Park SM, Prasad A, Rihal C, Bell MR, Oh JK. Left ventricular systolic and diastolic function in patients with apical ballooning syndrome compared with patients with acute anterior ST-segment elevation myocardial infarction: a functional paradox. Mayo Clin Proc 2009; 84:514-21. [PMID: 19483168 PMCID: PMC2688625 DOI: 10.1016/s0025-6196(11)60583-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare left ventricular (LV) systolic and diastolic function in patients with apical ballooning syndrome (ABS) and those with acute myocardial infarction (AMI) using 2-dimensional Doppler echocardiography and strain rate imaging (SRI). PATIENTS AND METHODS We prospectively enrolled patients with newly diagnosed AMI and ABS who had akinetic apical walls. Both 2-dimensional Doppler echocardiography and SRI were performed on hospital day 1 or within 24 hours of primary percutaneous coronary intervention. RESULTS Twenty-four patients with AMI and 13 patients with ABS (mean +/- SD age, 63+/-15 vs 73+/-12 years; P=.03) were prospectively enrolled in the study from October 3, 2005 through July 12, 2006. The mean +/- SD LV end-diastolic volume was larger (58.1+/-9.1 vs 45.2+/-10.6 mL/m(2); P<.001) and the mean +/- SD LV ejection fraction was lower (35%+/-6% vs 43%+/-9%; P=.006) in patients with ABS compared with patients with AMI. The early diastolic mitral annular velocity was similar (0.06+/-0.02 vs 0.06+/-0.02 m/s; P=.85) in both groups, but the ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was higher in patients with AMI than in patients with ABS (16.3+/-6.9 vs 12.2+/-3.2; P=.05). The systolic strain rate was decreased at the apex in both groups (P=.98). Both the early diastolic strain rate of the apex (0.64+/-0.24 vs 0.48+/-0.30 s(-1); P=.04) and the postsystolic shortening index of the apex (61%+/-15% vs 45%+/-23%; P=.006) were higher in the patients with ABS than in those with AMI. However, early diastolic SR was higher in the akinetic apical walls of patients with AMI with recovery than those with no recovery (0.64+/-0.35 vs 0.43+/-0.25 s(-1); P=.04) and was similar between akinetic apical walls of patients with AMI with recovery and the akinetic apical walls of ABS. CONCLUSION Compared with patients with AMI, those with ABS showed the functional paradox of worse initial LV systolic function with larger LV size but better LV diastolic function. The early systolic strain rate and postsystolic shortening were greater in patients with ABS than in those with AMI; hence, these measurements can be helpful in distinguishing ABS from AMI and in detecting myocardial viability.
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Affiliation(s)
| | | | | | | | - Jae K. Oh
- Individual reprints of this article are not available. Address correspondence to Jae K. Oh, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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Leurent G, Larralde A, Boulmier D, Fougerou C, Langella B, Ollivier R, Bedossa M, Le Breton H. Cardiac MRI studies of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy): a systematic review. Int J Cardiol 2009; 135:146-9. [PMID: 19401260 DOI: 10.1016/j.ijcard.2009.03.067] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 03/02/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND Since its first description in 1991, many cases of transient left ventricular apical ballooning syndrome (TLVABS) have been described, but the use of cardiac MRI in this condition is much more recent. METHODS AND RESULTS We performed a systematic review of the present literature in the MEDLINE and EMBASE databases for relevant case series of TLVABS (>or=5 reported original cases, MRI analysis in the acute phase) and summarized the main results in a narrative synthesis. Only 8 studies met the eligible criteria, counting 176 patients (women: 95%; age: 68, stress trigger: 80%). MRI assessed an improvement of mean left ventricular ejection fraction from 39 (in the acute phase) to 64% (in the recovery phase). A right ventricular dysfunction was reported in 38%, a myocardial oedema in 81% and an apical thrombus in 5%. CONCLUSIONS Although cardiac MRI is a very useful and inescapable tool in the management of TLVABS, there is no large published study concerning this topic. A systematic and multicentric register of TLVABS studied by cardiac MRI is necessary.
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Lockie T, Nagel E, Redwood S, Plein S. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. Circulation 2009; 119:1671-81. [PMID: 19332480 DOI: 10.1161/circulationaha.108.816512] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tim Lockie
- Division of Imaging Sciences, The Rayne Institute, KCL, St. Thomas' Campus, London, UK
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74
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Chest pain and reversible midventricular ballooning in a woman after witnessing sudden cardiac death: a possible variant of takotsubo cardiomyopathy. Can J Cardiol 2009; 25:e22. [PMID: 19148349 DOI: 10.1016/s0828-282x(09)70030-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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75
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A case of transient mid-ventricular akinesia (a variant form of Takotsubo cardiomyopathy) followed with I-123-beta-metyl-iodophenyl pentadecanoic acid and I-123-meta-iodobenzyl-guanidine myocardial scintigraphy. J Cardiol 2009; 53:140-5. [DOI: 10.1016/j.jjcc.2008.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/18/2008] [Accepted: 06/19/2008] [Indexed: 11/22/2022]
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76
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Shimizu I, Iguchi N, Watanabe H, Umemura J, Tobaru T, Asano R, Misu K, Nagayama M, Aikawa M, Funabashi N, Komuro I, Sumiyoshi T. Delayed enhancement cardiovascular magnetic resonance as a novel technique to predict cardiac events in dilated cardiomyopathy patients. Int J Cardiol 2009; 142:224-9. [PMID: 19185371 DOI: 10.1016/j.ijcard.2008.12.189] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/13/2008] [Indexed: 12/24/2022]
Abstract
PURPOSE Delayed enhancement cardiovascular magnetic resonance (DE-CMR) can detect cardiac scarring and has the potential to visualize the progression of myocardial remodeling. We determined whether DE-CMR can predict cardiac events in dilated cardiomyopathy patients. MATERIALS AND METHODS Transthoracic echocardiography, coronary arteriography, and DE-CMR studies were performed in 60 consecutive dilated cardiomyopathy (DCM) patients. Percent delayed enhancement (%DE) was determined as the ratio of the area showing delayed enhancement to the total myocardial area in three short-axis views. Patients were classified as advanced group (Group A) when %DE was 10% or higher, and as non-advanced group (Group NA) when %DE was less than 10%. The incidence of cardiac events and the clinical history were compared between Group A and Group NA. RESULTS There were 11 patients in Group A and 49 patients in Group NA. The incidence of cardiac events was significantly higher in Group A (36%; 4/11 patients) than in Group NA (2.0%; 1/49 patients) (log rank, p=0.0001). CONCLUSION DE-CMR is a useful tool to predict cardiac events in DCM patients.
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77
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Winchester DE, Ragosta M, Taylor AM. Concurrence of angiographic coronary artery disease in patients with apical ballooning syndrome (tako-tsubo cardiomyopathy). Catheter Cardiovasc Interv 2009; 72:612-6. [PMID: 18798323 DOI: 10.1002/ccd.21738] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the coexistence of coronary artery disease (CAD) in an unselected cohort of patients with apical ballooning syndrome (ABS). BACKGROUND ABS is a clinical condition of unknown etiology with symptoms that mimic an acute coronary syndrome and is characterized by the presence of transient left ventricular dysfunction primarily affecting the apex of the heart. METHODS We conducted a retrospective case series in a single tertiary care hospital. Patients were identified by searching for several inclusive discharge diagnoses in all hospitalized patients. Suspected cases were analyzed using prespecified diagnostic criteria. Demographic, clinical, and imaging data were collected. Coronary lesions were assessed by quantitative angiography. RESULTS Thirty-one cases of ABS were identified. The majority of the cases were female, and ischemia was documented in all patients by electrocardiographic or cardiac biomarker criteria. Nineteen patients (61.3%) had angiographic evidence of CAD, with multivessel involvement in seven (23%). Nine patients (29%) had luminal stenosis severity greater than 50% in at least one epicardial vessel. CONCLUSIONS In an unselected cohort of patients with ABS, coronary atherosclerosis is commonly present. Whether CAD simply coexists or is related to the pathophysiology of ABS is unclear.
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78
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Coats AJ. The top papers by download and citations from the International Journal of Cardiology in 2007. Int J Cardiol 2008; 131:e1-3. [DOI: 10.1016/j.ijcard.2008.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 11/02/2008] [Indexed: 12/29/2022]
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Shehata ML, Turkbey EB, Vogel-Claussen J, Bluemke DA. Role of cardiac magnetic resonance imaging in assessment of nonischemic cardiomyopathies. Top Magn Reson Imaging 2008; 19:43-57. [PMID: 18690160 DOI: 10.1097/rmr.0b013e31816fcb22] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnosis of nonischemic cardiomyopathy is a challenging process that influences patient morbidity and mortality. Currently, the well known World Health Organization classification has been revisited by an American Heart Association expert consensus panel. The contemporary classification is compatible with the rapid evolution in molecular genetics and evolving diagnostic tools such as cardiac magnetic resonance imaging (MRI). Magnetic resonance imaging is a robust diagnostic tool that offers various techniques to assess the function, morphology, perfusion, and scarring of myocardial tissue thus providing better understanding of the underlying causes of nonischemic cardiomyopathies. In this review, we discuss the current role of cardiac MRI in the evaluation of nonischemic cardiomyopathy, in the context of the current American Heart Association classification of these disorders.
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Affiliation(s)
- Monda L Shehata
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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80
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Bellera MN, Ortiz JT, Caralt MT, Pérez-Rodon J, Mercader J, Fernández-Gómez C, Paré C, Heras M. Magnetic resonance reveals long-term sequelae of apical ballooning syndrome. Int J Cardiol 2008; 139:25-31. [PMID: 18804880 DOI: 10.1016/j.ijcard.2008.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 08/10/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND The presence of small areas of necrosis has been occasionally reported immediately following apical ballooning syndrome (ABS). However, their persistence at later stages and impact on long-term prognosis are currently unknown. METHODS Twenty consecutive patients admitted for ABS between 2004 and 2007 were prospectively evaluated. Demographic, clinical, angiographic, and echocardiographic data were collected during hospital admission. At a mean of 11+/-9 months follow-up, a contrast enhanced cardiac magnetic resonance (ce-CMR) study was performed in 17 cases. The presence of hyperenhancement on ce-CMR images, reflecting irreversible myocardial damage, was recorded by two independent observers. RESULTS Two of 3 patients with hyperenhancement on ce-CMR images presented in worse condition, including pulmonary edema or cardiogenic shock, compared to just 2 of 14 patients without hyperenhancement (p=0.052). Segmental wall motion substantially improved in both of those cases; the third patient continued to have hypokinesis in a segment showing hyperenhancement. Segmental wall motion also significantly improved in all patients with no hyperenhancement. At a mean of 20+/-12 months follow-up, no deaths or major adverse cardiac events were documented among patients with or without hyperenhancement. CONCLUSIONS Despite segmental wall motion recovery, an area of irreversible myocardial damage can sometimes be identified long after ABS. However, in this limited series of patients, the presence of scar, even when presenting with heart failure and a higher troponin release, was not associated with adverse long-term outcomes as compared to patients with intact myocardium.
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81
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Eshtehardi P, Koestner SC, Adorjan P, Windecker S, Meier B, Hess OM, Wahl A, Cook S. Transient apical ballooning syndrome--clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int J Cardiol 2008; 135:370-5. [PMID: 18599137 DOI: 10.1016/j.ijcard.2008.03.088] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 03/06/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Transient apical ballooning syndrome (TABS) or Takotsubo cardiomyopathy mimics acute ST-elevation myocardial infarction, but is considered to have a good prognosis with only moderate elevation of myocardial enzymes and full recovery of left ventricular function. Although it is increasingly reported, its exact incidence, clinical presentation, and prognosis in non-Asian populations remain largely unknown. OBJECTIVE To describe the clinical characteristics and long-term follow-up of patients who presented with TABS at our institution over a 3 year-period. METHODS Patients were retrospectively retrieved from our local database. Patient charts were carefully reviewed and the diagnosis of TABS was based on the Mayo Clinic diagnostic criteria. Moreover, psychosocial stress or gastrointestinal disease was recorded. RESULTS During the study period, 13,715 coronary angiographies were performed at our institution, including 2459 patients presenting with an acute coronary syndrome (ACS). Forty-one TABS were diagnosed, which represents an incidence of 1.7% of ACS-patients and 0.3% of all coronary angiographies performed, respectively. Mean age was 65 years, with 85% women. Clinical presentations included chest pain, dyspnoea, and cardiogenic shock. A preceding psychological or physical condition perceived as "stress" was reported in 61%. At a mean follow-up of 675+/-288 days, none of the patients died of cardiac causes, but two patients had a recurrence of symptoms. CONCLUSIONS This is the largest cohort of TABS patients reported out of Europe so far. The good overall prognosis and low likelihood of recurrence were confirmed.
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82
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Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H. Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging. Eur Heart J 2008; 29:2651-9. [DOI: 10.1093/eurheartj/ehn433] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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83
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Labeyrie MA, Marmursztejn J, Daoud B, Vignaux O. [Cardiac CT and MRI in acute coronary syndrome]. Presse Med 2008; 37:705-15. [PMID: 18314301 DOI: 10.1016/j.lpm.2007.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 07/02/2007] [Indexed: 10/22/2022] Open
Abstract
Acute coronary syndrome, with an estimated prevalence of 300 000 cases annually in France, is one of the principal diagnostic and therapeutic emergencies in atheroma. In cases of atypical chest pain, with or without signs of severity, coronary, aortic and pulmonary CT should allow emergency specialists to rule out rapidly diagnoses of coronary disease, pulmonary embolism, aortic dissection or other chest conditions. Should acute coronary syndrome develop after immediate therapeutic management, a cardiac MRI will provide the cardiologist with the additional data necessary to assess the patient's prognosis--especially by assessing myocardial viability--and decide on subsequent management. In cases of acute coronary syndrome with normal coronary angiography, cardiac MRI can distinguish myocardial infarction from myocarditis or from Tako Tsubo syndrome.
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84
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Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008; 155:408-17. [PMID: 18294473 DOI: 10.1016/j.ahj.2007.11.008] [Citation(s) in RCA: 1234] [Impact Index Per Article: 77.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 11/02/2007] [Indexed: 02/07/2023]
Abstract
Apical ballooning syndrome (ABS) is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event and has a clinical presentation that is indistinguishable from a myocardial infarction. We review the best evidence regarding the pathophysiology, clinical features, investigation, and management of ABS. The incidence of ABS is estimated to be 1% to 2% of patients presenting with an acute myocardial infarction. The pathophysiology remains unknown, but catecholamine mediated myocardial stunning is the most favored explanation. Chest pain and dyspnea are the typical presenting symptoms. Transient ST elevation may be present on the electrocardiogram, and a small rise in cardiac troponin T is invariable. Typically, there is hypokinesis or akinesis of the mid and apical segments of the left ventricle with sparing of the basal systolic function without obstructive coronary lesions. Supportive treatment leads to spontaneous rapid recovery in nearly all patients. The prognosis is excellent, and a recurrence occurs in <10% of patients. Apical ballooning syndrome should be included in the differential diagnosis of patients with an apparent acute coronary syndrome with left ventricular regional wall motion abnormality and absence of obstructive coronary artery disease, especially in the setting of a stressful trigger.
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Gerbaud E, Montaudon M, Leroux L, Corneloup O, Dos Santos P, Jaïs C, Coste P, Laurent F. MRI for the diagnosis of left ventricular apical ballooning syndrome (LVABS). Eur Radiol 2008; 18:947-54. [PMID: 18236045 DOI: 10.1007/s00330-008-0853-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 12/07/2007] [Accepted: 12/27/2007] [Indexed: 11/24/2022]
Abstract
To compare MRI findings of left ventricular apical ballooning syndrome (LVABS) with those of acute myocardial infarction (AMI). Fifteen patients with a LVABS (group 1) and 25 patients with an AMI (group 2) were explored by MRI within 24 h after admission. Comparison of both groups for the number and location of myocardial segments with abnormal wall motion and abnormal perfusion or delayed enhancement was performed. The number of involved segments was higher in group 1 than in group 2 (p<0.001). In group 1, segments with abnormal wall motion were distributed in more than one vascular territory in all patients and confined to the medial, distal, and apical regions of the left ventricle. Subendocardial hypoenhancement was observed in 16/25 patients (64%) in group 2 and in none of group 1 (p<0.001). All patients in group 2 demonstrated delayed-enhancement abnormalities in a vascular distribution, whereas none in group 1 presented this abnormality (p<0.001). Diffusely distributed segmental wall-motion abnormalities and absence of first-pass perfusion hypoenhancement and of delayed enhancement at MRI help to differentiate LVABS from AMI. In the acute phase or in some difficult cases, cardiac MRI should become routine to confirm the diagnosis of LVABS.
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Affiliation(s)
- Edouard Gerbaud
- Institut National de la Santé et de la Recherche Médicale, Université Bordeaux 2, F 33076 Bordeaux, France
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86
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Ahmed HN, Linsky RA, Weinsier SB, Regnante RA, Sadiq I. Takotsubo cardiomyopathy. Future Cardiol 2008; 4:23-32. [DOI: 10.2217/14796678.4.1.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Takotsubo cardiomyopathy is a disease in which patients present with signs and symptoms mimicking an acute coronary syndrome and, thus, undergo cardiac catheterization. At the time of catheterization, however, no critical coronary lesions are found. Most of these patients have a characteristic left ventriculogram and recent history of a preceding stressor. While the acute phase of the illness can lead to ventricular tachyarrhythmias and possibly even death, a key feature of this syndrome in the majority of patients is its generally benign course and reversibility in myocardial dysfunction over a period of days to weeks. The pathophysiology of Takotsubo cardiomyopathy remains unclear. Optimal long-term medical therapy has not been well established at this time, since the etiology of the disease process remains a source of debate.
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Affiliation(s)
- Hanna N Ahmed
- Brown University Medical School, Department of Medicine, Division of Cardiology, Rhode Island & the Miriam Hospitals, Providence, RI, USA
| | - Russell A Linsky
- Brown University Medical School, Department of Medicine, Division of Cardiology, Rhode Island & the Miriam Hospitals, Providence, RI, USA
| | - Steven B Weinsier
- Brown University Medical School, Department of Medicine, Division of Cardiology, Rhode Island & the Miriam Hospitals, Providence, RI, USA
| | - Richard A Regnante
- Brown University Medical School, Department of Medicine, Division of Cardiology, Rhode Island & the Miriam Hospitals, Providence, RI, USA
| | - Immad Sadiq
- Brown University Medical School, Department of Medicine, Division of Cardiology, Rhode Island & the Miriam Hospitals, Providence, RI, USA
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87
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88
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Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol 2007; 124:283-92. [PMID: 17651841 DOI: 10.1016/j.ijcard.2007.07.002] [Citation(s) in RCA: 352] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 07/01/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction characterized by transient wall-motion abnormalities involving apical and mid-portions of the left ventricle in the absence of significant obstructive coronary disease. METHODS Searching the MEDLINE database 28 case series met the eligibility criteria and were summarized in a narrative synthesis of the demographic characteristics, clinical features and pathophysiological mechanisms. RESULTS TLVABS is observed in 0.7-2.5% of patients with suspected ACS, affects women in 90.7% (95% CI: 88.2-93.2%) with a mean age ranging from 62 to 76 years and most commonly presents with chest pain (83.4%, 95% CI: 80.0-86.7%) and dyspnea (20.4%, 95% CI: 16.3-24.5%) following an emotionally or physically stressful event. ECG on admission shows ST-segment elevations in 71.1% (95% CI: 67.2-75.1%) and is accompanied by usually mild elevations of Troponins in 85.0% (95% CI: 80.8-89.1%). Despite dramatic clinical presentation and substantial risk of heart failure, cardiogenic shock and arrhythmias, LVEF improved from 20-49.9% to 59-76% within a mean time of 7-37 days with an in-hospital mortality rate of 1.7% (95% CI: 0.5-2.8%), complete recovery in 95.9% (95% CI: 93.8-98.1%) and rare recurrence. The underlying etiology is thought to be based on an exaggerated sympathetic stimulation. CONCLUSION TLVABS is a considerable differential diagnosis in ACS, especially in postmenopausal women with a preceding stressful event. Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS.
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Affiliation(s)
- Thomas M Pilgrim
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
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Maruyama T, Hanaoka T, Nakajima H. Acute pericarditis in the recovery phase of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy). Intern Med 2007; 46:1857-60. [PMID: 18025768 DOI: 10.2169/internalmedicine.46.0184] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 64-year-old woman was admitted because of persistent chest pain and ST-elevation in the precordial and inferior leads on electrocardiogram. Emergent coronary angiography demonstrated that there was no obstruction, and left ventriculography showed apical akinesis and basal hyperkinesis. She was diagnosed with takotsubo cardiomyopathy. Chest pain subsided within the day of admission followed by T-wave inversion on electrocardiogram. Nevertheless, chest pain and ST-elevation reappeared late on the third hospital day, accompanied by fever and small amounts of pericardial and pleural effusions. Under the administration of nonsteroidal anti-inflammatory drug, the inflammation lessened. This is the first report of acute pericarditis in the recovery phase of takotsubo cardiomyopathy.
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