Reversible ventricular dysfunction takotsubo cardiomyopathy.
BACKGROUND
Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a takotsubo-shaped, dyskinetic left ventricle on left ventriculography.


OBJECTIVE
To determine the detailed clinical features of takotsubo cardiomyopathy.


METHODS
Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and takotsubo-like left ventricular dysfunction were prospectively enrolled in this study.


RESULTS
Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 microg/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years.


CONCLUSIONS
Takotsubo cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.
Akashi
Yoshihiro J
YJ
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki-city, Kanagawa-prefecture, Japan.
Musha
Haruki
H
Kida
Keisuke
K
Itoh
Kae
K
Inoue
Koji
K
Kawasaki
Kensuke
K
Hashimoto
Nobuyuki
N
Miyake
Fumihiko
F
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009638:Norepinephrine / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology
D015415:Biomarkers; D009638:Norepinephrine