title: Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.
abstract: BACKGROUND
  The frequency and potential differences between patients with apical ("typical") and midventricular ("atypical") ballooning have not been described.
  
  
  METHODS
  Consecutive patients with the diagnosis of a troponin-positive acute coronary syndrome (ACS) were prospectively included into a registry (n = 3,265). Of those, 2,944 patients underwent left-heart catheterization and form the study population. Demographic, clinical, and angiographic data including assessment of microvascular dysfunction (Thrombolysis in Myocardial Infarction [TIMI] blush grade, corrected TIMI frame count), as well as clinical outcome were assessed in all patients.
  
  
  RESULTS
  In patients with troponin-positive ACS, the frequency of transient cardiomyopathy was 1.2% (35 of 2,944 patients). Typical apical wall motion abnormality was observed in 21 of 35 patients (60%), as compared to an atypical (midventricular) pattern in 14 of 35 patients (40%). Both groups did not differ regarding demographic, clinical, laboratory, or angiographic parameters. Scintigraphy and PET studies were performed in 17 of 35 patients (49%) with transient cardiomyopathy, and showed a strong correlation between location of wall motion abnormality and myocardial metabolism defects, with a significantly higher apical decrease in glucose uptake in patients with a typical pattern.
  
  
  CONCLUSIONS
  Transient cardiomyopathy affects approximately 1% of patients with a troponin-positive ACS. A typical apical wall motion abnormality is seen in only 60% of patients. Transient cardiomyopathy, also termed Tako-Tsubo cardiomyopathy, therefore should no longer be regarded as an exclusively apical ballooning syndrome, but rather a transient left ventricular dysfunction syndrome with an apical or midventricular pattern of wall motion abnormality.
authors.affiliation: Medical Clinic II, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
authors.forename: Volkhard
authors.initials: V
authors.lastname: Kurowski
authors.forename: Axel
authors.initials: A
authors.lastname: Kaiser
authors.forename: Katharina
authors.initials: K
authors.lastname: von Hof
authors.forename: Dirk P
authors.initials: DP
authors.lastname: Killermann
authors.forename: Björn
authors.initials: B
authors.lastname: Mayer
authors.forename: Franz
authors.initials: F
authors.lastname: Hartmann
authors.forename: Heribert
authors.initials: H
authors.lastname: Schunkert
authors.forename: Peter W
authors.initials: PW
authors.lastname: Radke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003326:Coronary Circulation / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000150:complications; D013315:Stress, Psychological / Q000150:complications; D013318:Stroke Volume / Q000502:physiology; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*