Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.
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.
Kurowski
Volkhard
V
Medical Clinic II, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
Kaiser
Axel
A
von Hof
Katharina
K
Killermann
Dirk P
DP
Mayer
Björn
B
Hartmann
Franz
F
Schunkert
Heribert
H
Radke
Peter W
PW
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*