Left ventricular contraction patterns in patients with suspected acute coronary syndrome and normal coronary angiograms: a new look at the takotsubo syndrome.
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.


OBJECTIVE
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.
Division of Cardiology, Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA. andre.r.paixao@medstar.net
Andre R M
AR
Paixao
Nicholas
N
Balaji
Alex
A
Ryzhikov
Kambiz
K
Ghafourian
Sara
S
Collins
William O
WO
Suddath
Lowell F
LF
Satler
Kenneth M
KM
Kent
Augusto D
AD
Pichard
Ron
R
Waksman
Joseph
J
Lindsay
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left
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