The clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings of reverse or inverted takotsubo cardiomyopathy: comparison with mid or apical variant.
BACKGROUND
Although takotsubo cardiomyopathy (TTC) typically affects the apical and/or midventricular segments, several recent cases have reported a reverse or inverted variant of TTC. The aim of this study was to investigate the clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings in patients presenting as inverted TTC and compare those parameters to those presenting as mid or apical variant.


OBJECTIVE
The clinical features of inverted TTC are different from those of other types of TTC.


METHODS
Of 103 patients enrolled from the TTC registry database, 20 showed inverted TTC (inverted TTC group), and 83 showed mid or apical variant (other TTC group).


RESULTS
Clinical presentations and in-hospital courses were mostly similar between the groups. However, the inverted TTC group was younger (median, 54.5 vs 64.0 years; P = 0.006) than other TTC and had a higher prevalence of triggering stress (100% vs 77%, P = 0.018), whereas other TTC group had higher prevalence of dyspnea (58% vs 30%, P = 0.025), pulmonary edema (46% vs 20%, P = 0.035), cardiogenic shock (36% vs 10%, P = 0.023), T-wave inversion (81% vs 60%, P = 0.049), and significant reversible mitral regurgitation (MR) (19% vs 0%, P = 0.033). Also, the inverted TTC group had significantly higher creatine kinase MB fraction (CK-MB); CK-MB (median, 30.7 vs 7.6 ng/mL; P = 0.001) and troponin-I (median, 13.1 vs 1.6 ng/mL; P = 0.001), but lower N-terminalpro-brain natriuretic peptide (NT-proBNP) levels (median, 613.3 vs 4987.0 pg/mL; P = 0.020).


CONCLUSIONS
Inverted TTC presents at a younger age and has a higher prevalence of triggering stress, whereas other TTC has a higher prevalence of heart failure symptoms, significant reversible MR, and T-wave inversion and higher NT-proBNP levels despite other clinical features that are mostly similar.
Department of Medicine, Division of Cardiology, Cardiac and Vascular Center, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Bong Gun
BG
Song
Woo Jung
WJ
Chun
Yong Hwan
YH
Park
Gu Hyun
GH
Kang
JuHyeon
J
Oh
Sang-Chol
SC
Lee
Seung Woo
SW
Park
Jae K
JK
Oh
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D052279:Creatine Kinase, MB Form / Q000097:blood; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000150:complications; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form