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First published online on June 15, 2007
Chest, doi:10.1378/chest.07-0608
doi:10.1378/chest.07-0608
(Chest. 2007; 132:809-816)
© 2007 American College of Chest Physicians
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Apical and Midventricular Transient Left Ventricular Dysfunction Syndrome (Tako-Tsubo Cardiomyopathy)* Frequency, Mechanisms, and Prognosis

Volkhard Kurowski, MD; Axel Kaiser, MD; Katharina von Hof, MD; Dirk P. Killermann, MD; Björn Mayer, MD; Franz Hartmann, MD; Heribert Schunkert, MD and Peter W. Radke, MD

* From the Medical Clinic II (Drs. Kurowski, Kaiser, Killermann, Mayer, Hartmann, Schunkert, and Radke) and Department of Radiology and Nuclear Medicine (Dr. von Hof), University Hospital Schleswig-Holstein, Campus Luebeck, Germany.

Correspondence to: Peter W. Radke, MD, Medical Clinic II, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany; e-mail: peter.radke{at}uk-sh.de

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.

Key Words: acute myocardial infarction • myocardial stunning • Tako-Tsubo cardiomyopathy


Related Editorial

The Tako-Tsubo Syndrome: An Underappreciated, Novel Disease Entity
Norbert Frey, Hugo A. Katus, and Evangelos Giannitsis
Chest 2007 132: 743-744. [Full Text] [PDF]



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