Takotsubo cardiomyopathy: an Australian single centre experience with medium term follow up

• Published in: Internal medicine journal 2012-01, Vol.42 (1), p.35-42
• Main Authors: Samardhi, H., Raffel, O. C., Savage, M., Sirisena, T., Bett, N., Pincus, M., Small, A., Walters, D. L.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Adult; Aged; Aged, 80 and over; apical ballooning; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Cardiac Catheterization; cardiogenic shock; Cardiovascular Agents - therapeutic use; Chest Pain - etiology; Diagnosis, Differential; Electrocardiography; Female; Follow-Up Studies; Heart Arrest - etiology; Humans; left ventricular outflow gradient; Magnetic Resonance Imaging; Male; mid-wall variant; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Pulmonary Edema - epidemiology; Pulmonary Edema - etiology; Queensland - epidemiology; Shock, Cardiogenic - epidemiology; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Stress, Psychological - complications; Stroke Volume; Takotsubo cardiomyopathy; Takotsubo Cardiomyopathy - complications; Takotsubo Cardiomyopathy - diagnosis; Takotsubo Cardiomyopathy - diagnostic imaging; Takotsubo Cardiomyopathy - drug therapy; Takotsubo Cardiomyopathy - epidemiology; Takotsubo Cardiomyopathy - physiopathology; Ultrasonography; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - etiology
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/j.1445-5994.2011.02474.x

Background:  Takotsubo cardiomyopathy (TC) is increasingly recognised in patients presenting with features of acute coronary syndrome. We present a single centre experience of TC with medium term follow up. Methods:  Fifty‐two consecutive patients presenting with a diagnosis of TC were included. The clinical presentation, complications, baseline and follow‐up echocardiograms and cardiac magnetic resonance imaging were analysed. Results:  Fifty‐one patients were female. A stressful event preceded presentation in 37 (71%) patients. Chest pain was the most common symptom (83%). Two patients presented with an out‐of‐hospital cardiac arrest. ST segment elevation (40%) and global T wave inversion (44%) were the most frequent electrocardiogram changes. Left ventricular assessment demonstrated typical apical ballooning in 41 patients and 11 patients demonstrated the mid‐wall variant. In‐hospital complications occurred in 11 patients (21%) and included acute pulmonary oedema (n = 2), cardiogenic shock (n = 5); two of whom had a significant left ventricular outflow gradient, atrial fibrillation (n = 1), left ventricular thrombus (n = 2) and a cerebrovascular event (n = 2). Left ventricular function at presentation and follow up was compared in 40 patients. The mean ejection fraction in this group at presentation was 47% (20–70%) compared with that at follow up of 63% (44–76%). There were no significant complications or recurrences at follow up. Conclusions:  While TC is a reversible condition with low rates of complications and recurrence at follow up it is, as demonstrated in our cohort, associated with significant in‐hospital morbidity in a proportion of patients.