Apical and Midventricular Transient Left Ventricular Dysfunction Syndrome (Tako-Tsubo Cardiomyopathy) Frequency, Mechanisms, and Prognosis

BACKGROUND: Takotsubo cardiomyopathy (TC) usually is not recognized until heart catheterization reveals typical wall motion abnormalities in the absence of significant coronary artery disease. It was our aim to identify TC by its unique cardiac biomarker profile at an early stage and, preferably, with non-invasive procedures only. METHODS: Ratios of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and myoglobin, NT-proBNP and troponin T (TnT), NT-proBNP and creatinekinase-MB (CK-MB) were compared in patients with TC (n=39), patients with ST-elevation myocardial infarction (STEMI, n=48) and patients with non-ST-elevation myocardial infarction (NSTEMI, n=34). Biomarkers were recorded serially at admission and at the three consecutive days. Optimal cut-off values to distinguish TC from STEMI and NSTEMI were calculated with receiver operator characteristic (ROC) curves. RESULTS: At admission a NT-proBNP (ng/l)/myoglobin ( g/l) ratio of 3.8, distinguished TC from STEMI (sensitivity: 89%, specificity: 90%), while a NT-proBNP (ng/l)/myoglobin ( g/l) ratio of 14 separated well between TC and NSTEMI (sensitivity: 65%, specificity: 90%). Best differentiation of TC and ACS was possible with the ratio of peak levels of NT-proBNP (ng/l)/TnT ( g/l). A cut-off value of NT-proBNP (ng/l)/TnT ( g/l) ratio of 2889, distinguished TC from STEMI (sensitivity: 91%, specificity: 95%), while a NT-proBNP (ng/l)/TnT ( g/l) ratio of 5000 separated well between TC and NSTEMI (sensitivity: 83%, specificity: 95%). CONCLUSIONS: TC goes along with a singular cardiac biomarker profile, which might be useful to identify patients with TC among patients presenting with acute coronary syndromes (ACS).

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“…[24] Troponin and NT-proBNP assays might vary among different manufactures, which may lead to differing cut-off values.…”

Section: Limitationsmentioning

confidence: 99%

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy

Fröhlich

Schoch

Schmid

et al. 2012

International Journal of Cardiology

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“…Among patients with troponin-positive ACS, TTC accounts for only 1.2% of cases [3]. It occurs mainly in postmenopausal females and elderly individuals.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy in a patient with an ascending colon mass

González

Wahab

Elgamal

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Takotsubo cardiomyopathy (TTC) is a syndrome characterized by transient regional systolic dysfunction of the left ventricle in the absence of angiographic evidence of obstructive coronary artery disease (CAD). A variety of stress-related triggers, including malignancies, have been reported in patients with TTC. However, to our knowledge, a recent diagnosis of a colon mass preceding the development of TTC has not been reported. We report on a female patient who was recently diagnosed with a colon mass by colonoscopy who was then scheduled to undergo robotic hemicolectomy, but was subsequently admitted to our hospital for intractable nausea and abdominal pain. While admitted, she developed transient ventricular tachycardia with elevated cardiac markers. The echocardiogram revealed markedly decreased ejection fraction and mid to distal apical akinesis with regional wall motion abnormalities. Coronary angiogram demonstrated no significant CAD, consistent with the diagnosis of TTC. The recently diagnosed colon mass was the most likely stress trigger in the development of TTC.

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“…Basal/reverse type of Takotsubo cardiomyopathy represents only 2.2% cases of TCMP [2]. It is characterized by echocardiographic findings of basal inferior wall hypokinesis.…”

Section: Discussionmentioning

confidence: 99%

“…Study of International Takotsubo Registry (1750 patients) identified 4 types of TCMP, apical (81.7%), midventricular (14.6%), basal/reverse (2.2%) and focal type (1.5%) [2]. These patterns of myocardial dysfunction are reminiscent of myocardial stunning associated with an increased catecholamine release.…”

Section: Introductionmentioning

confidence: 99%

Reverse Takotsubo Cardiomyopathy: A Rare Complication of Epidural Steroid Injection

Isakadze¹

2017

MOJCR

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Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy (TCMP) is characterized by a rapid, severe and usually reversible ventricular wall dysfunction, ST segment changes on EKG and troponin leak without evidence of obstructive coronary artery disease by coronary angiography. It represents approximately 1.2% of all troponin positive acute coronary syndromes [1]. Physical or emotional stressors have been identified as triggers precipitating this syndrome in the majority of the cases.Classification of TCMP is based on the distribution of wall motion abnormalities noted on Echocardiogram. Study of International Takotsubo Registry (1750 patients) identified 4 types of TCMP, apical (81.7%), midventricular (14.6%), basal/reverse (2.2%) and focal type (1.5%) [2]. These patterns of myocardial dysfunction are reminiscent of myocardial stunning associated with an increased catecholamine release. It has been hypothesized that the distribution of adrenergic receptors in myocardial tissue explains the difference in anatomical distribution of injury [3]. Here we present a case of a middle-aged female patient who developed acute severe heart failure caused by reverse TCMP following a cervical steroid injection.With this case report, we intend to highlight the possible association between epidural steroid injection and development of TCMP. We also emphasize the high clinical suspicion required to diagnose TCM in patients who present with acute coronary syndrome, heart failure, specific pattern of wall motion abnormalities and angiographically normal coronaries. We further illustrate the utility of cardiac MRI as a non-invasive study with increased sensitivity over other imaging modalities in diagnosing TCM. Case PresentationA highly functional middle-aged postmenopausal female with remote history of depression, cervical canal stenosis and no other significant medical history presented to the emergency room after awakening around midnight with severe headache, diaphoresis, palpitations, shortness of breath, nausea, vomiting and diarrhea. The patient was severely hypertensive upon presentation. At presentation she had severely elevated blood pressure (BP 220/150mm Hg), was diaphoretic and complained of severe sub sternal non-radiating chest pain. Physical examination revealed regular rhythm, with a heart rate of 122 beats per minute, mild respiratory distress and she was afebrile. Her jugular venous pressure was not elevated and no carotid bruits were present. Cardiac auscultation revealed normal first and second heart sounds with a 2/6 holosystolic murmur at the apex radiating to axilla. Her peripheral pulses were equal in all extremities. Lung fields were clear. She denied any acute stressors. Patient reported cervical spinal pain for which she had received a cervical steroid injection several hours before presentation. InvestigationsDue to her complains of chest pain, a stat electrocardiogram (EKG) was obtained. Initial EKG showed fascicular ventricular tachycardia with HR of 148 beats per minute, which s...

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Apical and Midventricular Transient Left Ventricular Dysfunction Syndrome (Tako-Tsubo Cardiomyopathy) Frequency, Mechanisms, and Prognosis

Cited by 539 publications

References 17 publications

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy

Takotsubo cardiomyopathy in a patient with an ascending colon mass

Reverse Takotsubo Cardiomyopathy: A Rare Complication of Epidural Steroid Injection

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