Discrimination of stress (Takotsubo) cardiomyopathy from acute coronary syndrome with clinical risk factors and coronary evaluation in real-world clinical practice

Clinical characteristics of patients with Takotsubo syndrome diagnosed without coronary artery evaluation: A retrospective nationwide study

“…A recent validation study of the DPC data showed high specificities (>96%) for diagnoses with relatively low sensitivities (<85%) [14]; thus, TTS may have been under-reported rather than over-reported in this study. Second, misdiagnosis of ACS as TTS may have occurred in the CAE (À) group, as suggested in a previous study [39]. In addition, misdiagnosis of ACS as TTS also may have occurred in the CAE (+) group, especially when only CCTA was undertaken for coronary artery assessment.…”

“…Consequently, all recent studies with relatively large samples (n > 250) enrolled only patients who underwent CAE (mostly CAG) [10,27,28,30,31,[35][36][37][38]. Nevertheless, this and other studies [8,9,39] have shown that a substantial proportion (35-78%) of patients with the diagnosis of TTS received this diagnosis without CAE in real-world clinical settings. These patients who did not undergo CAE were not enrolled in the recent TTS studies [10,27,28,30,31,[35][36][37][38] because they did not fulfill the current diagnostic criteria.…”

“…Sixth, cause of death was not recorded in the DPC database. Although patients diagnosed with TTS reportedly often have noncardiac comorbidities [10][11][12] that can cause non-cardiac death [27,37,39,43], we were unable to investigate the differences in the incidences of cardiac and non-cardiac death between the CAE (+) and CAE (À) groups. Finally, our results may not be generalizable to patients hospitalized with TTS at non-Japanese Circulation Society board-certified teaching hospitals or hospitals in other countries.…”

Prevalence and risk factors for postoperative stress-related cardiomyopathy in adults

“…To diagnose postoperative SRC, characteristics of the postoperative setting were considered; additionally, the Johns Hopkins criteria for the diagnosis of SRC were set as the standard for this study [ 19 ]. The diagnostic method for SRC recently reported by a study conducted at SNUBH was referred to as a reference [ 20 ]. To diagnose postoperative SRC, the following criteria had to be satisfied: 1) among patients who did not have symptoms that may indicate preoperative SRC (e.g., chest pain, change on the electrocardiogram, shock, hypoxia, altered mentality, and dyspnea), SRC developed before discharge; 2) findings indicating SRC (e.g., typical apical ballooning and ventricular wall motion abnormality) detected using a two-dimensional (2D) echocardiographic evaluation after the observation of symptoms; 3) lack of significant obstruction greater than 75% in the coronary artery on coronary angiogram; and 4) recovery of ventricular wall motion abnormality within days or weeks.…”

Can aldosterone break your heart? Takotsubo cardiomyopathy in a patient with newly diagnosed primary aldosteronism

“…Discrimination of TCM from acute coronary syndrome is crucial in initial diagnostic approach 2. This unique form of acute heart failure is classically developed in response to intense emotional or physical stress.…”