P815Tako-Tsubo Cardiomyopathy: clinical correlations of typical and atypical left ventricular contraction patterns

Abstract

Background Takotsubo cardiomyopathy (TCM) is diagnosed in 1–2% of all patients presenting with acute coronary syndrome (ACS). Clinical differences in individuals presenting with either the typical (apical) or atypical (midventricular, basal and focal) localization of left ventricular contraction abnormalities are not well understood. Methods We retrospectively analyzed 102 consecutive patients diagnosed with TCM based on clinical presentation, coronary angiography, and laevocardiography. Patients with different contraction abnormality patterns were compared regarding sex, clinical presentation, trigger for TCM, LV-function and LV enddiastolic pressure (LVEDP) as well as coronary artery disease. Results Of all TCM 102 patients, 69 (68%) presented with the typical pattern of apical contraction abnormality. 33 patients (32%) had an atypical pattern: 22 (22%) with the midventricular type, 2 (2%) with the basal type and 9 (9%) with a focal type. There was no difference in sex distribution among the different types of TCM (female: typical 86% vs atypical 85% p=0.83). Presentation as a ST-elevation ACS was more common in patients with atypical compared to typical TCM (21% vs. 17%; p=0.85), but without statistical significance. Cardiogenic shock (typical 6% vs atypical 3%; p=0.91) as well as intra-hospital death (typical 3% vs atypical 3%; p=0.56) were rare in both types. A trigger was not more common in patients with typical TCM (58% vs atypical 55%; p=0.91). The trigger was more often physical in typical (73%) and atypical TCM (78%) than psychological, but the distribution did not differ between the two types (p=0.92). 83.6% of the patients showed an impaired LV-EF. Median LV-EF in patients with typical TCM (35% (IQR 25–40)) tended to be lower than in patients with atypical TCM (40% (IQR 25–40); p=0.63; LV-EF ≤30% typical TCM 45% vs. atypical TCM 39%; p=0.75). In 72% (73/102) of the patients the LVEDP was determined. In 75% (55/73) the LVEDP was elevated (>15mmHg). LVEDP tended to be more often elevated in patients with typical TCM (83% vs. atypical 52%; p=0.11). Extent of coronary artery disease did not differ in the different types of TCM. Coronary stenosis >50% was rare (typical TCM 20% vs atypical TCM 9%; p=0.26), whereas exclusion of coronary artery disease was common in both types (typical TCM 71%; atypical TCM 76%; p=0.79). Conclusion While an apical contraction anomaly is the most common type of presentation in TCM, atypical contraction patterns are found in 32% of the patients. Overall, psychological triggers are not found as frequently in TCM as previously described. Patients with typical and atypical TCM do not differ in clinical presentation, LV-EF, LVEDP and extent of coronary artery disease.