Copyright
©The Author(s) 2016.
World J Cardiol. Jul 26, 2016; 8(7): 413-424
Published online Jul 26, 2016. doi: 10.4330/wjc.v8.i7.413
Published online Jul 26, 2016. doi: 10.4330/wjc.v8.i7.413
Table 1 Epidemiological and clinical features of takotsubo cardiomyopathy
Tsuchihashi et al[15] | Núñez et al[14] | Kurowski et al[13] | Eshtehardi et al[16] | Parodi et al[11] | Ahmed et al[17] | Templin et al[18] | |
Country | Japan | Spain | Germany | Swiss | Italy | United States | Europe and United States |
Year of publication | 2001 | 2015 | 2007 | 2009 | 2007 | 2013 | 2015 |
Subjects, n | 88 | 202 | 35 | 41 | 36 | 620 (systematic review) | 1750 (international registry) |
Age (yr) | 67 ± 13 | 70 ± 12.5 | 72 ± 9 | 65 ± 11 | 75 ± 7 | 67 | 66.8 ± 13 |
In percentage (%) | |||||||
Reported incidence1 | --- | 1.2 | 1.2 | 1.7 | 2 | --- | --- |
Women | 86 | 90 | 94 | 85 | 1006 | 91 | 89.8 |
Hypertension | 48 | 67 | 74 | 56 | 50 | --- | 65 |
Diabetes | 12 | 15 | 23 | 5 | 5.5 | --- | 14 |
Hyperlipidemia | 24 | 41 | 34 | 39 | 39 | --- | 31 |
Current smoking | --- | 15 | 20 | 27 | 19 | --- | 20 |
Apical type | 1003 | --- | 60 | --- | --- | --- | 81.7 |
Emotional/psychological trigger | 20 | 50 | 43 | 46 | --- | 41 | 27.7 |
Physical (acute diseases, exercise, surgery and medical procedures) trigger | 53 | 20 | 43 | 17 | --- | 45 | 36 |
No identified triggering factor | 26 | 27 | 14 | 37 | 28 | 14 | 28.5 |
Chest pain | 67 | 80 | --- | 76 | 1002 | 54 | 76 |
Dyspnea | 7 | 45 | --- | 24 | --- | 26 | 47 |
Syncope | --- | 9 | --- | --- | --- | --- | 7.7 |
ST segment elevation | 90 | 62 | 69 | 39 | 1002 | 39 | 43.7 |
T wave inversion | 97 | 94.4 | --- | 46 | --- | 31 | 415 |
In hospital mortality | 1 | 2.44 | 9 | 0 | --- | 4 | 4.1 |
Long term mortality from all causes | --- | --- | 8.6 (at 12 mo) | 2 (23 ± 10 mo) | 3 (at 6 mo) | --- | 5.6 (per patient-year) |
Recurrences | 2.7 | 0 | 6 | 5 | --- | --- | 1.8 (per patient-year) |
Table 2 Clinical comparison between takotsubo cardiomyopathy and STEMI
TTC | STEMI | |
Predominant gender | Women | Men |
Myocardial segments involved | Extent beyond one coronary artery | Corresponding to culprit vessel |
Peak of troponin | Lower | Higher |
Left ventricle dysfunction recovery | Complete and at short term | Variable |
Long term mortality | Lower | Higher |
Table 3 Diagnosis criteria for takotsubo cardiomyopathy
Patients must satisfy all the following | |
ECG | New abnormalities: ST-segment elevation and or T waves inversion |
Blood test | Modest peak of troponin |
Imaging | Transient wall motion abnormalities (with or without apical involvement) that extend beyond a single epicardial coronary artery |
Angiography | Normal or near normal epicardial coronary arteries and no evidence of plaque rupture |
Excluding other diseases | Pheochromocytoma, myocarditis |
Table 4 Electrocardiographic findings in takotsubo cardiomyopathy
T waves inversion | ST-segment | QRS complex | Q waves |
Are the most frequent finding along ECG evolution | Makes priority rule out obstructive coronary artery disease | aVR lead is especially sensible to changes in voltage because it "faces" the apex | Permanent pathological Q waves are exceptional |
Appear mainly in precordial leads (V2-V6) | More frequent on precordial leads, except V1 | ||
Negative T waves are deep, symmetrical and widespread | Reciprocal depression is less frequent than in STEMI | ||
Progressive QT-interval prolongation | Suspicious combinations: | ||
ST-depression in aVR plus no elevation in V1 (91% sensitivity, 96% specificity)[87] | |||
The sum of elevation in V4-V6/V1-V3 ≥ 1 (77% sensitivity, 80% specificity)[65] | |||
No negative T wave in V1 plus positive T wave in aVR must raise suspicion (95% sensitivity, 97% specificity)[62] | Level of ST segment elevation lesser than in anterior STEMI |
- Citation: Mejía-Rentería HD, Núñez-Gil IJ. Takotsubo syndrome: Advances in the understanding and management of an enigmatic stress cardiomyopathy. World J Cardiol 2016; 8(7): 413-424
- URL: https://www.wjgnet.com/1949-8462/full/v8/i7/413.htm
- DOI: https://dx.doi.org/10.4330/wjc.v8.i7.413