Jeanette Stansborough

Takotsubo cardiomyopathy (TTC) has generally been regarded as a relatively transient disorder, characterized by reversible regional left ventricular systolic dysfunction. However, most patients with TTC experience prolonged lassitude or dyspnea after acute attacks. Although this might reflect continued emotional stress, myocardial inflammation and accentuated brain-type natriuretic peptide (BNP) release persist for at least 3 months. We therefore tested the hypotheses that this continued inflammation is associated with (1) persistent contractile dysfunction and (2) consequent impairment of quality of life. Echocardiographic parameters (global longitudinal strain [GLS], longitudinal strain rate [LSR], and peak apical twist [AT]) were compared acutely and after 3 months in 36 female patients with TTC and 19 age-matched female controls. Furthermore, correlations were sought between putative functional anomalies, inflammatory markers (T2 score on cardiovascular magnetic resonance, plasma NT-proBNP, and high-sensitivity C-reactive protein levels), and the physical composite component of SF36 score (SF36-PCS). In TTC cases, left ventricular ejection fraction returned to normal within 3 months. GLS, LSR, and AT improved significantly over 3-month recovery, but GLS remained reduced compared to controls even at follow-up (-17.9 ± 3.1% vs -20.0 ± 1.8%, p = 0.003). Impaired GLS at 3 months was associated with both persistent NT-proBNP elevation (p = 0.03) and reduced SF36-PCS at ≥3 months (p = 0.04). In conclusion, despite normalization of left ventricular ejection fraction, GLS remains impaired for at least 3 months, possibly as a result of residual myocardial inflammation. Furthermore, perception of impaired physical exercise capacity ≥3 months after TTC may be explained by persistent myocardial dysfunction.

Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS). We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses. Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24 hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90 mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock a...

ABSTRACT Purpose: Takotsubo Cardiomyopathy (TTC) was initially thought to be a rare disorder predominantly presenting like ST elevation myocardial infarction (STEMI). However, recent data suggests that TTC may occur relatively commonly, especially among ageing women, and STEMI-like changes may not represent the major mode of presentation of TTC. We therefore sought to evaluate (1) the incidence of STEMI- like TTC among women > 50 years (2) the proportion of recognized TTC cases presenting as "STEMI". Methods: Four years' data from 2 major tertiary referral hospitals were audited. Diagnosis of TTC was based on (1) typical left ventricular wall motion anomalies (2) exclusion of myocardial infarction, and (3) demonstration of typical inflammatory changes. Results: During the period concerned 1,426 patients presented as STEMI, including 343 women of whom 98% were >50 years old. TTC was diagnosed in 9.3% of women older than 50 years presenting with STEMI. Of the total TTC cases over four years, 29 women (26%) presented as STEMI. Despite the relatively stable prevalence of TTC, the proportion of TTC cases mimicking STEMI increased over the evaluation period (Figure). Presentation with STEMI-like TTC was also associated with marginally greater extensive wall motion anomalies (p=0.07) and similar NT pro BNP release.