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(Circulation. 2003;108:e158.)
© 2003 American Heart Association, Inc.

Correspondence

Tako-Tsubo–Like Left Ventricular Dysfunction

Junya Ako, MD; Yasuhiro Honda, MD; Peter J. Fitzgerald, MD, PhD

The Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, Calif, junya-tky{at}umin.ac.jp

To the Editor:

We read with great interest the recent Images in Cardiovascular Medicine article by Girod et al¹ regarding a case with tako-tsubo–like transient left ventricular dysfunction. In their article, the authors well described a case of this rather unusual disorder and also provided an impressive picture of a tako-tsubo (octopus catcher). Although the exact mechanism for this entity has yet to be clarified, there have been suggestions of abnormal microvascular involvement after emotional or physical stress in this still-mysterious transient disorder.²

This apparently extraordinary phenomenon has several similarities to the left ventricular dysfunction seen in cases of subarachnoid hemorrhage³ as well as brain death. This is of particular importance as some of these individuals become organ donors. Findings such as mild elevation of cardiac enzymes without evidence of obstructive epicardial arteries, reversible nature of the clinical course, and focal pathological changes in myocardium are all commonly observed in this wall-motion abnormality. As a result of these wall-motion abnormalities, the potential donor heart may be rejected for transplant, accounting for nearly one fourth of the unused donor hearts. The clinical impact of reversal of the left ventricular dysfunction seen with brain death^4,5 may hold great promise for patients awaiting a donor heart.

For these reasons, we applaud the publication but encourage that this phenomenon receive more clinical attention and comprehensive research rather than merely classifying it as an uncommon finding.

References

1. Girod JP, Messerli AW, Zidar F, et al. Tako-tsubo–like transient left ventricular dysfunction. Circulation. 2003; 107: e120–e121.[Medline] [Order article via Infotrieve]
   
2. Ako J, Takenaka K, Uno K, et al. Reversible left ventricular systolic dysfunction: reversibility of coronary microvascular abnormality. Jpn Heart J. 2001; 42: 355–363.[CrossRef][Medline] [Order article via Infotrieve]
   
3. Kono T, Morita H, Kuroiwa T, et al. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol. 1994; 24: 636–640.[Abstract]
   
4. Zaroff JG, Babcock WD, Shiboski SC, et al. Temporal changes in left ventricular systolic function in heart donors: results of serial echocardiography. J Heart Lung Transplant. 2003; 22: 383–388.[CrossRef][Medline] [Order article via Infotrieve]
   
5. Deibert E, Aiyagari V, Diringer MN. Reversible left ventricular dysfunction associated with raised troponin I after subarachnoid haemorrhage does not preclude successful heart transplantation. Heart. 2000; 84: 205–207.[Abstract/Free Full Text]
   

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Response

John P. Girod, DO; Adrian W. Messerli, MD; Frank Zidar, MD; W.H. Wilson Tang, MD; Sorin J. Brener, MD

Cleveland Clinic Foundation, Cleveland, Ohio

We greatly appreciate the comments by Drs Ako, Honda, and Fitzgerald. It is important to recognize that recovery of left ventricular function may occur in patients who have suffered sudden cardiac death and whose hearts may be suitable for transplantation. Equally important is the appreciation of the transient nature of left ventricular systolic dysfunction in patients suffering from acute myocardial infarction and undergoing successful reperfusion. In these patients, recovery of left ventricular function after days or weeks may prevent the need for implantation of defibrillators or chronic therapy for severe left ventricular systolic dysfunction.

This article has been cited by other articles:

				J. Ako, Y. Honda, and P. J. Fitzgerald Transient Left Ventricular Apical Ballooning Ann Intern Med, April 19, 2005; 142(8): 678 - 678. [Full Text] [PDF]

				K A Connelly, A I MacIsaac, and V M Jelinek Stress, myocardial infarction, and the "tako-tsubo" phenomenon Heart, September 1, 2004; 90(9): e52 - e52. [Abstract] [Full Text] [PDF]

				J. Ako, Y. Honda, P. J. Fitzgerald, I. A. Andrianakis, E. D. Papadomichelakis, A. N. Kotanidou, T. O. Cheng, E. Fossum, K. Nils-Einar, A. Mangschau, et al. Conditions Associated with ST-Segment Elevation N. Engl. J. Med., March 11, 2004; 350(11): 1152 - 1155. [Full Text] [PDF]

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