Abstract 2268: Is Tako- Tsubo- Cardiomyopathy a Benign Disease? Comparison With Anterior Myocardial Infarction.
Background: “Tako-tsubo”-like transient left ventricular (LV) dysfunction is characterized by chest pain, ECG changes and LV regional akinesia mimicking anterior myocardial infarction (AMI) in the absence of coronary artery disease. Since LV function returns to normal within days, prognosis is believed to be excellent.
Methods and Results: Among 1922 patients with an acute coronary syndrome (ACS) undergoing coronary angiography over a 6-year period, 46 patients (2.4%) with tako-tsubo cardiomyopathy (TTC) were identified (41 f, 5 m, age 70±12). Prevalence of TTC was 6.4% in females and 0.4% in males with ACS. TTC patients were compared to 25 consecutive age and sex matched AMI patients undergoing PCI of the LAD with similar findings on LV angiography. There was no significant difference regarding symptoms or ECG changes (ST-segment elevation, T-wave inversion) between both groups. A triggering event was present in 44/46 TTC vs 1/25 AMI patients (p<0.001) consisting of emotional (n=31) ± physical stress (n=33). In TTC levels of CK (204±117 vs 1903 ±1651 U/l) and troponin I (6.5±4.2 vs 231±249 ng/ml) were significantly lower than in AMI (p<0.001). Ejection fraction was similar (54±14 vs 55±13%) but LVEDP (25±8 vs 33±9 mm Hg) was higher in AMI (p<0.05). Overall, complications occurred in 18/46 (39%) TTC vs 2/25 (8%) AMI patients (p<0.01). One patient in each group died from cardiogenic shock. One AMI patient had reinfarction due to stent thrombosis. Other complications were seen only in TTC: atrial fibrillation (n=6), ventricular tachycardia (n=1), pulmonary edema (n=6), LV thrombus (n=3, with stroke n=2), transient LV pressure gradient (n=4), RV involvement (n=1). Normalization of LV function (within 23±20 days) and ECG normalization (within 88±111 days) occurred in 46/46 TTC but only in 1/25 AMI patients (p<0.001).
Conclusion: Despite similar symptoms, ECG changes and ejection fraction, a lower level of cardiac markers and a normal coronary angiogram, TTC patients have a significantly higher rate of severe complications compared to AMI patients undergoing PCI. Although ECG changes and LV function return to normal within days to weeks in TTC, the initial clinical presentation is not at all benign, and careful monitoring during in the acute phase is required.