Abstract 1618: Clinical Spectrum of Tako-Tsubo-Cardiomyopathy in a Western Population: Results of the Tako-Tsubo-Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenkenhausaerzte (ALKK)
Purpose: Tako-tsubo-cardiomyopathy (TTC), initially described in Japan, has increasingly been recognized in western countries over the past years. Most studies, however, comprise relatively few patients. A German tako-tsubo-registry has been initiated to further characterize the clinical profile of this syndrome in a western population.
Methods: So far 119 patients (P) were included according to following criteria:
acute chest symptoms,
ischemic ECG changes with ST-segment elevation ± T-wave inversion,
reversible left ventricular akinesia not corresponding to a single coronary artery territory,
absence of significant coronary artery stenoses.
Results: Among 119 P (age 68±13 years) 104 were female (87%) and 15 male (13%). Triggering events present in 112 P (94%) consisted of emotional (n=82) or physical stress (n=59); 29 P (24%) experienced combined stress. The admission ECG showed ST-segment elevation (78%), reciprocal ST-segment depression (17%), negative T-waves (47%) and QTc prolongation (498±78 msec). Q-waves present in 27% on admission resolved during follow-up. Cardiac markers were slightly elevated (CK 264±573 U/l, troponin I 15±52 ng/ml). Ejection fraction was reduced (EF 54±15%). Left ventriculography showed apical ballooning in 83 (70%) and mid-ventricular ballooning in 36 P (30%). Except for a lower EF (50±15 vs 56±14%, p<0.05) in mid-ventricular ballooning, both variants had an identical clinical profile. Right ventricular involvement was seen in 30 P (25%). Complications included pulmonary edema (19%), intraventricular pressure gradient (7%), VT (2%), cardiogenic shock (4%), 1 P died. Cardiac MRI performed in 66 P (55%) displayed no late enhancement within the regional wall motion abnormality. Echocardiography showed normalization of LV function within 3 months. ECG changes completely resolved within 6 months. Recurrence of TTC occurred in 4 P (4%) after 2–35 months. Regarding all parameters, no gender difference was observed.
Conclusion: TTC predominantly occurs in elderly patients after a stressful event. Atypical mid-ventricular ballooning and right ventricular involvement are common. Cardiac MRI typically shows no late enhancement within the wall motion abnormality. The recurrence rate appears to be low.