Abstract 3934: Recurrence Rate in Patients With Tako- Tsubo Cardiomyopathy During Long Term Follow-up
Background: Prognosis of tako-tsubo cardiomyopathy (TTC) is believed to be excellent since left ventricular function normalizes within days. Recurrence has been observed in 3–9% of patients, but only small studies with a short observation period have been reported so far. We aimed to assess the recurrence rate of TTC in a larger group of pts during long term follow-up.
Methods: Among 3057 pts with an acute coronary syndrome evaluated by angiography over a 9-year period, 70 pts (2.3%) with TTC were identified (63 f, 7 m, age 71±12). Retrospectively, all available documents (patient chart, ECG, heart catheterization) over the past 20 years were reviewed for typical findings of TTC. After the index event, all pts underwent a prospective follow-up.
Results: Retrospective analysis revealed previous occurrence of TTC in 8/70 pts (11%). There were 13 events in 8 pts. TTC had been misdiagnosed as myocardial infarction (n=5), pulmonary embolism (n=2), hypertensive heart disease (n=2), heart failure (n=2), pericarditis or coronary spasm (n=1 each). Angiography had been performed in 8/13 events after median 10 (2–23) days. In 3 events evaluated within 3 days of symptom onset, retrospectively the typical angiographic features of TTC were diagnosed. One pt with apical ballooning at the index event had 2 previous episodes of mid-ventricular ballooning. Five pts underwent angiography after 7–38 days, and LV-function had already normalized. During a prospective follow- up of median 49 months after the index event, recurrence was observed in 5/70 pts (7%). Two pts developed new ECG changes, 2 recurrence of apical and 1 recurrence of mid-ventricular ballooning. Over the entire period, recurrence of TTC occurred in 13/70 pts (19%) and was unrelated to age, ballooning pattern or medication. There were 18 events in 13 pts (11×1 event, 1×3 and 1×4 events). Median time interval between recurrent events was 29 (range 2–92) months. Recurrence rate was similar in females and males (10/63 vs 3/7, p=ns). COPD as trigger mechanism for TTC was more common in pts with recurrence than in those without (6/13 vs 10/57 p<0.05).
Conclusion: Recurrent events occur in 19% of TTC pts during long term follow-up and are more common than previously recognized. COPD is the main trigger mechanism for TTC recurrence.