0118: Takotsubo cardiomyopathy following acute cerebral events

Abstract

Takotsubo cardiomyopathy is characterized by a transient apical ventricular dysfunction typically induced by an acute stress. Acute cerebral events including ischemic stroke (IS) or Epileptic Event (EE) may both be associated with massive catecholamine release. We aimed to identify the characteristics and outcomes of patients who experienced Takotsubo syndrome complicating an IS or EE. Between 2008 and 2013, 87 patients were admitted in our Intensive Care Unit for suspected Takotsubo syndrome, of whom 6 previously experienced acute cerebral symptoms with either IS or EE, within two days. Takotsubo syndrome was diagnosed on Cardiac Magnetic Resonance, echocardiographic, electrocardiographic, biological and coronary angiography data. Five women and one man were included. The mean age was 63.7±20.1 years old (range: 44-84). Four of them (67%) presented initially an acute IS and two (33%) had EE. The suspected culprit brain injury was the insular cortex for three patients or posterior fossa for two patients. Hemiparesis, aphasia and cerebellar symptoms were the main neurological signs. Abnormal ECG findings including ST segment elevation (33%) or T waves inversion (50%) developed between few hours and 48 hours after the onset of IS or EE. Troponin peak was at 1,8 (0,79-14,11) µg/L. A transient alteration of the left ventricular ejection fraction (46±12%) with apical hypokinesis was found at echocardiography. Two (33%) patients developed an acute heart failure. Coronary angiography confirmed the lack of significant coronary stenosis for all the patients. Takotsubo cardiomyopathy can develop early within in the first days after an acute cerebral event, predominantly in women with insular or posterior fossa lesions and induced by possible vegetative reactions.