Apical and Midventricular Transient Left Ventricular Dysfunction Syndrome (Tako-tsubo Cardiomyopathy): Response

Abstract

We thank Dr. Ako for his thoughtful comments regarding our article in CHEST (September 2007).1Kurowski V Kaiser A von Hof K et al.Apical and midventricular transient left ventricular dysfunction syndrome (“tako-tsubo” cardiomyopathy): frequency, mechanisms and prognosis.Chest. 2007; 132: 809-816Abstract Full Text Full Text PDF PubMed Scopus (403) Google Scholar Indeed, over recent years a number of studies have broadened our pathophysiologic understanding of “tako-tsubo” cardiomyopathy (TTC). With a deeper insight into the characteristic temporal structural and functional changes of this entity, however, the terminology, primarily referred to as the left ventricular apical ballooning syndrome, now has to adapt to this process. Among a number of very important observations recently, at least two will have to be reflected in future terminology. First, the right ventricle is also affected in a number of patients2Haghi D Athanasiadis A Papavassiliu T et al.Right ventricular involvement in Takotsubo cardiomyopathy.Eur Heart J. 2006; 27: 2433-2439Crossref PubMed Scopus (218) Google Scholar; and second, approximately 40% of patients present with an “atypical” midventricular wall motion abnormality and not with a “classical” apical pattern.1Kurowski V Kaiser A von Hof K et al.Apical and midventricular transient left ventricular dysfunction syndrome (“tako-tsubo” cardiomyopathy): frequency, mechanisms and prognosis.Chest. 2007; 132: 809-816Abstract Full Text Full Text PDF PubMed Scopus (403) Google Scholar Furthermore, impaired glucose metabolism and (to a lesser extent) a decrease in myocardial perfusion closely relate to wall motion abnormalities and seems to be a uniform characteristic in TTC patients,3Yoshida T Hibino T Kako N et al.A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography.Eur Heart J. 2007; 28: 2598-2604Crossref PubMed Scopus (133) Google Scholar regardless of the localization of left ventricular dysfunction.1Kurowski V Kaiser A von Hof K et al.Apical and midventricular transient left ventricular dysfunction syndrome (“tako-tsubo” cardiomyopathy): frequency, mechanisms and prognosis.Chest. 2007; 132: 809-816Abstract Full Text Full Text PDF PubMed Scopus (403) Google Scholar Until now, TTC has been largely defined by the “proposed Mayo criteria”4Bybee KA Kara T Prasad A et al.Systematic review: transient left ventricular apical ballooning; a syndrome that mimics ST-segment elevation myocardial infarction.Ann Intern Med. 2004; 141: 858-865Crossref PubMed Scopus (1160) Google Scholar that is based on the morphology of left ventricular dysfunction, ECG changes, and absence of significant coronary artery disease. Transient cardiomyopathy clearly should no longer be regarded as the left ventricular apical ballooning syndrome. We propose a redefinition of TTC. The term transient cardiac dysfunction syndrome with an apical or midventricular pattern of wall motion abnormality may provide a matrix for doing so. Apical and Midventricular Transient Left Ventricular Dysfunction Syndrome (Tako-tsubo Cardiomyopathy)ChestVol. 133Issue 4PreviewI read with great interest the recent article by Dr. Kurowski et al,1 who observed that 40% of transient left ventricular dysfunction showed a midventricular pattern. Currently, the frequently used terminology, including left ventricular apical ballooning2 and tako-tsubo–like left ventricular dysfunction,3 suggests that involvement of the left ventricular apex is a requisite for diagnosis, while this article demonstrates that an apical sparing pattern is a variant form, or more likely a variation along the continuum of this disorder in its broadest sense. Full-Text PDF