Assessment of Left Ventricular Dysfunction in Tako-Tsubo Cardiomyopathy

Abstract

We read with great interest the recent report of Chao et al 1 Chao T. Lindsay J. Collins S. Woldeyes L. Joshi S.B. Steinberg D.H. Satler L.F. Kent K.M. Suddath W.O. Pichard A.D. Waksman R. Can acute occlusion of the left anterior descending coronary artery produce a typical “takotsubo” left ventricular contraction pattern?. Am J Cardiol. 2009; 104: 202-204 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar concerning the diagnostic difficulties of tako-tsubo cardiomyopathy by left ventricular (LV) angiography. We agree that a blinded review of LV angiography may be difficult and may lead to misdiagnosis. However, biplane LV angiography could be of interest to avoid such a misdiagnosis. 2 Pillière R. Mansencal N. Digne F. Lacombe P. Joseph T. Dubourg O. Prevalence of tako-tsubo syndrome in a large urban agglomeration. Am J Cardiol. 2006; 98: 662-665 Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar , 3 Prasad A. Lerman A. Rihal C.S. Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008; 155: 408-417 Abstract Full Text Full Text PDF PubMed Scopus (1243) Google Scholar We recently demonstrated that systolic dysfunction in tako-tsubo cardiomyopathy during the acute phase is circular and is different from the LV systolic dysfunction observed in patients with left anterior descending coronary artery occlusion, suggesting that tako-tsubo cardiomyopathy is not the consequence of transient coronary artery occlusion. 4 Mansencal N. Abbou N. Pillière R. El Mahmoud R. Farcot J.C. Dubourg O. Usefulness of two-dimensional speckle tracking echocardiography for assessment of tako-tsubo cardiomyopathy. Am J Cardiol. 2009; 103: 1020-1024 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar , 5 Wittstein I.S. Thiemann D.R. Lima J.A.C. Baughman K.L. Schulman S.P. Gerstenblith G. Wu K.C. Rade J.J. Bivalacqua T.J. Champion H.C. Neurohumoral features of myocardial stunning due to emotional stress. N Engl J Med. 2005; 352: 539-548 Crossref PubMed Scopus (2323) Google Scholar Once the acute phase has passed, tako-tsubo cardiomyopathy may mimic LV dysfunction observed in patients with coronary artery disease and may lead to misdiagnosis if a patient is not seen on the first day of tako-tsubo cardiomyopathy. 4 Mansencal N. Abbou N. Pillière R. El Mahmoud R. Farcot J.C. Dubourg O. Usefulness of two-dimensional speckle tracking echocardiography for assessment of tako-tsubo cardiomyopathy. Am J Cardiol. 2009; 103: 1020-1024 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar Thus, the interpretation of LV angiography should be cautiously made according to the time between the onset of this disease and the performance of angiography.