Clinical findings of Takotsubo cardiomyopathy: results from a multicenter international study

Abstract

Takotsubo cardiomyopathy consists of reversible systolic left ventricular apical ballooning associated with chest pain. Electrocardiographic abnormalities and the minimal rise of serum cardiac markers are similar to those in acute myocardial infarction, but without evidence of myocardial ischemia or injury. To date, many reports concerning this kind of acute reversible heart failure have been published, but the information available about the management of affected patients is scarce and the clinical data are incomplete. In the present study, we report a collection of 40 patients who were affected by Takotsubo cardiomyopathy obtained in a multicentric international study, aiming to investigate the origins, and the clinical and instrumental patterns, and to establish the best diagnostic criteria for this syndrome. In the analysed group, the mean age was 68 years, of whom 85% were women. On admission to hospital, 68% of patients reported chest pain. An electrocardiogram (ECG) showed anterolateral (34%) or anterior (36%) ST segment elevation. The ECG demonstrated hyperkinesis of the basal segments with a severe hypokinesis of the other segments. Mean ejection fraction was 42.53%. Three patients died within the first 24 h from acute heart failure. The remaining 37 patients showed a complete resolution of symptoms and a complete normalization of the kinesis deficiency. Sixteen patients underwent myocardial scintigraphy, nine cases underwent myocardial biopsy and two patients received an ergonovine test. Our results demonstrate a good course of Takotsubo cardiomioathy, after the initial phase. An echocardiogram is an important tool for improving the diagnosis.