Isolated Left Ventricular Basal Ballooning in Young Women: “Inverted Takotsubo” Pattern Related to Catecholamine-Toxicity

Abstract

We read with great interest the recent report by Reuss et al 1 Reuss C.S. Lester S.J. Hurst R.T. Askew J.W. Nager P. Lusk J. Altemose G.T. Tajik A.J. Isolated left ventricular basal ballooning phenotype of transient cardiomyopathy in young women. Am J Cardiol. 2007; 99: 1451-1453 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar describing 3 young women who presented with transient and isolated basal left ventricular akinesia, normal midventricular wall contractility, and apical hyperkinesia. The first patient had experienced emotional stress, the second presented with an acute flare-up of multiple sclerosis, and the third case involved methamphetamine use. As the investigators pointed out, this entity probably represents a variant of stress-related cardiomyopathy, the physiopathology of which is believed to be mediated by catecholamines. This atypical pattern of contractility has been described in various conditions with high levels of catecholamines, such as pheochromocytoma, acute cerebral disorders, septic shock treated with noradrenaline, delirium tremens, alcoholic pancreatitis, and Guillaume-Barré syndrome in acute respiratory distress. 2 Sanchez-Recalde A. Costero O. Iborra C. Oliver J.M. Ruiz E. Sobrino J.A. Pheochromocytoma-related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation. 2006; 113: e738-e739 Crossref PubMed Scopus (110) Google Scholar , 3 Ennezat P.V. Pesenti-Rossi D. Aubert J.M. Rachenne V. Bauchart J.J. Auffray J.L. Logeart D. Cohen-Solal A. Asseman P. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005; 22: 599-602 Crossref PubMed Scopus (88) Google Scholar , 4 Copetti R. Gonano C. Colombo T. Cattarossi L. “Inverted Takotsubo” pattern. Resuscitation. 2007; 74: 394 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 5 Van de Walle S.O. Gevaert S.A. Gheeraert P.J. De Pauw M. Gillebert T.C. Transient stress-induced cardiomyopathy with an “inverted Takotsubo” contractile pattern. Mayo Clin Proc. 2006; 81: 1499-1502 Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar Reuss et al 1 Reuss C.S. Lester S.J. Hurst R.T. Askew J.W. Nager P. Lusk J. Altemose G.T. Tajik A.J. Isolated left ventricular basal ballooning phenotype of transient cardiomyopathy in young women. Am J Cardiol. 2007; 99: 1451-1453 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar described the first patient with a history of emotional stress after an unexpected death in the family. However, experiencing emotional stress does not exclude having an underlying organic disorder, such as pheochromocytoma. The investigators did not mention the hormonal status of this patient or whether pheochromocytoma was excluded with some diagnostic imaging techniques. This neuroendocrine tumor may present without hypertension or with paroxysmal hypertension. Also, pheochromocytoma can present with anxiety and nervousness, which could be confused with emotional stress, in about 20% to 40% of patients. 6 Ross E.J. Griffith D.N.W. The clinical presentation of pheochromocytoma. Q J Med. 1989; 266: 485-496 Google Scholar