Ventriculography for the study of TAKO-TSUBO Syndrome

Abstract

Tako-Tsubo Cardiomyopathy (TTC) is an acute syndrome, identified in the early 1990s by Japanese researchers, which mimics an acute myocardial infarction. Cardiomyopathy is transient and begins with a clinical picture similar to that of an acute myocardial infarction. This pathology seems to be related to intense psychological and physical stress with a prevalence in the female sex (95%) in post-menopause. The term Tako-Tsubo means ‘octopus trap’ in Japanese: the left ventricle takes on a peculiar appearance in systole, similar to a narrow-necked amphora, morphologically identical to the vessel (tsubo) that Japanese fishermen use to catch octopuses (tako). The appearance of the left ventricle (tako-tsubo shape) is due to a ‘complete’ depletion of cardiac muscle activity (myocardial stunning), a kind of ‘stunning’ or paralysis of the middle and apical portions of the heart. Coronarography and ventriculography are an essential step in the diagnosis of TTC. The mere demonstration of a coronary tree free of angiographically significant stenosis is not sufficient for the diagnosis of TTC. The other key diagnostic element is, in fact, the demonstration of left ventricular hypokinesia or akinesia. Since left ventricular wall motility disorders change rapidly, ventriculography performed immediately after coronary examination is the gold standard examination to allow the characteristic appearance of the syndrome to be verified and, consequently, to distinguish it from an acute coronary syndrome with uninjured coronary arteries, thus avoiding a diagnostic error.