Clinical features differentiating Takotsubo cardiomyopathy in the peripartum period from peripartum cardiomyopathy

  • Woo-In Yang
  • Jae Youn MoonEmail author
  • Minjung Shim
  • Pil-Sung Yang
  • Se Hun Kang
  • Sang-Hoon Kim
  • Won-Jang Kim
  • Jung-Hoon Sung
  • In Jai Kim
  • Sang-Wook Lim
  • Dong-Hun Cha
  • Jong-Won Ha
Original Article


There are some similarities in clinical features between Takotsubo cardiomyopathy during the peripartum period (PTCM) and peripartum cardiomyopathy (PPCM). Both conditions present as acute heart failure and decreased left ventricular (LV) ejection fraction in the peripartum period in previously heart-healthy women. The present study aimed to evaluate the differences in clinical features and outcomes between PTCM and PPCM. Between January 2004 and December 2016, 37 consecutive patients who demonstrated LV dysfunction during the peripartum period without previous heart disease were recruited retrospectively. The clinical, laboratory, and echocardiographic data of these patients were comprehensively reviewed. Twenty-one (57%) and 16 (43%) patients were classified into PPCM and PTCM groups, respectively, based on echocardiographic findings. The initial LV ejection fraction did not differ significantly between the 2 groups. However, all patients with PTCM showed complete recovery of LV ejection fraction at the 1-month follow-up. However, among 20 patients with PPCM who underwent 1-month echocardiography, only 6 (30%) showed complete recovery of LV ejection fraction at the 1-month follow-up. At the 12-month follow-up, only 10 patients showed complete recovery of LV ejection fraction. The incidence of PTCM was much higher than expected. Although LV dysfunction was similar at the initial diagnosis, the prognosis of LV recovery was more favorable in PTCM than in PPCM. Therefore, physicians should differentiate these two diseases entities, although they have several similarities in acute LV dysfunction.


Peripartum cardiomyopathy Stress-induced cardiomyopathy Takotsubo cardiomyopathy 



This study was supported by a grant from Alvogen Korea (Grand No. 1111).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Demakis JG, Rahimtoola SH (1971) Peripartum cardiomyopathy. Circulation 44(5):964–968CrossRefGoogle Scholar
  2. 2.
    Demakis JG, Rahimtoola SH, Sutton GC, Meadows WR, Szanto PB, Tobin JR, Gunnar RM (1971) Natural course of peripartum cardiomyopathy. Circulation 44(6):1053–1061CrossRefGoogle Scholar
  3. 3.
    Asad ZUA, Maiwand M, Farah F, Dasari TW (2018) Peripartum cardiomyopathy: a systematic review of the literature. Clin Cardiol 41(5):693–697CrossRefGoogle Scholar
  4. 4.
    Sliwa K, Mebazaa A, Hilfiker Kleiner D, Petrie MC, Maggioni AP, Laroche C, Regitz Zagrosek V, Schaufelberger M, Tavazzi L, van der Meer P, Roos Hesselink JW, Seferovic P, van Spandonck-Zwarts K, Mbakwem A, Böhm M, Mouquet F, Pieske B, Hall R, Ponikowski P, Bauersachs J (2017) Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail 19(9):1131–1141CrossRefGoogle Scholar
  5. 5.
    Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ, Ruschitzka F, Filippatos G, Mebazaa A, Omerovic E (2016) Current state of knowledge on Takotsubo syndrome: a position statement from the taskforce on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 18(1):8–27CrossRefGoogle Scholar
  6. 6.
    Pelliccia F, Kaski JC, Crea F, Camici PG (2017) Pathophysiology of Takotsubo Syndrome. Circulation 135(24):2426–2441CrossRefGoogle Scholar
  7. 7.
    Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL (2012) Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J 164(1):66–71.e61CrossRefGoogle Scholar
  8. 8.
    Pilgrim TM, Wyss TR (2008) Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol 124(3):283–292CrossRefGoogle Scholar
  9. 9.
    Ruiz S, Martinez Marin M, Luque P, Nassar N, Oros D (2017) Takotsubo cardiomyopathy after cesarean section: a case report and literature review. J Obstet Gynaecol Res 43(2):392–396CrossRefGoogle Scholar
  10. 10.
    Minatoguchi M, Itakura A, Takagi E, Nishibayashi M, Kikuchi M, Ishihara O (2014) Takotsubo cardiomyopathy after cesarean: a case report and published work review of pregnancy-related cases. J Obstet Gynaecol Res 40(6):1534–1539CrossRefGoogle Scholar
  11. 11.
    Citro R, Giudice R, Mirra M, Petta R, Baldi C, Bossone E, Piscione F (2013) Is Tako-tsubo syndrome in the postpartum period a clinical entity different from peripartum cardiomyopathy? J Cardiovasc Med 14(8):568–575CrossRefGoogle Scholar
  12. 12.
    Arany Z, Elkayam U (2016) Peripartum cardiomyopathy. Circulation 133(14):1397–1409CrossRefGoogle Scholar
  13. 13.
    Rickham PP (1964) Human experimentation. Code of ethics of the World Medical Association. Declaration of Helsinki. Br Med J 2(5402):177CrossRefGoogle Scholar
  14. 14.
    Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kühl U, Maisch B, McKenna WJ, Monserrat L, Pankuweit S, Rapezzi C, Seferovic P, Tavazzi L, Keren A (2008) Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 29(2):270–276CrossRefGoogle Scholar
  15. 15.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463CrossRefGoogle Scholar
  16. 16.
    Yang W, Park S, Youn J, Son NH, Lee S, Kang S, Jang Y (2011) Augmentation index association with reactive hyperemia as assessed by peripheral arterial tonometry in hypertension. Am J Hypertens 24(11):1234–1238CrossRefGoogle Scholar
  17. 17.
    Yang W, Shim C, Cho I, Chang H, Choi D, Jang Y, Chung N, Cho S, Ha J (2010) Dyssynchronous systolic expansion of carotid artery in patients with marfan syndrome. J Am Soc Echocardiogr 23(12):1310–1316CrossRefGoogle Scholar
  18. 18.
    Tsuchihashi K, Ueshima K, Uchida T, Ohmura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I (2001) Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol 38(1):11–18CrossRefGoogle Scholar
  19. 19.
    Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB (2006) Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 113(14):1807–1816CrossRefGoogle Scholar
  20. 20.
    Muller O, Roguelov C, Pascale P (2007) A basal variant form of the transient ‘midventricular’ and ‘apical’ ballooning syndrome. QJM 100(11):738–739CrossRefGoogle Scholar
  21. 21.
    Ueyama T, Ishikura F, Matsuda A, Asanuma T, Ueda K, Ichinose M, Kasamatsu K, Hano T, Akasaka T, Tsuruo Y, Morimoto K, Beppu S (2007) Chronic estrogen supplementation following ovariectomy improves the emotional stress-induced cardiovascular responses by indirect action on the nervous system and by direct action on the heart. Circ J 71(4):565–573CrossRefGoogle Scholar
  22. 22.
    Mendelsohn ME, Karas RH (1999) The protective effects of estrogen on the cardiovascular system. N Engl J Med 340(23):1801–1811CrossRefGoogle Scholar
  23. 23.
    Vitale C, Mendelsohn ME, Rosano GM (2009) Gender differences in the cardiovascular effect of sex hormones. Nat Rev Cardiol 6(8):532–542CrossRefGoogle Scholar
  24. 24.
    Abraham J, Mudd JO, Kapur NK, Klein K, Champion HC, Wittstein IS (2009) Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol 53(15):1320–1325CrossRefGoogle Scholar
  25. 25.
    Litvinov IV, Kotowycz MA, Wassmann S (2009) Iatrogenic epinephrine-induced reverse Takotsubo cardiomyopathy: direct evidence supporting the role of catecholamines in the pathophysiology of the “broken heart syndrome”. Clin Res Cardiol 98(7):457–462CrossRefGoogle Scholar
  26. 26.
    Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 132(3):809–816CrossRefGoogle Scholar
  27. 27.
    Mansencal N, Abbou N, N’Guetta R, Pillière R, El Mahmoud R, Dubourg O (2010) Apical-sparing variant of Tako-Tsubo cardiomyopathy: prevalence and characteristics. Arch Cardiovasc Dis 103(2):75–79CrossRefGoogle Scholar
  28. 28.
    Stiermaier T, Möller C, Graf T, Eitel C, Desch S, Thiele H, Eitel I (2016) Prognostic usefulness of the ballooning pattern in patients with Takotsubo cardiomyopathy. Am J Cardiol 118(11):1737–1741CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Woo-In Yang
    • 1
  • Jae Youn Moon
    • 1
    Email author
  • Minjung Shim
    • 1
  • Pil-Sung Yang
    • 1
  • Se Hun Kang
    • 1
  • Sang-Hoon Kim
    • 1
  • Won-Jang Kim
    • 1
  • Jung-Hoon Sung
    • 1
  • In Jai Kim
    • 1
  • Sang-Wook Lim
    • 1
  • Dong-Hun Cha
    • 1
  • Jong-Won Ha
    • 2
    • 3
  1. 1.Department of Cardiology, CHA Bundang Medical CenterCHA University School of MedicineSeongnamRepublic of Korea
  2. 2.Cardiology Division, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulRepublic of Korea

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