Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis

Mayo-Klinik-Diagnosekriterien und Langzeitprognose der Tako-Tsubo-Kardiomyopathie

Abstract

Tako-Tsubo cardiomyopathy (TTC) is a reversible cardiomyopathy with a clinical presentation indistinguishable from myocardial infarction. TTC is estimated to represent 1%–2% of patients presenting with acute myocardial infarction. It most commonly occurs in postmenopausal women and is frequently precipitated by a stressful event. Chest pain and dyspnea are the typical presenting symptoms. Transient ST-segment elevation on ECG and a small rise in cardiac biomarkers are common. Characteristic wall motion abnormalities extend beyond the territory of a single epicardial coronary artery in the absence of obstructive coronary lesions. Supportive treatment leads to spontaneous rapid recovery in nearly all patients. The prognosis is excellent, and recurrence occurs in < 10% of patients. In this article, we review the clinical features of TTC that form the basis of the Mayo Clinic diagnostic criteria, as well as the long-term prognosis for this type of cardiomyopathy.

Zusammenfassung

Die Tako-Tsubo-Kardiomyopathie (TTC) ist eine reversible Kardiomyopathie, deren klinische Symptome jenen des akuten Myokardinfarkts gleichen. Eine TTC liegt schätzungsweise bei 1–2% der Patienten vor, die Symptome eines akuten Myokardinfarkts zeigen. Betroffen sind überwiegend Frauen in der Postmenopause; in vielen Fällen geht ein Stressereignis voraus. Brustschmerzen und Luftnot sind typische Symptome. Zu den häufigen Befunden zählen transiente ST-Streckenhebungen im EKG und gering erhöhte kardiale Marker. Die charakteristischen Wandbewegungsstörungen können nicht dem Versorgungsgebiet einer einzelnen epikardialen Koronararterie zugeordnet werden bei gleichzeitiger Abwesenheit atherosklerotischer Koronarläsionen. Eine supportive Behandlung unterstützt die rasche spontane Genesung fast aller Betroffenen. Die Prognose der TTC ist somit sehr gut; Rezidive kommen in weniger als 10% der Fälle vor. In der vorliegenden Arbeit werden die klinischen Charakteristika der TTC auf der Basis der Diagnosekriterien der Mayo-Klinik vorgestellt und die Langzeitprognose der Erkrankung erörtert.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Bybee KA, Prasad A (2008) Stress-related cardiomyopathy syndromes. Circulation 118:397–409

    PubMed  Article  Google Scholar 

  2. 2.

    Prasad A (2007) Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation 115:e56–e59

    PubMed  Article  Google Scholar 

  3. 3.

    Dote K, Sato H, Tateishi H et al (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 21:203–214

    PubMed  CAS  Google Scholar 

  4. 4.

    Hoyt J, Lerman A, Lennon RJ et al (2009) Left anterior descending artery length and coronary atherosclerosis in apical ballooning syndrome (Takotsubo/stress induced cardiomyopathy). Int J Cardiol, doi 10.1016/iycard2009.06.018

  5. 5.

    Mitchell JH, Hadden TB, Wilson JM et al (2007) Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome). Am J Cardiol 100:296–301

    PubMed  Article  Google Scholar 

  6. 6.

    Seth PS, Aurigemma GP, Krasnow JM et al (2003) A syndrome of transient left ventricular apical wall motion abnormality in the absence of coronary disease: a perspective from the United States. Cardiology 100:61–66

    PubMed  Article  Google Scholar 

  7. 7.

    Sharkey SW, Windenburg DC, Lesser JR et al (n d) Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol 55:333–341

  8. 8.

    Wittstein IS, Thiemann DR, Lima JA et al (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352:539–548

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Desmet WJ, Adriaenssens BF, Dens JA (2003) Apical ballooning of the left ventricle: first series in white patients. Heart 89:1027–1031

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    El Mahmoud R, Mansencal N, Pilliere R et al (2008) Prevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndrome. Am Heart J 156:543–548

    Article  Google Scholar 

  11. 11.

    Haghi D, Fluechter S, Suselbeck T et al (2007) Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy). Int J Cardiol 120:205–211

    PubMed  Article  Google Scholar 

  12. 12.

    Abe Y, Kondo M, Matsuoka R et al (2003) Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol 41:737–742

    PubMed  Article  Google Scholar 

  13. 13.

    Akashi YJ, Musha H, Kida K et al (2005) Reversible ventricular dysfunction takotsubo cardiomyopathy. Eur J Heart Fail 7:1171–1176

    PubMed  Article  Google Scholar 

  14. 14.

    Kurisu S, Sato H, Kawagoe T et al (2002) Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 143:448–455

    PubMed  Article  Google Scholar 

  15. 15.

    Abdulla I, Kay S, Mussap C et al (2006) Apical sparing in tako-tsubo cardiomyopathy. Intern Med J 36:414–418

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Maron BJ, Towbin JA, Thiene G et al (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 113:1807–1816

    PubMed  Article  Google Scholar 

  17. 17.

    Azzarelli S, Galassi AR, Amico F et al (2006) Clinical features of transient left ventricular apical ballooning. Am J Cardiol 98:1273–1276

    PubMed  Article  Google Scholar 

  18. 18.

    Bybee KA, Prasad A, Barsness GW et al (2004) Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 94:343–346

    PubMed  Article  Google Scholar 

  19. 19.

    Elian D, Osherov A, Matetzky S et al (2006) Left ventricular apical ballooning: not an uncommon variant of acute myocardial infarction in women. Clin Cardiol 29:9–12

    PubMed  Article  Google Scholar 

  20. 20.

    Parodi G, Del Pace S, Carrabba N et al (2007) Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol 99:182–185

    PubMed  Article  Google Scholar 

  21. 21.

    Pilliere R, Mansencal N, Digne F et al (2006) Prevalence of tako-tsubo syndrome in a large urban agglomeration. Am J Cardiol 98:662–665

    PubMed  Article  Google Scholar 

  22. 22.

    Elesber AA, Prasad A, Lennon RJ et al (2007) Four-year recurrence rate and prognosis of the apical ballooning syndrome. J Am Coll Cardiol 50:448–452

    PubMed  Article  Google Scholar 

  23. 23.

    Gianni M, Dentali F, Grandi AM et al (2006) Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 27:1523–1529

    PubMed  Article  Google Scholar 

  24. 24.

    Pilgrim TM, Wyss TR (2008) Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol 124:283–292

    PubMed  Article  Google Scholar 

  25. 25.

    Haghi D, Athanasiadis A, Papavassiliu T et al (2006) Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J 27:2433–2439

    PubMed  Article  Google Scholar 

  26. 26.

    Sato M, Fujita S, Saito A et al (2006) Increased incidence of transient left ventricular apical ballooning (so-called ‘Takotsubo’ cardiomyopathy) after the mid-Niigata Prefecture earthquake. Circ J 70:947–953

    PubMed  Article  Google Scholar 

  27. 27.

    Tsuchihashi K, Ueshima K, Uchida T et al (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 38:11–18

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Dib C, Asirvatham S, Elesber A et al (2009) Clinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy). Am Heart J 157:933–938

    PubMed  Article  Google Scholar 

  29. 29.

    Sharkey SW, Lesser JR, Menon M et al (2008) Spectrum and significance of electrocardiographic patterns, troponin levels, and thrombolysis in myocardial infarction frame count in patients with stress (tako-tsubo) cardiomyopathy and comparison to those in patients with ST-elevation anterior wall myocardial infarction. Am J Cardiol 101:1723–1728

    PubMed  Article  Google Scholar 

  30. 30.

    Bybee KA, Motiei A, Syed IS et al (2007) Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction. J Electrocardiol 40:38 e31–e36

    PubMed  Article  Google Scholar 

  31. 31.

    Prasad A, Lerman A, Rihal CS (2008) Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 155:408–417

    PubMed  Article  Google Scholar 

  32. 32.

    Madhavan M, Borlaug BA, Lerman A et al (2009) Stress hormone and circulating biomarker profile of apical ballooning syndrome (Takotsubo cardiomyopathy): insights into the clinical significance of B-type natriuretic peptide and troponin levels. Heart 95:1436–1441

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Akashi YJ, Musha H, Nakazawa K, Miyake F (2004) Plasma brain natriuretic peptide in takotsubo cardiomyopathy. QJM 97:599–607

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Gaibazzi N, Ugo F, Vignali L et al (2009) Tako-Tsubo cardiomyopathy with coronary artery stenosis: a case-series challenging the original definition. Int J Cardiol 133:205–212

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Deetjen AG, Conradi G, Mollmann S et al (2006) Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction. J Cardiovasc Magn Reson 8:367–372

    PubMed  Article  Google Scholar 

  36. 36.

    Sharkey SW, Lesser JR, Zenovich AG et al (2005) Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 111:472–479

    PubMed  Article  Google Scholar 

  37. 37.

    Hahn JY, Gwon HC, Park SW et al (2007) The clinical features of transient left ventricular nonapical ballooning syndrome: comparison with apical ballooning syndrome. Am Heart J 154:1166–1173

    PubMed  Article  Google Scholar 

  38. 38.

    Hurst RT, Askew JW, Reuss CS et al (2006) Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol 48:579–583

    PubMed  Article  Google Scholar 

  39. 39.

    Kurowski V, Kaiser A, Hof K von et al (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 132:809–816

    PubMed  Article  Google Scholar 

  40. 40.

    Elesber AA, Prasad A, Bybee KA et al (2006) Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement. J Am Coll Cardiol 47:1082–1083

    PubMed  Article  Google Scholar 

  41. 41.

    Lee VH, Connolly HM, Fulgham JR et al (2006) Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction. J Neurosurg 105:264–270

    PubMed  Article  Google Scholar 

  42. 42.

    Lee VH, Oh JK, Mulvagh SL, Wijdicks EF (2006) Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage. Neurocrit Care 5:243–249

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A. Prasad MD.

Additional information

Disclosure

The authors declare that they have no financial or personal relations to other parties whose interests could have affected the content of this article in any way, either positively or negatively.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Madhavan, M., Prasad, A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz 35, 240–244 (2010). https://doi.org/10.1007/s00059-010-3339-x

Download citation

Schlüsselwörter

  • Tako-Tsubo Kardiomyopathie
  • Apikale Ballonierung
  • Stress-Kardiomyopathie

Keywords

  • Tako-Tsubo cardiomyopathy
  • Apical ballooning syndrome
  • Stress cardiomyopathy