Abstract
Background
Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction that predominantly affects older women and has three main variants: apical, mid-ventricular, and basal. The recurrence rate of TTC is roughly around 11 % at 4-year follow-up. The pathogenesis of TTC is not clear and various theories have been proposed without concrete evidence.
Case series
We present a case series of 3 patients with recurrent TTC involving a different region of the ventricle during recurrence. All the patients presented with acute coronary syndrome (ACS) during the initial and recurrent episode. At the initial presentation, all the patients underwent selective coronary angiography (CA), transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR) evaluation. However, the recurrent episodes were diagnosed without the need of CA, except in 1 patient who presented with ST-segment elevation myocardial infarction.
Conclusion
Recurrence of TTC is common and can be diagnosed without CA in some cases. During recurrence, the regional involvement of the left ventricle can vary in the same person. Variable regional involvement in the same patient rules out some of the proposed theories on the pathogenesis such as: beta-receptor gradient, wrap-around left anterior descending, and coronary artery spasm.
Zusammenfassung
Hintergrund
Bei der Takotsubo-Kardiomyopathie (TTC) handelt es sich um eine transiente linksventrikuläre Funktionsstörung, die überwiegend ältere Frauen betrifft und 3 Hauptvarianten aufweist: die apikale, mittventrikuläre und basale Form. Die Rezidivrate der TTC liegt bei einer 4-Jahres-Nachbeobachtung grob um 11 %. Die Pathogenese der TTC ist nicht klar, es bestehen verschiedene Theorien ohne konkrete Belege.
Fallserie
Es wird hier eine Fallserie von 3 Patienten mit rezidivierender TTC und Beteiligung einer anderen Region beim Rezidiv vorgestellt. Bei allen Patienten lag während der Index- und der Rezidivepisode das Bild eines akuten Koronarsyndroms vor. Im Rahmen der Indexerkrankung wurden bei allen Patienten eine selektive Koronarangiographie, eine transthorakale Echokardiographie und eine kardiale MRT-Untersuchung durchgeführt. Die Rezidivepisoden wurden jedoch ohne die Notwendigkeit einer Koronarangiographie außer bei einem Patienten mit ST-Hebungs-Infarkt diagnostiziert.
Schlussfolgerung
Ein Rezidiv einer TTC ist häufig und kann in einigen Fällen ohne Koronarangiographie diagnostiziert werden. Während des Rezidivs kann die regionale Beteiligung des linken Ventrikels bei derselben Person variieren. Die Beteiligung variabler Regionen bei demselben Patienten schließt einige der vorgeschlagenen Theorien zur Pathogenese aus, z. B.: ein Betarezeptorgradient, eine Umhüllung um den Ramus interventricularis anterior der A. coronaria sinistra und ein Koronararterienspasmus.
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On behalf of all authors, the corresponding author states that there are no conflicts of interest.
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Additional material onlineThis article includes three additional Videos. You will find this supplemental at dx.doi.org/10.1007/s00059-013-3896-x.
Electronic supplementary material
Video 1: Cardiac magnetic resonance imaging (CMR) of first patient revealing hypokinetic base and hyperkinetic apex of the left ventricle. (AVI 0,8MB)
Video 2: Transthoracic echocardiogram of second patient showing the presenhce of Takotsubo cardiomyopathy. (AVI 4,7 MB)
59_2013_3896_MO3_ESM.avi
Video 3: Contrast left ventriculogram of the third patient during recurrence showing the presence of mid left ventricle wall hypokinesis during systole. (AVI 3,2MB)
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Singh, K., Parsaik, A. & Singh, B. Recurrent takotsubo cardiomyopathy. Herz 39, 963–967 (2014). https://doi.org/10.1007/s00059-013-3896-x
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DOI: https://doi.org/10.1007/s00059-013-3896-x