Skip to main content
SpringerLink
Log in

“Ballooning” patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Whether different patterns of ventricular ballooning in takotsubo cardiomyopathy (TCM) reflect differences in trigger mechanisms or clinical outcomes is unclear. Here we examined differences in the clinical characteristics of typical and atypical forms of TCM. TCM patients (n = 251) in the BOREAS Registry were enrolled for comparison of TCM with apical ballooning (type A, n = 217) and TCM with non-apical ballooning (type non-A, n = 34). The percentage of females was significantly lower in the type non-A group (58.8 vs. 75.6 %), while other demographic parameters and triggers of TCM were similar in the two groups. Rate of mid-ventricular obstruction (MVO) was lower (2.9 vs. 14.3 %) in the type non-A group than in the type A group, though left ventricular ejection fractions in the two groups were comparable. During a follow-up period of 2.6 ± 2.8 years, TCM recurred in 2.9 % of the patients and cardiac death occurred in 4.0 %. Cox proportional hazard analysis indicated that body mass index (hazard ratio [HR]: 0.75, 95 % confidence interval [CI] 0.54–0.99) and MVO (HR: 14.71, CI 1.87–304.66) were determinants of TCM recurrence and that advanced age (HR: 1.09, CI 1.02–1.17) and cardiogenic shock (HR: 4.27, CI 1.07–18.93) were significantly associated with cardiac death. In conclusion, approximately 20 % of TCM patients show non-apical left ventricular ballooning, and female sex and MVO are less frequent in this type than in apical ballooning type TCM. Low body mass index and MVO are risk factors of recurrence, and advanced age and cardiogenic shock are risk factors of cardiac death in TCM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tsuchihashi K, Ueshima U, Uchida T, Oh-mura 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. J Am Coll Cardiol 38:11–18

    Article  CAS  PubMed  Google Scholar 

  2. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008) Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 118:2754–2762

    Article  PubMed  Google Scholar 

  3. Dote K, Sato H, Takeishi H, Uchida T, Ishihara M (1991) Myocardial stunning due to simultaneous multivessel spasms: a review of five cases. J Cardiol 21:203–214

    CAS  PubMed  Google Scholar 

  4. Hurst RT, Askew JW, Reuss CS, Lee RW, Sweeney JP, Fortuin FD, Oh JK, Tajik AJ (2006) Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol 48:579–583

    Article  PubMed  Google Scholar 

  5. Bonnemeier H, Schafer U, Schunkert H (2006) Apical ballooning without apical ballooning. Eur Heart J 27:2246

    Article  PubMed  Google Scholar 

  6. 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). Chest 132:809–816

    Article  PubMed  Google Scholar 

  7. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG (2011) Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy. JAMA 306:277–286

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS (2004) Systemic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 141:858–865

    Article  PubMed  Google Scholar 

  10. Omerovic E (2011) How to think about stress-induced cardiomyopathy?—think “out of the box’’! Scand Cardiovasc J 45:67–71

    Article  PubMed  Google Scholar 

  11. Cacciotti L, Passaseo I, Marazzi G, Camastra G, Campolongo G, Beni S, Lupparelli F, Ansalone G (2012) Observational study on takotsubo-like cardiomyopathy: clinical features, diagnosis, prognosis and follow-up. BMJ Open 2:e00165

    Article  Google Scholar 

  12. Spes C, Knape A, Mudra H (2006) Recurrent tako-tsubo-like left ventricular dysfunction (apical ballooning) in a patient with pheochromocytoma—a case report. Clin Res Cardiol 95:307–311

    Article  CAS  PubMed  Google Scholar 

  13. Otsuka M, Kohno K, Itoh A (2006) Periodic fluctuation of blood pressure and transient left ventricular apical ballooning in pheochromocytoma. Heart 92:1837

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Park JH, Kim JY, Sul JY, Shin SK, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW (2011) Prevalence and patterns of left ventricular dysfunction in patients with pheochromocytoma. J Cardiovasc Ultrasound 19:76–82

    Article  PubMed Central  PubMed  Google Scholar 

  15. Yoshioka T, Hashimoto A, Tsuchihashi K, Nagao K, Kyuma M, Ooiwa H, Nozawa A, Shimoshige S, Eguchi M, Wakabayashi T, Yuda S, Hase M, Nakata T, Shimamoto K (2008) Clinical implications of midventricular obstruction and intravenous propranolol use in transient left ventricular apical ballooning (Tako-tsubo cardiomyopathy). Am Heart J 155:526.e1–526.e17. doi:10.1016/j.ahj.2007.10.042

    Article  Google Scholar 

  16. Iio K, Sakurai S, Kato T, Nishiyama S, Hata T, Mawatari E, Suzuki C, Takekoshi K, Higuchi K, Aizawa T, Ikeda U (2013) Endomyocardial biopsy in a patient with hemorrhagic pheochromocytoma presenting as inverted Takotsubo cardiomyopathy. Heart Vessels 28:255–263

    Article  PubMed  Google Scholar 

  17. Murakami T, Yoshikawa T, Maekawa Y, Ueda T, Isogai T, Konishi Y, Sakata K, Nagao K, Yamamoto T, Takayama M, CCU Network Scientific Committee (2014) Characterization of predictors of in-hospital cardiac complications of takotsubo cardiomyopathy: multi-center registry from Tokyo CCU Network. J Cardiol 63:269–273

    Article  PubMed  Google Scholar 

  18. Ghadri JR, Ruschitzka F, Lüscher TF, Templin C (2014) Takotsubo cardiomyopathy: still much more to learn. Heart [Epub ahead of print]. doi:10.1136/heartjnl-2013-304691

  19. Pirzer R, Elmas E, Haghi D, Lippert C, Kralev S, Lang S, Borggrefe M, Kälsch T (2012) Platelet and monocyte activity markers and mediators of inflammation in Takotsubo cardiomyopathy. Heart Vessels 27:186–192

    Article  PubMed  Google Scholar 

  20. Vidi V, Rajesh V, Singh PP, Mukherjee JT, Lago RM, Venesy DM, Waxman S, Pyne CT, Piemonte TC, Gossman DE, Nesto RW (2009) Clinical characteristics of tako-tsubo cardiomyopathy. Am J Cardiol 104:578–582

    Article  PubMed  Google Scholar 

  21. Previtali M, Repetto A, Camporotondo R, Citro R, Faggiano P, Bovelli D, Baldini E, Pasquetto G, Ascione L, Vignali L, Rosso R, Baralis G, Rossi ML, Ferlini M, Bossone E, Panciroli C, Rovere FD, Visconti LO, Klersy C (2011) Clinical characteristics and outcome of left ventricular ballooning syndrome in a European population. Am J Cardiol 107:120–125

    Article  PubMed  Google Scholar 

  22. Parodi G, Bellandi B, Del Pace S, Barchielli A, Zampini L, Velluzzi S, Carrabba N, Gensini GF, Antoniucci D (2011) Natural history of tako-tsubo cardiomyopathy. Chest 139:887–892

    Article  PubMed  Google Scholar 

  23. Ramaraj R, Movahed MR (2010) Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congest Heart Fail 16:284–286

    Article  PubMed  Google Scholar 

  24. Song BG, Chun WJ, Park YH, Kang GH, Oh J, Lee SC, Park SW, Oh JK (2011) The clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings of reverse or inverted takotsubo cardiomyopathy: comparison with mid or apical variant. Clin Cardiol 34:693–699

    Article  CAS  PubMed  Google Scholar 

  25. Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ (2010) Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol 55:333–341

    Article  PubMed  Google Scholar 

  26. Carroll D, Phillips AC, Der G (2008) Body mass index, abdominal adiposity, obesity, and cardiovascular reactions to psychological stress in a large community sample. Psychosom Med 70:653–660

    Article  PubMed  Google Scholar 

  27. Phillips AC, Roseboom TJ, Carroll D, de Rooij SR (2012) Cardiovascular and cortisol reactions to acute psychological stress and adiposity: cross-sectional and prospective associations in the Dutch Famine Birth Cohort Study. Psychosom Med 74:699–710

    Article  PubMed  Google Scholar 

  28. Kyuma M, Tsuchihashi K, Shinshi Y, Hase M, Nakata T, Ooiwa H, Abiru M, Hikita N, Adachi T, Shoji T, Fujise Y, Shimamoto K (2002) Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): three cases. Circ J 66:1181–1184

    Article  PubMed  Google Scholar 

  29. Brinjikji W, El-Sayed AM, Salka S (2012) In-hospital mortality among patients with takotsubo cardiomyopathy: a study of the National Inpatient Sample 2008 to 2009. Am Heart J 164:215–221

    Article  PubMed  Google Scholar 

  30. Wiswell JG, Crago RM (1969) Reversible cardiomyopathy with pheochromocytoma. Trans Am Clin Climatol Assoc 80:185–195

    PubMed Central  CAS  PubMed  Google Scholar 

  31. Sanchez-Recalde A, Costero O, Oliver JM, Iborra C, Ruiz E, Sobrino JA (2006) Pheochromocytoma-related cardiomyopathy: inverted takotsubo contractile pattern. Circulation 113:e738–e739

    Article  PubMed  Google Scholar 

  32. Kim S, Yu A, Filippone LA, Kolansky DM, Raina A (2010) Inverted-takotsubo pattern cardiomyaopathy secondary to pheochromocytoma: a clinical case and literature review. Clin Cardiol 33:200–205

    Article  PubMed  Google Scholar 

  33. Wittstein IS, Thiemann DR, Lima J, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352:539–548

    Article  CAS  PubMed  Google Scholar 

  34. Nef HM, Möllmann H, Kostin S, Troidl C, Voss S, Weber M, Dill T, Rolf A, Brandt R, Hamm CW, Elsässer A (2007) Tako-tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J 28:2456–2464

    Article  PubMed  Google Scholar 

  35. Frustaci A, Loperfido F, Gentiloni N, Caldarulo M, Morgante E, Russo MA (1991) Catecholamine-induced cardiomyopathy in multiple endocrine neoplasia. A histologic, ultrastructural, and biochemical study. Chest 99:382–385

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Sapporo Medical University Education and Research Grants. There is no relationship with industry and no conflict of interest in this study.

BOREAS-TCM investigators Junichi Nishida, Hidemichi Kouzu, Kazufumi Tsuchihashi, Takefumi Fujito, Mina Kawamukai, Atsushi Mochizuki, Atsuko Muranaka, Nobuaki Kokubu, Shinya Shimoshige, Satoshi Yuda, Mamoru Hase, Akiyoshi Hashimoto, Tetsuji Miura, Sapporo Medical University; Naoko Kobayashi, Gorinbashi Hospital; Hiroyuki Kita, Takayuki Fukuma, Satoshi Genda, Hakodate Goryoukaku Hospital; Daisuke Hotta, Hokkaido Cardiovascular Hospital; Atsushi Doi, Japanese Red Cross Asahikawa Hospital; Shuzaburo Fukuyama, Jikeikai Hospital; Hitomi Suzuki, Kin-ikyo Chuo Hospital; Norie Tanaka, Kushiro Koujinkai Memorial Hospital; Kimio Nishizato, Takuto Maeda, Muroran City General Hospital; Manabu Hayashi, Daigo Nagahara, Yasuyuki Shinshi, Yoshiaki Terashima, Obihiro Kosei General Hospital; Row Ishimoto, Jun Agata, Kazuyuki Naitoh, Yutaka Yokoyama, Obihiro Kyokai Hospital; Nobuhiro Yoshioka, Sapporo Cardiovascular Hospital; Noriyuki Fujii, Sapporo Social Insurance General Hospital; Takuji Yoshioka, Teine Keijinkai Hospital; Michifumi Kyuma, Tenshi Hospital.

Author information

Authors and Affiliations

  1. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan

    Junichi Nishida, Hidemichi Kouzu, Akiyoshi Hashimoto, Takefumi Fujito, Mina Kawamukai, Atsushi Mochizuki, Atsuko Muranaka, Nobuaki Kokubu, Shinya Shimoshige & Tetsuji Miura

  2. Department of Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan

    Satoshi Yuda

  3. Department of Emergency Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan

    Mamoru Hase

  4. Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan

    Kazufumi Tsuchihashi

Authors
  1. Junichi Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidemichi Kouzu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akiyoshi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takefumi Fujito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mina Kawamukai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsushi Mochizuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Atsuko Muranaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nobuaki Kokubu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shinya Shimoshige
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Satoshi Yuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mamoru Hase
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kazufumi Tsuchihashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tetsuji Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tetsuji Miura.

Additional information

On behalf of BOREAS-TCM investigators.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishida, J., Kouzu, H., Hashimoto, A. et al. “Ballooning” patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study. Heart Vessels 30, 789–797 (2015). https://doi.org/10.1007/s00380-014-0548-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-014-0548-x

Keywords

Search

Navigation