Review
Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review

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Abstract

Background

Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction characterized by transient wall-motion abnormalities involving apical and mid-portions of the left ventricle in the absence of significant obstructive coronary disease.

Methods

Searching the MEDLINE database 28 case series met the eligibility criteria and were summarized in a narrative synthesis of the demographic characteristics, clinical features and pathophysiological mechanisms.

Results

TLVABS is observed in 0.7–2.5% of patients with suspected ACS, affects women in 90.7% (95% CI: 88.2–93.2%) with a mean age ranging from 62 to 76 years and most commonly presents with chest pain (83.4%, 95% CI: 80.0–86.7%) and dyspnea (20.4%, 95% CI: 16.3–24.5%) following an emotionally or physically stressful event. ECG on admission shows ST-segment elevations in 71.1% (95% CI: 67.2–75.1%) and is accompanied by usually mild elevations of Troponins in 85.0% (95% CI: 80.8–89.1%). Despite dramatic clinical presentation and substantial risk of heart failure, cardiogenic shock and arrhythmias, LVEF improved from 20–49.9% to 59–76% within a mean time of 7–37 days with an in-hospital mortality rate of 1.7% (95% CI: 0.5–2.8%), complete recovery in 95.9% (95% CI: 93.8–98.1%) and rare recurrence. The underlying etiology is thought to be based on an exaggerated sympathetic stimulation.

Conclusion

TLVABS is a considerable differential diagnosis in ACS, especially in postmenopausal women with a preceding stressful event. Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS.

Section snippets

Background

Transient left ventricular apical ballooning syndrome (TLVABS) or takotsubo cardiomyopathy is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction that is characterized by transient wall-motion abnormalities extending beyond a single coronary distribution and involving apical and mid-portions of the left ventricle resembling the shape of a traditional Japanese octopus trap in the absence of significant obstructive coronary disease. It is typically observed in

Literature search

We reviewed published case series searching the MEDLINE database (through January 2007) as well as references from the reviewed full-length articles with no language restrictions that met the criteria depicted in Table 1. The following search terms were used: transient left ventricular apical ballooning syndrome, takotsubo cardiomyopathy, stress-induced cardiomyopathy, broken heart syndrome and ampulla cardiomyopathy. In case of more than one publication from the same Medical Center or the same

Results

The 28 case series that met the inclusion criteria for this systematic review comprised a total of 563 patients. 11 studies from Asia [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28] contributed 249 patients (44.2%), 14 studies from Europe [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42] 231 patients (41.0%), and 3 studies from North America [43], [44], [45] 83 patients (14.7%). Twelve studies were performed prospectively [20], [23], [25], [27],

Discussion

TLVABS is predominantly observed in postmenopausal women subsequent to a stressful event. Dramatic clinical presentation with substantial risk of complications in the acute setting is contrasting with complete recovery of the left ventricular function and favorable outcome in the majority of patients. Similar wall-motion dysfunctions extending beyond a single coronary distribution in the absence of obstructive coronary artery disease have also been demonstrated in patients with subarachnoid

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