Clinical InvestigationCongestive Heart FailurePrevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndromed
Section snippets
Methods
Over a 6-year period (January 2000-September 2006), we reviewed from our databases all patients (N = 10,366) referred to 2 catheterization laboratories for coronary angiography. Data concerning the prevalence of Tako-Tsubo syndrome has been previously published.2 According to the clinical data, electrocardiogram, and biological markers, we thus individualized patients with suspected ACS, representing the study population (n = 3,909) (Figure 1). Criteria for selection included patients aged >18
Population characteristics
Among the 3,909 patients with suspected ACS (Figure 1), 2,755 (70%) underwent percutaneous coronary interventions, 111 (3%) were referred for coronary artery bypass graft surgery, and 1,043 (27%) had a medical treatment. Coronary angiography revealed the following distribution: 37% with single-vessel disease (1,456 patients), 24% with 2-vessel disease (956 patients), and 22% with 3-vessel disease (870 patients).
Tako-Tsubo syndrome
Thirty-two patients with a mean age of 71 ± 13 years (range 35-90 years) presented
Discussion
Left ventricular outflow tract obstruction may occur in Tako-Tsubo syndrome.6, 7, 8, 9 At the time of this study, its prevalence was uncertain because of a scarcity of data.5, 10, 17 In the present report, LVOT obstruction was detected in 25% of patients with Tako-Tsubo syndrome and we found that the characteristics of this population are different. Patients were older and all presented septal hypertrophy associated with systolic anterior motion of the mitral valve.
Tako-Tsubo syndrome is most
Conclusions
The present study demonstrates that the prevalence of LVOT obstruction in Tako-Tsubo syndrome is high, with specific characteristics as compared with patients without LVOT obstruction. Echocardiography should be systematically performed for all patients presenting with Tako-Tsubo syndrome for the detection of a dynamic intraventricular pressure gradient.
References (25)
- et al.
Prevalence of tako-tsubo syndrome in a large urban agglomeration
Am J Cardiol
(2006) - et al.
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
(2001) - et al.
Dynamic left ventricular outflow tract obstruction in acute coronary syndromes: an important cause of new systolic murmur and cardiogenic shock
Mayo Clin Proc
(1999) - et al.
Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction
Am Heart J
(2008) - et al.
ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J Am Coll Cardiol
(2006) - et al.
Transient midventricular ballooning syndrome: a new variant
J Am Coll Cardiol
(2006) - et al.
Assessment of clinical features in transient left ventricular apical ballooning
J Am Coll Cardiol
(2003) - et al.
Tako-tsubo–like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction
Am Heart J
(2002) - et al.
Anteroapical stunning and left ventricular outflow tract obstruction
Mayo Clin Proc
(2001) - et al.
Classification of the cardiomyopathies: a position statement from the European society of cardiology working group on myocardial and pericardial diseases
Eur Heart J
(2008)
Acute and reversible cardiomyopathy provoked by stress in women from the United States
Circulation
Neurohumoral features of myocardial stunning due to sudden emotional stress
N Engl J Med
Cited by (194)
Longitudinal Strain Patterns in Stress (Takotsubo) Cardiomyopathy: Evidence of Global Myocardial Injury and Incomplete Recovery
2024, American Journal of CardiologyPrognostic utility of the pericoronary fat attenuation index in patients with takotsubo cardiomyopathy
2023, Journal of Cardiovascular Computed TomographyThe impact of ST-segment elevation on the prognosis of patients with Takotsubo cardiomyopathy
2022, Journal of ElectrocardiologySepsis-related cardiomyopathy: Not an easy task for ICU physicians
2022, Journal of Intensive MedicineCitation Excerpt :Routine echocardiography may help physicians to identify patients with ST. In this context, a normal or hypercontractile LV basal segment can lead to LV outflow tract obstruction (LVOTO) in takotsubo patients. El Mahmoud et al.[35] reported that LVOTO occurs in 25% of all patients with takotsubo cardiomyopathy. Patients with takotsubo cardiomyopathy who are in a state of shock can usually be categorized into two types depending on the presence of LVOTO.
Kounis syndrome and anaphylaxis
2022, American Journal of Emergency MedicineEpidemiology, Pathogenesis, and Clinical Course of Takotsubo Syndrome
2022, Heart Failure Clinics
- d
Drs El Mahmoud and Mansencal contributed equally to this work.