Elsevier

American Heart Journal

Volume 156, Issue 3, September 2008, Pages 543-548
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Prevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndromed

https://doi.org/10.1016/j.ahj.2008.05.002Get rights and content

Background and Objective

Tako-Tsubo syndrome is a clinical entity mimicking acute coronary syndrome (ACS). Left ventricular outflow tract (LVOT) obstruction may occur in Tako-Tsubo syndrome. The aim of this study was to determine the prevalence and features of LVOT obstruction in Tako-Tsubo syndrome in a population presenting with ACS.

Methods

This study included consecutive patients admitted to 2 catheterization laboratories for suspected ACS. All patients underwent echocardiography, coronary arteriography, and left ventricular angiography if no significant coronary lesions were found.

Results

Among 10,366 patients referred for coronary angiography, the study population consisted of 3,909 patients with suspected ACS. Thirty-two patients (mean age 71 ± 13 years old) presented with Tako-Tsubo syndrome, resulting in a prevalence of 0.8% in our population of ACS and 5% of patients without significant coronary lesions. Eight women (mean age 81 ± 4 years old, P = .01) exhibited LVOT obstruction, a prevalence of 25% among Tako-Tsubo syndrome cases. All patients with intraventricular pressure gradient had systolic anterior motion of the mitral valve and septal bulge. Prevalence of septal bulge was 100% in patients with Tako-Tsubo syndrome and LVOT obstruction versus 29% in patients without LVOT obstruction (P = .002). Mean degree of mitral regurgitation was 2.1 ± 0.7 in cases of LVOT obstruction versus 0.9 ± 0.7 in patients without LVOT (P = .0003) and significantly decreased during follow-up (1 ± 0.8, P = .002). Recovery of left ventricular ejection fraction was similar in patients with and without LVOT obstruction (P = .58).

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 LVOT obstruction.

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)

  • SharkeyS.W. et al.

    Acute and reversible cardiomyopathy provoked by stress in women from the United States

    Circulation

    (2005)
  • WittsteinI.S. et al.

    Neurohumoral features of myocardial stunning due to sudden emotional stress

    N Engl J Med

    (2005)
  • Cited by (194)

    • Sepsis-related cardiomyopathy: Not an easy task for ICU physicians

      2022, Journal of Intensive Medicine
      Citation 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 Medicine
    View all citing articles on Scopus
    d

    Drs El Mahmoud and Mansencal contributed equally to this work.

    View full text