Introduction Takotsubo Cardiomyopathy (TCM) was first described in Japan and has been studied in a number of Western countries, although little in the UK. There is an increasing recognition that TCM can co-exist with coronary artery disease (CAD), although it is not understood how the two conditions might interact. We describe the prevalence and presenting features in a British population, and investigate its relationship to CAD.
Methods We identified patients with TCM who underwent coronary angiography at the Royal Cornwall Hospital by analysing our database of angiogram reports from 01/01/2010 to 01/11/2013, using the search terms “takot-”, “stress car-” and “apical bal-”. The paper and electronic records of these patients were examined.
Results 37 reports matched our search criteria. Of these, 4 were given other diagnoses, leaving 33 which met the revised Mayo Clinic diagnostic criteria for TCM. 88% of patients were female, all were of white British origin, and the median age was 66 years (inter-quartile range: 11 years). The main presenting symptom was chest pain (69.7%), while 9.1% presented with breathlessness only. Other presenting symptoms were palpitations, syncope and vomiting. 61% of patients had documented stressful precipitating events: 25% were related to bereavement, 25% to general psychological stress, and 15% to a physical stressor. ECG changes included 49% with ST elevation, 27% with T-wave inversion only, 3% with new LBBB, 3% with ventricular ectopics, and 15% with no ECG changes. Mean peak troponin was 470.1 ng/L [normal range <14 ng/L]. At angiogram, 53% had no evidence of CAD, 38% had mild to moderate disease, and 6% had severe disease (but no flow-limiting lesions). During this period, 2728 patients were admitted for troponin-positive acute coronary syndrome (ACS), giving a prevalence of 1.2% of TCM among these patients, and 3.3% among females.
36% suffered acute complications: 27% had acute pulmonary oedema, 3% suffered non-sustained VT, 6% new AF, and 6% (2 patients) experienced VF arrest after presentation, both of whom survived. 27% of the 18 patients with CAD on angiogram suffered complications, while 44% of those with no evidence of CAD suffered complications.
Conclusions In the largest TCM case series from the UK to date, we found a prevalence of 1.2% of TCM among patients presenting with troponin-positive ACS, matching that of other European studies, and higher than previous UK studies. Although many patients experienced a precipitating stressful event, a large minority (39%) did not, which has implications for the condition’s alternative name: “stress cardiomyopathy”. The rate of acute pulmonary oedema, arrhythmias and cardiac arrest was high, though prognosis was good. The co-prevalence of CAD was also high, as would be expected in patients of this age group, but patients with CAD did not have a higher rate of complications than those with no CAD.
- Apical Ballooning
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