© 2005 European Society of Cardiology
Reversible ventricular dysfunction takotsubo cardiomyopathy
a Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine 2-16-1 Sugao Miyamae-district, Kawasaki-city, Kanagawa-prefecture 216-8511, Japan
b St. Marianna University Yokohama-city Seibu Hospital 1197-1 Yasashi-cho, Asahi-district Yokohama-city, Kanagawa-prefecture 241-0811, Japan
* Corresponding author. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-district, Kawasaki-city, Kanagawa-prefecture 216-8511, Japan. Tel.: +81 44 977 8111; fax: +81 44 976 7093. E-mail address: Johnny{at}marianna-u.ac.jp
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Abstract |
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Background: Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a takotsubo-shaped, dyskinetic left ventricle on left ventriculography.
Aim: To determine the detailed clinical features of takotsubo cardiomyopathy.
Methods: Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and takotsubo-like left ventricular dysfunction were prospectively enrolled in this study.
Results: Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 µg/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years.
Conclusion: Takotsubo cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.
Key Words: Takotsubo • Reversible ventricular dysfunction • Cardiomyopathy • Catecholamine • Stunned myocardium • Heart failure
Received April 3, 2004; Revised April 25, 2004; Accepted March 11, 2005
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