Key result
The Takotsubo syndrome contraction pattern identified a distinct subset of ACS patients without obstructive coronary disease who were older, had greater myocardial injury, and were >85% women.
Why the study?
Do patients with the Takotsubo syndrome left ventricular contraction pattern differ clinically from those with other contraction patterns among suspected ACS patients without obstructive CAD?
Observational (n=31)
Do patients with the Takotsubo syndrome left ventricular contraction pattern differ clinically from those with other contraction patterns among suspected ACS patients without obstructive CAD?
The classic apical ballooning pattern of Takotsubo syndrome identifies a distinct clinical subset of suspected ACS patients without obstructive CAD, predominantly postmenopausal women with greater myocardial injury.
Answers are grounded in this paper and cite their sources.
Supports phenotyping by contraction pattern in MINOCA; leaves open effects on outcomes and therapy.
BACKGROUND: Original descriptions of the takotsubo syndrome (TS) included a characteristic left ventricular (LV) contraction pattern, "apical ballooning." Recently, several reports have associated contraction patterns not strictly conforming to the original description with TS. The specifics of the contraction pattern seem to set TS apart from the much larger population of patients with acute coronary syndrome (ACS) but no obstructive coronary artery disease (OCAD). This study was undertaken to compare patients with midventricular and apical dysfunction with those with other LV contraction patterns. HYPOTHESIS: If TS can present with a variety of patterns of LV dysfunction, then both those with and those without the pattern should have the clinical components previously assigned to the syndrome. METHODS: We studied LV contraction patterns in consecutive ACS patients referred for consideration of emergent or urgent percutaneous coronary intervention. RESULTS: Of the 893 patients evaluated in 2008, we excluded 862 on the basis of OCAD, preexisting LV dysfunction, or an obvious alternative cause of symptoms. The remaining 31 (3.5%) also had no OCAD but manifested an LV contraction abnormality. We compared the 15 patients (1.7%) whose ventriculograms met criteria for TS with the 16 patients (1.8%) whose did not. The most common alternative pattern was global hypokinesis, followed by a variety of segmental contraction abnormalities. Patients with the TS pattern were older and had evidence of greater myocardial injury. More than 85% were women. CONCLUSIONS: The TS pattern identifies a distinct subset of ACS patients with a remarkable predominance of postmenopausal women and is therefore fundamental to the definition of this entity. This distinctive facet of the syndrome is likely to be an important clue to its pathogenesis. We did not encounter patients with other patterns of LV dysfunction that could be thought to represent stress-induced cardiomyopathy.
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Paixão et al. (2011) conducted an observational in Suspected Acute Coronary Syndrome (n=31). Takotsubo syndrome left ventricular contraction pattern vs. Other left ventricular contraction patterns was evaluated on Clinical characteristics (age, myocardial injury, sex). The Takotsubo syndrome contraction pattern identified a distinct subset of ACS patients without obstructive coronary disease who were older, had greater myocardial injury, and were >85% women.
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