Revised clinical diagnostic criteria for Tako-tsubo syndrome: The Tako-tsubo Italian Network proposal

Tako-tsubo syndrome (TTS) or stress cardiomyopathy is a relatively new entity that manifests with a clinical scenariomimicking an acute myocardial infarction [1–6]. TTS accounts for ∼2% of all patients presenting with apparent symptoms of acute myocardial infarction [2]. The clinical characteristics are heterogeneous and the clinical spectrum of presentation somehow wide, a fact that has long proven researchers and physicians in their diagnostic competence. Current TTS diagnostic criteria have been initially proposed by the Mayo Clinic Investigators in 2004 [1], and only slightly modified in 2008 [7], despite the great amount in TTS literature provided in the last 10 years. Of note, TTS patients not correctly identified, but considered common acute coronary syndrome patients, may receive unjustified aggressive therapies resulting in increased complications and costs. Thus, accuracy is needed to differentiate TTC from acute myocardial infarction, because of the different therapeutic and prognostic implications [1–7]. For this purpose, the Tako-tsubo Italian Network (TIN) Investigators, in their multicentre registry including several hundreds of TTS patients, adopted modified TTS diagnostic criteria in order to better detect and treat patients with TTS. The TIN diagnostic criteria that could be considered modified and updated Mayo Clinic diagnostic criteria are summarized in Table 1. The main advantages and novelty of the TIN diagnostic criteria are the following: