Clinical spectrum of tako-tsubo cardiomyopathyin Germany

BACKGROUND: Tako-tsubo cardiomyopathy(TTC) was first described in 1990 in Japan. A TTC registry was initiatedby the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK)in order to evaluate the clinical spectrum and the management ofpatients with this syndrome in Germany. METHODS: Patients from 37 hospitalswere included in the registry if they fulfilled the following criteria:1. acute chest symptoms or syncope, 2. new ischemic ECG changeswith ST-segment elevation ± T-wave inversion, 3. reversibleleft ventricular regional wall motion abnormality not correspondingto a single coronary artery territory, 4. absence of significantcoronary artery stenoses. RESULTS: 296 of the 324 patients (age68 ± 12) were women (91 %) and28 men (9 %). Leading symptoms were angina pectoris(72 %), dyspnoea (16 %), syncope(3 %) or resuscitation/cardiogenic shock (2 %).An antecedent trigger was found in 77 %. Timefrom symptom onset to hospital admission was 7,6 ± 6,9hours. An acute coronary syndrome (ACS) was clinically suspectedin 87 %. The ECG showed ST-segment elevation in85 %. Cardiac troponin was elevated in more than90 % of patients. Left ventricular ejection fractionby angiography was reduced to 49 ± 14 %.Initial medical treatment corresponded to the working diagnosisof an ACS. Catecholamines or an intraaortic balloon pump were necessaryin 5 % and 1 %, respectively.Seven patients (2.2 %) died in hospital. CONCLUSION: TTC afflicts mainly womenand presents clinically as an ACS in 87 %. Hospitalmortality is low with symptomatic therapy.