Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy

Ingo Eitel*, Florian Von Knobelsdorff-Brenkenhoff, Peter Bernhardt, Iacopo Carbone, Kai Muellerleile, Annachiara Aldrovandi, Marco Francone, Steffen Desch, Matthias Gutberlet, Oliver Strohm, Gerhard Schuler, Jeanette Schulz-Menger, Holger Thiele, Matthias G. Friedrich

*Corresponding author for this work
628 Citations (Scopus)

Abstract

Context: Stress cardiomyopathy (SC) is a transient form of acute heart failure triggered by stressful events and associated with a distinctive left ventricular (LV) contraction pattern. Various aspects of its clinical profile have been described in small singlecenter populations, but larger, multicenter data sets have been lacking so far. Furthermore, it remains difficult to quickly establish diagnosis on admission. Objectives: To comprehensively define the clinical spectrum and evolution of SC in a large population, including tissue characterization data from cardiovascular magnetic resonance (CMR) imaging; and to establish a set of CMR criteria suitable for diagnostic decision making in patients: acutely presenting with suspected SC. Design, Setting, and Patients Prospective study conducted at 7 tertiary care centers in Europe and North America between January 2005 and October 2010 among 256 patients with SC assessed at the time of presentation as well as 1 to 6 months after the acute event. Main Outcome Measures: Complete recovery of LV dysfunction. Results: Eighty-one percent of patients (n=207) were postmenopausal women, 8% (n=20) were younger women (aged ≤50 years), and 11% (n=29) were men. A stressful trigger could be identified in 182 patients (71%). Cardiovascular magnetic resonance imaging data (available for 239 patients [93%]) revealed 4 distinct patterns of regional ventricular ballooning: apical (n=197 [82%]), biventricular (n=81 [34%]), midventricular (n=40 [17%]), and basal (n=2 [1%]). Left ventricular ejection fraction was reduced (48% [SD, 11%]; 95% confidence interval [CI], 47%-50%) in all patients. Stress cardiomyopathy was accurately identified by CMR using specific criteria: a typical pattern of LV dysfunction, myocardial edema, absence of significant necrosis/fibrosis, and markers for myocardial inflammation. Follow-up CMR imaging showed complete normalization of LV ejection fraction (66% [SD, 7%]; 95% CI, 64%-68%) and inflammatory markers in the absence of significant fibrosis in all patients. Conclusions: The clinical profile of SC is considerably broader than reported previously. Cardiovascular magnetic resonance imaging at the time of initial clinical presentation may provide relevant functional and tissue information that might aid in the establishment of the diagnosis of SC.

Original languageEnglish
JournalJAMA
Volume306
Issue number3
Pages (from-to)277-286
Number of pages10
ISSN0098-7484
DOIs
Publication statusPublished - 20.07.2011

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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