Tako-Tsubo cardiomyopathy characteristics in long-term follow-up

Tako-Tsubo cardiomyopathy (TTC) is described as left ventricular (LV) dysfunction with the phenomenon of "apical ballooning", rapidly resolving, without coronary artery stenoses.

Fifteen patients with TTC and transthoracic echocardiography (TTE) at their admission, were reviewed (2001 to 2006). Follow-up (F/U) TTE was performed in varying intervals. To compare diameters of posterior wall (PW), interventricular septum (IVS), left atrium (LA), LV in end-diastole (LVED) and LV in end-systole (LVES) and valve insufficiencies, patients with comparable F/U are selected.

Fourteen patients were female (mean age 69.6 years). Angiography demonstrated LV systolic dysfunction with mean ejection fraction (EF) of 31.3%. In the acute-phase (day 0 to day 3), TTE showed a mean EF of 35.7%, not significantly different from EF obtained in angiography. Short-term F/U was performed in 9 patients after median time-interval of 20 days with an increase to a mean EF of 58.8%. F/U in 2006 has been performed in 10 patients (median time-interval 18.7 months) and showed normal EF. No significant difference in diameters of LA, LVED and LVES could be obtained comparing baseline and long-term data (p=0.493, p=0.790 and p=0.275). PW and IVS were significantly thicker at baseline compared to TTE > or = day 62 of F/U (p=0.003 and p=0.026). At baseline mitral valve insufficiency (MI) was mild in 50.0% and moderate in 12.5%, mild and moderate tricuspid valve insufficiency (TI) was recognized in 50% (25% respectively). MI and TI were regredient in F/U. In three patients an intraventricular systolic flow acceleration could be detected in the acute phase.

Characteristics of TTC, besides transient LV apical ballooning are also a significant change in LV wall thickness and reversible valve insufficiencies.