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Cardiac rupture in takotsubo cardiomyopathy: a systematic review

Sanjay Kumar1, Sashank Kaushik, Amit Nautiyal

  • 1Department of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA. kumarsanjay@sbcglobal.net

Clinical Cardiology
|September 16, 2011
PubMed

Insights

Cardiac rupture (CR) in Takotsubo cardiomyopathy (TSC) is more common than thought. Older female patients with higher ejection fraction and double product are at risk. Beta-blocker use may prevent CR.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Takotsubo cardiomyopathy (TSC) is increasingly recognized.
  • Cardiac rupture (CR) is a rare but fatal complication of TSC.
  • Identifying risk factors for CR in TSC is crucial for patient management.

Purpose of the Study:

  • To compare demographic and clinical characteristics of TSC patients with and without cardiac rupture.
  • To identify predictors of cardiac rupture in Takotsubo cardiomyopathy.

Main Methods:

  • Literature search of MEDLINE for Takotsubo cardiomyopathy with cardiac rupture case reports.
  • Comparison of 12 TSC with CR cases against 12 randomly selected TSC without CR cases.
  • Analysis of demographic and clinical data, including ECG findings and hemodynamic parameters.

Main Results:

  • Patients with TSC and CR were significantly older and predominantly female.
  • Higher frequency of ST elevation (lead II) and absence of T-wave inversion (lead V5) on admission in the CR group.
  • Elevated ejection fraction, systolic blood pressure, and double product were observed in the CR group.
  • Less frequent use of beta-blockers in patients who developed CR.

Conclusions:

  • Cardiac rupture may be an under-recognized complication of Takotsubo cardiomyopathy.
  • Higher intracardiac pressure fluctuations, indicated by elevated double product and ejection fraction, may contribute to CR.
  • Beta-blocker therapy might offer protective benefits against cardiac rupture in TSC patients.
Abstract

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