Reverse Takotsubo cardiomyopathy: a comprehensive review

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Internal Medicine

Background:

• Takotsubo cardiomyopathy (TTC) is an acute, reversible left ventricular (LV) dysfunction often triggered by stress.
• Reverse Takotsubo cardiomyopathy (rTTC) is a variant characterized by basal akinesis/hypokinesis and apical hyperkinesis.
• rTTC presents similarly to acute coronary syndrome (ACS) but without obstructive coronary artery disease.

Purpose of the Study:

• To describe the characteristics, diagnosis, and management of reverse Takotsubo cardiomyopathy (rTTC).
• To highlight the differences between rTTC and typical TTC.
• To review potential mechanisms and complications associated with rTTC.

Main Methods:

• Literature review of reported cases and studies on TTC and rTTC.
• Analysis of diagnostic criteria for rTTC, including imaging and biomarker findings.
• Summary of clinical presentation, triggers, and management strategies for rTTC.

Main Results:

• rTTC incidence varies (1-23% of TTC cases) and is associated with younger age, less LV dysfunction, and more neurological disease.
• Common triggers include emotional/physical stress, neurological conditions, and anesthesia.
• Diagnostic criteria include LV basal hypokinesis, EKG/troponin changes, and absence of obstructive CAD, pheochromocytoma, or myocarditis.

Conclusions:

• rTTC management is supportive, similar to TTC, focusing on complication treatment.
• Recurrence rate is approximately 10%, with complications including myocarditis and LV thrombi.
• Decreased LVEF, atrial fibrillation, and neurological disease are predictors of mortality in rTTC.