Recurrence of Takotsubo Cardiomyopathy

Abstract

IntroductionTakotsubo cardiomyopathy (TC) is transient systolic dysfunction of the left ventricle (LV) occurring mainly in post-menopausal women after a stressful event. It is associated with characteristic LV contraction patterns, typically apical dyskinesia and basal hyperkinesia. 1 The exact pathophysiology of TC is still unclear, although several hypotheses, such as multivessel coronary spasm, microvascular impairment, and direct catecholaminemediated myocardial stunning, have been proposed.2 While the prognosis for TC patients is generally favorable, with complete recovery from LV wall motion abnormality, some patients experience recurrence of TC, once or sometimes multiple times. There is little information about the efficacy of chronic pharmacological therapy for preventing TC recurrence. This review summarizes current knowledge of TC recurrence. Recurrence rate of takotsubo cardiomyopathyThe reported recurrence rate of TC has ranged from 0 to 10% (Table. 1). Elesber et al. reported the highest recurrence rate within the first 4 years at 2.9% per year and subsequently it decreased at 1.3% per year.3 Singh et al. performed metaanalysis from 31 cohorts (1,664 TC patients) and reported that the annual incidence of recurrence was 1.5% and the cumulative recurrence rate increased from 1.2% at 6 months to nearly 5% at 6 years. 4 Several cases of multiple recurrences have also been reported. 4 It may be interpreted that severe LV dysfunction reflects increased susceptibility to stressful events. Patel et al. reported that the recurrence rate was 5-fold higher in female patients <50 years of age than in those aged 50 years old or more. 6 The reason for higher recurrence rate in younger females is unknown. The recurrence of TC is more frequent in women but no statistically significant difference has shown between men and women, probably because of the low numbers of recurrence. Morphology and pathophysiologyMost cases of recurrent TC have the same ballooning pattern compared to that of the initial event.8-10 However, some case reports have documented recurrent TC with different ballooning patterns (i.e., apical ballooning to mid-ventricular ballooning, 11,12 mid-ventricular ballooning to apical ballooning, [13][14][15] and apical ballooning to basal ballooning. 16 These observations are inconsistent with the currently proposed mechanisms of TC such as anatomic variations in sympathetic innervation and adrenergic receptor density. The exact pathophysiology of TC and its recurrence is unknown. Dynamic variation in the sensitivity of the cardiac adrenergic receptors or differences in the degree of stress and the subsequent level of catecholamine * Corresponding author. E-mail: kkatou0424@yahoo.co.jp AbstractTakotsubo cardiomyopathy (TC) is transient systolic dysfunction of the left ventricle (LV) occurring mainly in post-menopausal women after a stressful event. It is associated with characteristic LV contraction patterns. While the prognosis for TC patients is generally favorable, some patients experience recurrenc...

The Gap In Meeting The Educational And Support Needs Of Women With Takotsubo Syndrome Compared To Women With An Acute Coronary Syndrome

“…Emerging evidence indicates that Takotsubo is a syndrome with a significant risk of recurrence (Kato, Kitahara & Kobayashi, 2016;Singh et al 2014) and lingering symptoms that can severely impair QoL. As observed by Dahlviken et al (2015), women with TS require education and counselling from healthcare professionals to help them to comprehend and manage having a TS diagnosis.…”

Takotsubo syndrome

“…In a meta-analysis of 31 studies involving 1664 patients, Singh et al 55 reported a cumulative recurrence rate of 5% at 6 years with an annual rate of 1.5%. Kato et al 56 in a recent meta-analysis of 3513 patients, recurrence rate was varying 0–10% in the 16 studies. Factors predictive of recurrence were severe LV dysfunction, increased susceptibility to emotion or physical stress, dynamic variation in the sensitivity of cardiac adrenergic receptors and females under 50 years.…”

Cardiomyopathy

“…Left ventricular dysfunction usually resolves over days to weeks, but in patients who have persistent HFrEF, medical therapy for heart failure should be offered. The incidence of recurrence is not well defined but may be up to 10% (Kato et al., 2016). All patients should have initial follow-up in secondary care.…”