Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis

Abstract

Takotsubo cardiomyopathy (TC) is characterized by reversible ventricular dysfunction, not limited to the distribution of an epicardial coronary artery. A disease primarily afflicting post-menopausal women, it is frequently mistaken for acute anterior wall myocardial infarction. Alternatively called Stress Cardiomyopathy, physical or emotional triggers are identified in only three fourths of TC patients. Long considered a benign condition, recent findings suggest poor short term prognosis similar to acute coronary syndrome (ACS). Despite the widely recognized pathophysiological role of catecholamine excess, its diagnostic role is uncertain. TC is suspected based on typical wall motion abnormalities in ventriculogram or echocardiogram. Several additional electrocardiographic, laboratory and imaging parameters have been studied with the goal of clinical diagnosis of TC. While several clinical clues differentiate it from ACS, a clinical diagnosis is often elusive leading to avoidable cardiac catheterizations. Natriuretic peptides (NPs), a family of peptide hormones released primarily in response to myocardial stretch, play a significant role in pathophysiology, diagnosis as well as treatment of congestive heart failure. TC with its prominent ventricular dysfunction is associated with a significant elevation of NPs. NPs are elevated in ACS as well but the degree of elevation is typically lesser than in TC. Markers of myocardial injury such as troponin are usually elevated to a higher degree in ACS than in TC. This differential elevation of NPs and markers of myocardial injury may play a role in early clinical recognition of TC.

Acute arterial occlusion due to left ventricular thrombus of Takotsubo cardiomyopathy in a young adult: a case report

“…The criteria used to diagnose Takotsubo cardiomyopathy have been described in detail by the Mayo Clinic [5], and it is essential to exclude significant organic stenosis or coronary artery spasm. Although women have a 9-fold higher risk of developing this cardiomyopathy when compared to men, women who are less than 55 years of age have a 5-fold risk reduction of developing the cardiomyopathy when compared to women who are older than 55 years of age [6]. Therefore, the case reported here was not at a common age for development of Takotsubo cardiomyopathy.…”

Under-diagnosis of Takotsubo Cardiomyopathy Increases Risk of Adverse Events: A Case Study

“…The gold standard for diagnosis of TC is to use radio-contrast dye with a ventricular flow study to assess contraction of the ventricle [8]. In TC, the left ventricle fails to contract at the bottom (akinesia), with normal contraction towards the atrial end of the ventricle.…”

Speckle tracking echocardiography in early detection of myocardial injury in a rat model with stress cardiomyopathy

“…Previous studies observed that cardiac biomarkers such as cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) may play a role in the early clinical recognition of SCM. However, to the best of our knowledge, data is limited regarding the pattern in which cardiac biomarkers are released in patients with SCM [6,7]. In addition, the changes in myocardial function during IMO stress and the optimal measurement time point are still unknown, even though this is of clinical importance [3].…”