FACTORS SUGGESTIVE OF CARDIAC COMPLICATIONS IN TAKOTSUBO CARDIOMYOPATHY: MULTICENTER STUDY

Background: Takotsubo cardiomyopathy (TM) is characterized by acute and transient myocardial segmental wall motion abnormality especially at the apical area with chest pain mimicking acute myocardial infarction. TM is generally accepted to show good prognosis, however, we experience some cases with severe cardiac complications including acute heart failure (AHF), cardiac rupture and ventricular arrhythmias. We characterized TM patients developing these complications. Methods and results: Eighty three patients were studied. Patients with AHF, cardiac rupture, ventricular arrhythmias and death due to cardiac complications (CC group, n = 29) were compared with other patients without cardiac complications (NC group, n = 54). There was no difference between the two groups in age, sex, and coronary risk factors. Common primary symptom in the CC group was dyspnea but was chest pain in NC group. A preceding emotional stress was a common trigger for CC group. Left ventriculography showed significantly decreased ejection fraction in the CC group (39.7 ± 10.2% vs. 53.9 ± 14.1%, p = 0.002). Similarly, more than two segments of impaired left ventricular wall motion was a significant predictor of severe cardiac complications. Conclusions: Clinical onset with dyspnea and extended area of left ventricular ballooning are signs predicting cardiac complications in TM.