J Cardiovasc Ultrasound.  2013 Sep;21(3):116-122. 10.4250/jcu.2013.21.3.116.

Different Characteristics between Patients with Apical and Non-Apical Subtypes of Stress-Induced Cardiomyopathy

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School & Hospital, Jeonju, Korea. shleemd@jbnu.ac.kr

Abstract

BACKGROUND
Stress-induced cardiomyopathy (SCM) is characterized by apical ballooning on echocardiography, but some of SCM patients show non-apical involvement and their characteristics are not well defined.
METHODS
We investigated 56 patients that were diagnosed as SCM and divided them into 2 groups: apical ballooning syndrome (ABS, n = 49, 87.5%) and non-apical ballooning syndrome (N-ABS, n = 7, 12.5%) groups. Patients with N-ABS were significantly younger than those of the ABS group (52 +/- 11 vs. 73 +/- 10 years, p < 0.001).
RESULTS
Types of preceding stressors and clinical presentation including chest pain, pulmonary edema, cardiogenic shock and in-hospital mortality were comparable between the two groups. In the N-ABS group, wall motion score index was significantly lower than in the ABS group (1.61 +/- 0.35 vs. 1.93 +/- 0.31, p = 0.016). On electrocardiogram (ECG), T-wave inversion (57.1% vs. 95.8%, p < 0.001) were less frequent in the N-ABS than in the ABS group. Furthermore, maximum QT and corrected QT (QTc) intervals in the N-ABS patients were significantly shorter than the ABS patients (QT, 419.9 +/- 66.1 vs. 487.3 +/- 79.6 ms, p = 0.038; QTc, 479.0 +/- 61.9 vs. 568.0 +/- 50.5 ms, p < 0.001).
CONCLUSION
Patients with the N-ABS showed not only atypical echocardiographic findings, but also atypical clinical and ECG manifestations. Integrated consideration is needed to reach a diagnosis of the non-apical subtype of SCM.

Keyword

Stress cardiomyopathy; Echocardiography

MeSH Terms

Chest Pain
Echocardiography
Electrocardiography
Hospital Mortality
Humans
Pulmonary Edema
Shock, Cardiogenic
Takotsubo Cardiomyopathy*

Figure

  • Fig. 1 Three cases of stress-induced cardiomyopathy (SCM). Apical four-chamber views in diastole (A) and in systole (B) of a 75-year-old woman with apical ballooning SCM subtype and right ventricular (RV) involvement. Note ballooning of the mid to apical segments and hyperkinesis of the base of the left ventricle (LV). The arrow indicates concomitant ballooning of the RV apex during systole. Apical long-axis views in diastole (C) and in systole (D) of an 82-year-old woman with non-apical ballooning subtype of SCM involving midventricle. Apical four-chamber views in diastole (E) and in systole (F) of a 54-year-old man with non-apical ballooning subtype of SCM involving basal segments. Note ballooning of the LV base during systole.


Cited by  1 articles

Variable Morphology of Stress-Induced Cardiomyopathy
Dong Ryeol Ryu
J Cardiovasc Ultrasound. 2013;21(3):113-115.    doi: 10.4250/jcu.2013.21.3.113.


Reference

1. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. [Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases]. J Cardiol. 1991; 21:203–214.
2. Yoshida T, Nishizawa T, Yajima K, Tsuruoka M, Fujimaki T, Oguri M, Kato K, Hibino T, Ohte N, Yokoi K, Kimura G. A rare case of tako-tsubo cardiomyopathy with variable forms of left ventricular dysfunction: a new entity. Int J Cardiol. 2009; 134:e73–e75.
Article
3. Zanobetti M, Vicidomini S, Conti A, Innocenti F, Pini R. An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature. Intern Emerg Med. 2010; 5:215–219.
Article
4. Hurst RT, Askew JW, Reuss CS, Lee RW, Sweeney JP, Fortuin FD, Oh JK, Tajik AJ. Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol. 2006; 48:579–583.
5. Hurst RT, Prasad A, Askew JW 3rd, Sengupta PP, Tajik AJ. Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 2010; 3:641–649.
Article
6. Park HE, Kim JH, Yoon YE, Park JB, Lee W, Cho Y, Heo EY, Kim HK, Kim YJ, Sohn DW. A unique case of transient midventricular ballooning: an atypical manifestation of stress-induced cardiomyopathy involving both ventricles. Korean Circ J. 2008; 38:677–680.
Article
7. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. Chamber Quantification Writing Group. American Society of Echocardiography's Guidelines and Standards Committee. European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18:1440–1463.
Article
8. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS. American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002; 105:539–542.
Article
9. Ramaraj R, Movahed MR. Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congest Heart Fail. 2010; 16:284–286.
Article
10. Ramaraj R, Sorrell VL, Movahed MR. Levels of troponin release can aid in the early exclusion of stress-induced (takotsubo) cardiomyopathy. Exp Clin Cardiol. 2009; 14:6–8.
11. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008; 155:408–417.
Article
12. Lee PH, Song JK, Sun BJ, Choi HO, Seo JS, Na JO, Kim DH, Song JM, Kang DH, Kim JJ, Park SW. Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital. J Am Soc Echocardiogr. 2010; 23:766–771.
Article
13. Lee JW, Kim JY, Youn YJ, Sung JK, Lee NS, Lee KH, Yoo BS, Lee SH, Yoon J, Choe KH. Clinical characteristics and prognostic factors of stress-induced cardiomyopathy. Korean Circ J. 2010; 40:277–282.
Article
14. Hahn JY, Gwon HC, Park SW, Choi SH, Choi JH, Choi JO, Lee SC, On YK, Kim JS, Kim DK, Jeon ES, Lee SH, Hong KP, Park JE. The clinical features of transient left ventricular nonapical ballooning syndrome: comparison with apical ballooning syndrome. Am Heart J. 2007; 154:1166–1173.
Article
15. Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol. 2008; 124:283–292.
Article
16. Hong KW, Park DG, Choi HH, Kim SE, Yoon DH, Lee JH, Han KR, Oh DJ. Tako-Tsubo cardiomyopathy by transient dynamic left midventricular obstruction. Korean Circ J. 2009; 39:37–41.
Article
17. Kumar S, Kaushik S, Nautiyal A, Choudhary SK, Kayastha BL, Mostow N, Lazar JM. Cardiac rupture in takotsubo cardiomyopathy: a systematic review. Clin Cardiol. 2011; 34:672–676.
Article
18. Elesber AA, Prasad A, Bybee KA, Valeti U, Motiei A, Lerman A, Chandrasekaran K, Rihal CS. Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement. J Am Coll Cardiol. 2006; 47:1082–1083.
Article
19. Movahed MR, Donohue D. Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla cardiomyopathy, atypical apical ballooning, or Tako-Tsubo cardiomyopathy. Cardiovasc Revasc Med. 2007; 8:289–292.
Article
20. Joe BH, Jo U, Kim HS, Park CB, Hwang HJ, Sohn IS, Jin ES, Cho JM, Park JH, Kim CJ. APACHE II score, rather than cardiac function, may predict poor prognosis in patients with stress-induced cardiomyopathy. J Korean Med Sci. 2012; 27:52–57.
Article
21. Song BG, Chun WJ, Park YH, Kang GH, Oh J, Lee SC, Park SW, Oh JK. The clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings of reverse or inverted takotsubo cardiomyopathy: comparison with mid or apical variant. Clin Cardiol. 2011; 34:693–699.
Article
22. Jabara R, Gadesam R, Pendyala L, Chronos N, King SB, Chen JP. Comparison of the clinical characteristics of apical and non-apical variants of "broken heart" (takotsubo) syndrome in the United States. J Invasive Cardiol. 2009; 21:216–222.
23. Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007; 132:809–816.
Article
24. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004; 141:858–865.
Article
Full Text Links
  • JCU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr