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Correspondence |

Apical and Midventricular Transient Left Ventricular Dysfunction Syndrome (Tako-tsubo Cardiomyopathy)Response FREE TO VIEW

Junya Ako, MD
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Affiliations: The Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, CA,  Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

Correspondence to: Junya Ako, MD, Center for Research in Cardiovascular Interventions, Stanford University Medical Center, 300 Pasteur Dr, Room H3554, Stanford, CA 94305; e-mail: junya-tky@umin.ac.jp



Chest. 2008;133(4):1052-1053. doi:10.1378/chest.07-2744
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I read with great interest the recent article by Dr. Kurowski et al,1who observed that 40% of transient left ventricular dysfunction showed a midventricular pattern. Currently, the frequently used terminology, including left ventricular apical ballooning2and tako-tsubo–like left ventricular dysfunction,3 suggests that involvement of the left ventricular apex is a requisite for diagnosis, while this article demonstrates that an apical sparing pattern is a variant form, or more likely a variation along the continuum of this disorder in its broadest sense. It has been suggested that the pattern of wall motion abnormality itself is not pathognomonic for the diagnosis.4 With better clarification of the pathophysiology, we should find a more appropriate and consistent medical term to describe this phenomenon, instead of using names derived predominately from the shape of the left ventriculogram.

The author has no conflict of interest to disclose.

The authors have no conflicts of interest to disclose.

Kurowski, V, Kaiser, A, von Hof, K, et al (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.Chest132,809-816. [PubMed] [CrossRef]
 
Tsuchihashi, K, Ueshima, K, Uchida, T, et al Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction; Angina Pectoris-Myocardial Infarction Investigations in Japan.J Am Coll Cardiol2001;38,11-18. [PubMed]
 
Kurisu, S, Sato, H, Kawagoe, T, et al Tako-tsubo–like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction.Am Heart J2002;143,448-455. [PubMed]
 
Ako, J, Sudhir, K, Farouque, HM, et al Transient left ventricular dysfunction under severe stress: brain-heart relationship revisited.Am J Med2006;119,10-17. [PubMed]
 
To the Editor:

We thank Dr. Ako for his thoughtful comments regarding our article in CHEST (September 2007).1Indeed, over recent years a number of studies have broadened our pathophysiologic understanding of “tako-tsubo” cardiomyopathy (TTC). With a deeper insight into the characteristic temporal structural and functional changes of this entity, however, the terminology, primarily referred to as the left ventricular apical ballooning syndrome, now has to adapt to this process. Among a number of very important observations recently, at least two will have to be reflected in future terminology. First, the right ventricle is also affected in a number of patients2; and second, approximately 40% of patients present with an “atypical” midventricular wall motion abnormality and not with a “classical” apical pattern.1 Furthermore, impaired glucose metabolism and (to a lesser extent) a decrease in myocardial perfusion closely relate to wall motion abnormalities and seems to be a uniform characteristic in TTC patients,3 regardless of the localization of left ventricular dysfunction.1

Until now, TTC has been largely defined by the “proposed Mayo criteria”4 that is based on the morphology of left ventricular dysfunction, ECG changes, and absence of significant coronary artery disease. Transient cardiomyopathy clearly should no longer be regarded as the left ventricular apical ballooning syndrome. We propose a redefinition of TTC. The term transient cardiac dysfunction syndrome with an apical or midventricular pattern of wall motion abnormality may provide a matrix for doing so.

References
Kurowski, V, Kaiser, A, von Hof, K, et al Apical and midventricular transient left ventricular dysfunction syndrome (“tako-tsubo” cardiomyopathy): frequency, mechanisms and prognosis.Chest2007;132,809-816. [PubMed] [CrossRef]
 
Haghi, D, Athanasiadis, A, Papavassiliu, T, et al Right ventricular involvement in Takotsubo cardiomyopathy.Eur Heart J2006;27,2433-2439. [PubMed]
 
Yoshida, T, Hibino, T, Kako, N, et al A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography.Eur Heart J2007;28,2598-2604. [PubMed]
 
Bybee, KA, Kara, T, Prasad, A, et al Systematic review: transient left ventricular apical ballooning; a syndrome that mimics ST-segment elevation myocardial infarction.Ann Intern Med2004;141,858-865. [PubMed]
 

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References

Kurowski, V, Kaiser, A, von Hof, K, et al (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.Chest132,809-816. [PubMed] [CrossRef]
 
Tsuchihashi, K, Ueshima, K, Uchida, T, et al Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction; Angina Pectoris-Myocardial Infarction Investigations in Japan.J Am Coll Cardiol2001;38,11-18. [PubMed]
 
Kurisu, S, Sato, H, Kawagoe, T, et al Tako-tsubo–like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction.Am Heart J2002;143,448-455. [PubMed]
 
Ako, J, Sudhir, K, Farouque, HM, et al Transient left ventricular dysfunction under severe stress: brain-heart relationship revisited.Am J Med2006;119,10-17. [PubMed]
 
Kurowski, V, Kaiser, A, von Hof, K, et al Apical and midventricular transient left ventricular dysfunction syndrome (“tako-tsubo” cardiomyopathy): frequency, mechanisms and prognosis.Chest2007;132,809-816. [PubMed] [CrossRef]
 
Haghi, D, Athanasiadis, A, Papavassiliu, T, et al Right ventricular involvement in Takotsubo cardiomyopathy.Eur Heart J2006;27,2433-2439. [PubMed]
 
Yoshida, T, Hibino, T, Kako, N, et al A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography.Eur Heart J2007;28,2598-2604. [PubMed]
 
Bybee, KA, Kara, T, Prasad, A, et al Systematic review: transient left ventricular apical ballooning; a syndrome that mimics ST-segment elevation myocardial infarction.Ann Intern Med2004;141,858-865. [PubMed]
 
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