Takotsubo cardiomyopathy: which role for serial electrocardiogram changes?

Loris Roncon, Marco Zuin


Takotsubo cardiomyopathy (TTC) is a cardiac syndrome characterized by acute regional-reversible systolic dysfunction of the left ventricle (LV) and related to psycho-physical acute stress. Recently, physicians and researchers have posed their attention on the time course of  ECG changes in TTC. Knowledge of  ECG changes in TTC could be useful for the clinical management of this disease. Among all TTC deaths, 38% of cases are directly related to in-hospital complications. Serial ECG assessment could be a first line defence in reducing mortality and in-hospital complications in patients with TTC. 


Takotsubo cardiomyopathy; electrocardiogram; ECG changes.

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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 J 2002 Mar;143(3):448-55. doi: 10.1067/mhj.2002.120403

Wittstein IS, Thiemann DR, Lima JA et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med N Engl J Med. 2005 Feb 10;352(6):539-48. doi: 10.1056/NEJMoa043046

Yasu T, Tone K, Kubo N, Saito M. Transient mid-ventricular ballooning cardiomyopathy; a new entity of Takotsubo cardiomyopathy. Int J Cardiol 2006 Jun 7;110(1):100-1. doi: 10.1016/j.ijcard.2005.05.060

Hurst RT, Askew JW, Reuss C, et al. Transient mid ventricular ballooning syndrome: a new variant. J Am Coll Cardiol. 2006 Aug 1;48(3):579-83. doi: 10.1016/j.jacc.2006.06.015

Bybee KA, Motiei A, Syed Is, et al. Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome form anterior ST- segment elevation myocardial infarction. J Electrocardiol. 2007 Jan;40(1):38.e1-6. doi: 10.1016/j.jelectrocard.2006.04.007.

Kosuge M, Ebina T, Hibi K, Morita S et al. Simple and accurate electrocardiography criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. Am Coll Cardiol. 2010;55(22):2514-2516. doi: 10.1016/j.jacc.2009.12.059

Tamura A, Watanabe T, Ishihara M, Ando S, et al. A new electrocardiographic criterion to differentiate between Takotsubo cardiomyopathy and anterior wall ST-segment elevation acute myocardial infarction. Am J Cardiol. 2011 Sep 1;108(5):630-3. doi: 0.1016/j.amjcard.2011.04.006.

Kosuge M, Ebina T, Hibi K, Iwahashi N, et al. Differeneces in negative T waves between takotsubo cardiomyopathy and reperfused anterior acute myocardial infarction. Circ J. 2012;76(2):462-8. doi: 10.1253/circj.CJ-11-1036

La Vecchia L, Cabianca E, Vincenzi P, Varotto L, Fontanelli A. Diagnostic criteria for apical balloning derived from quantitative analysis of left ventricular angiograms. Minerva Cardioangiol. 2010 Feb;58(1):17-21. doi: not avaialbe

Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008 Dec 16;118(25):2754-62. doi:10.1161/CIRCULATIONAHA.108.767012

Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz. 2010 Jun;35(4):240-3. doi: 10.1007/s00059-010-3339-x

Kurisu S, Inoue I, Kawagoe T, Ishihara M, et al. Time course of electrocardiographic changes in patients with tako-tsubo syndrome: comparison with acute myocardial infarction with minimal enzymatic release. Circ J. 2004 Jan;68(1):77-81. doi: 10.1253/circj.68.77

Mitsuma W, Kodama M, Ito M, Tanaka K, Yanagawa T, Ikarashi N, et al. Serial electrocardiographic findings in women with Takotsubo cardiomyopathy. Am J Cardiol. 2007 Jul 1;100(1):106-9. doi: 10.1016/j.amjcard.2007.02.062

Kurisu S1, Inoue I, Kawagoe T, Ishihara M, et al. Takotsubo-like transient biventricular dysfunction with pressure gradients. Intern Med. 2005 Jul;44(7):727-32. doi: 10.2169/internalmedicine.44.727

Owa M, Aizawa K, Urasawa N, Ichinose H, et al. Emotional stress-induced 'ampulla cardiomyopathy': discrepancy between the metabolic and sympathetic innervation imaging performed during the recovery course. Jpn Circ J. 2001 Apr;65(4):349-52.doi: 10.1253/jcj.65.349.

Inoko M, Nakashima J, Haruna T, Nakano K, et al. Images in cardiovascular medicine. Serial changes of the electrocardiogram during the progression of subarachnoidal hemorrhage. Circulation. 2005 Nov 22;112(21):e331-2.doi: 10.1161/CIRCULATIONAHA.104.531780

Thakar S, Chandra P, Hollander G, Lichstein E. Electrocardiographic Changes in Takotsubo Cardiomyopathy. Pacing Clin Electrophysiol. 2011 Oct;34(10):1278-82. doi: 10.1111/j.1540-8159.2011.03151.

Looi JL, Wong CW, Lee M, Khan A, Webster M, Kerr AJ. Usefulness of ECG to differentiate Takotsubo cardiomyopathy from acute coronary syndrome Int J Cardiol. 2015 Nov 15;199:132-40. doi: 10.1016/j.ijcard.2015.07.046

Singh K, Carson K, Shah R, Sawhney G, et al. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy. Am J Cardiol. 2014 Apr 15;113(8):1420-8. doi: 10.1016/j.amjcard.2014.01.419.

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4

DOI: https://doi.org/10.17987/icfj.v5i0.200

Copyright (c) 2016 Loris Roncon, Marco Zuin

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