Why Is Reverse Takotsubo “Reverse”?

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Abstract

Objectives

Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome simulating myocardial infarction that is characterized by transient wall motion abnormalities in the absence of coronary artery obstruction. Reverse TTC (rTTC) is a recently described variant of TTC. This review defines and compares both forms of TTC, stating their resemblances and differences.

Methods

We conducted a search of the MEDLINE database. Forty-one cases of rTTC met our eligibility criteria and were summarized in a synthesis of the demographic features, clinical characteristics, and laboratory studies.

Results

Of the 41 patients studied, 73% were women. Patients’ ages ranged from 19 to 69 years and the mean age was 43. The predominant electrocardiogram finding was ST-segment depression, whereas ST-segment elevation was present in only 6 patients (14.5%). Troponin levels were raised in 92.6% of the patients, with a mean troponin I of 7.7 ng/mL. All of the patients had wall motion abnormalities on echocardiography and the mean ejection fraction was 29.3%. Of the 27 patients (66%) who had a documented angiography, 22 (81.5%) had normal coronaries and 5 (18.5%) had minor or mild obstructive coronary artery disease. Of the 41 patients, 9 (22%) died, and the mean recovery time of the ejection fraction in the survivors was 16 days.

Conclusions

rTTC is a distinct presentation from the classic TTC. Remarkable differences exist between both forms in terms of mean age, sex, electrocardiogram presentation, troponin levels, and mortality.

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