Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review

Background Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction characterized by transient wall-motion abnormalities involving apical and mid-portions of the left ventricle in the absence of significant obstructive coronary disease. Methods Searching the MEDLINE database 28 case series met the eligibility criteria and were summarized in a narrative synthesis of the demographic characteristics, clinical features and pathophysiological mechanisms. Results TLVABS is observed in 0.7–2.5% of patients with suspected ACS, affects women in 90.7% (95% CI: 88.2–93.2%) with a mean age ranging from 62 to 76 years and most commonly presents with chest pain (83.4%, 95% CI: 80.0–86.7%) and dyspnea (20.4%, 95% CI: 16.3–24.5%) following an emotionally or physically stressful event. ECG on admission shows ST-segment elevations in 71.1% (95% CI: 67.2–75.1%) and is accompanied by usually mild elevations of Troponins in 85.0% (95% CI: 80.8–89.1%). Despite dramatic clinical presentation and substantial risk of heart failure, cardiogenic shock and arrhythmias, LVEF improved from 20–49.9% to 59–76% within a mean time of 7–37 days with an in-hospital mortality rate of 1.7% (95% CI: 0.5–2.8%), complete recovery in 95.9% (95% CI: 93.8–98.1%) and rare recurrence. The underlying etiology is thought to be based on an exaggerated sympathetic stimulation. Conclusion TLVABS is a considerable differential diagnosis in ACS, especially in postmenopausal women with a preceding stressful event. Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS.