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Takotsubo cardiomyopathy: a historical note

Editor(s): WANG, Mou-yue

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doi: 10.3760/cma.j.issn.0366-6999.2009.08.024
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To the Editor: I read with interest the case report of Takotsubo cardiomyopathy in a Chinese woman.1 Unfortunately, the authors mistakenly attributed the original description of this syndrome to Tsuchihashi et al in 2001.2 Actually Dote et al3 first described this syndrome in 1991, ten years before Tsuchihashi et al did.2 Incidentally, the authors did make a reference in their case report to the article by Dote et al3 which was cited as reference 1.

This syndrome has most commonly been known as takotsubo cardiomyopathy because of the resemblance of the left ventriculogram to a traditional Japanese octopus trap or pot - takotsubo,Symbol in Japanese with a round bottom and a narrow neck.4,5 It has also been called many other names, including ampulla cardiomyopathy, apical ballooning syndrome, atypical apical ballooning, broken heart syndrome, stressinduced cardiomyopathy, and transient left ventricular apical ballooning.6,7 This case report would attract more immediate attention of the readers if the authors used one of these terms in their article. Readers are usually attracted to read a paper from reading the title. By the way, the authors should be congratulated for presenting their case with very beautiful illustrations. As the saying goes, one picture is better than a thousand words.


Finally, regardless of which nomenclature one wishes to use to describe the syndrome, the underlying mechanism is coronary artery spasm.8,9 It represents a form of myocardial stunning following a stressful event that evokes intense vasospasm of the coronary arteries, which may or may not be atherosclerotic.4,8,9 Such an association was clearly recognized in 1991 by the original Japanese investigators led by Dote.3


1. Kang LM, Zhang J, Dou KF, Xu ZM, Gao XJ, Yang YJ. Acute and reversible cardiomyopathy provoked by stress in a Chinese woman. Chin Med J 2008; 121: 2454-2457.
2. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Agnina Pectoris-Myocrdial Infarction Investigations in Japan. J Am Coll Cardiol 2001; 38: 11-18.
3. 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.
4. Cheng TO. Takotsubo cardiomyopathy represents a stress-induced myocardial stunning. J Cardiol 2007; 49: 106-107.
5. Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy. A new form of acute, reversible heart failure. Circulation 2008; 118: 2754-2762.
6. 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.
7. Dorfman TA, Iskandrian AE. Takotsubo cardiomyopathy: state of the art review. J Nucl Carediol 2009; 16: 122-134.
8. Cheng TO. Whether you called it apical ballooning syndrome or takotsubo cardiomyopathy, it is due to coronary artery spasm with or without underlying atherosclerosis. Cathet Cardiovasc Intervent, in press.
9. Cheng TO. Pathophysiologic mechanisms of left ventricular apical ballooning in takotsubo cardiomyopathy. Int J Cardiol, in press.
© 2009 Chinese Medical Association