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Heterogeneity of clinical presentation in Tako-Tsubo syndromes

the prevalence of normal segmental wall motion and normal ECG pattern

Rellini, Gianluigia; Piazza, Ritaa; Loiudice, Elviraa; Cassin, Matteoa; Bernardi, Guglielmoa; Pavan, Danielaa; Cervesato, Eugenioa; Nicolosi, Gian L.a,b

Journal of Cardiovascular Medicine: December 2018 - Volume 19 - Issue 12 - p 717–724
doi: 10.2459/JCM.0000000000000729
Research articles: Acute cardiac care

Aim The aim of this study is to report the heterogeneity of clinical presentation in Tako-Tsubo syndrome (TTS), including a significant prevalence of normal ECG and echocardiographic patterns in a series of consecutive patients from a single center.

Methods and results From our database we selected a total of 168 cases of TTS. A total of 140 of these (Group A); 14 men (10%), mean age 60.3 years, range 39–87; 126 women (90%), mean age 66.1 years, range 43–93; matched the following reported criteria: typical stenocardic pain immediately following an emotional acute stress, or acute medical or surgical event within the preceding 12 h; acute rise and fall of troponin release; absence of significant coronary disease at coronary angiography. ECG findings at presentation ranged from T wave abnormalities (41 cases, 29.3%) to ST elevation (52 cases, 37.1%) and ST depression (11 cases, 7.9%), whereas in 36 cases (25.7%) the ECG was normal. Echocardiography at presentation showed akinesia of the total apical or medium-apical segments in 74 patients (53%), whereas it showed akinesia of left ventricular wall segments in other locations in 30 patients (21%) and even normal regional wall motion and thickening in 36 patients (26%). We described also a series of 13 female patients (mean age 70.2 years; age range 45–85 years) (Group B) who did not complain of chest pain at presentation, but showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography. Finally we selected 15 female patients (mean age 69.3 years; age range 49–89 years) (Group C) who formally did not report acute stress immediately preceding their presentation to the hospital for chest pain. They showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography and only one case of normal ECG pattern at presentation.

Conclusion In this series of acute TTS, a wide variability of ECG and echocardiographic patterns are observed, ranging from ST elevation with coexisting segmental wall motion abnormalities of the typical TTS to a clinical presentation characterized by normal ECG and normal segmental wall motion pattern.

aCardiology Department, ARC, Ospedale Civile

bCardiology Clinic, Policlinico San Giorgio, Pordenone, Italy

Correspondence to Gianluigi Rellini, MD, A.O. S. Maria degli Angeli, Via Montereale 24, Pordenone, Pordenone Province 33170, Italy E-mail:

Received 16 June, 2018

Accepted 30 September, 2018

© 2018 Italian Federation of Cardiology. All rights reserved.