Transient apical ballooning syndrome — clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population

Abstract 

Background

Transient apical ballooning syndrome (TABS) or Takotsubo cardiomyopathy mimics acute ST-elevation myocardial infarction, but is considered to have a good prognosis with only moderate elevation of myocardial enzymes and full recovery of left ventricular function. Although it is increasingly reported, its exact incidence, clinical presentation, and prognosis in non-Asian populations remain largely unknown.

Objective

To describe the clinical characteristics and long-term follow-up of patients who presented with TABS at our institution over a 3 year-period.

Methods

Patients were retrospectively retrieved from our local database. Patient charts were carefully reviewed and the diagnosis of TABS was based on the Mayo Clinic diagnostic criteria. Moreover, psychosocial stress or gastrointestinal disease was recorded.

Results

During the study period, 13,715 coronary angiographies were performed at our institution, including 2459 patients presenting with an acute coronary syndrome (ACS). Forty-one TABS were diagnosed, which represents an incidence of 1.7% of ACS-patients and 0.3% of all coronary angiographies performed, respectively. Mean age was 65 years, with 85% women. Clinical presentations included chest pain, dyspnoea, and cardiogenic shock. A preceding psychological or physical condition perceived as “stress” was reported in 61%. At a mean follow-up of 675±288 days, none of the patients died of cardiac causes, but two patients had a recurrence of symptoms.

Conclusions

This is the largest cohort of TABS patients reported out of Europe so far. The good overall prognosis and low likelihood of recurrence were confirmed.

Keywords: Transient apical ballooning syndrome, Takotsubo cardiomyopathy, Acute coronary syndrome, ST-segment elevation myocardial infarction, Emotional stress