International Journal of Cardiology 129 (2008) 272 – 273 www.elsevier.com/locate/ijcard
Letter to the Editor
Transient mid-ventricular dyskinesia: A variant of Takotsubo syndrome Giovanni Fazio a,⁎, Giuseppina Novo a , Salvatore Azzarelli c , Salvatore Evola a , Giuseppe Barbaro b , Loredana Sutera a , Gabriele Di Gesaro a , Yoshihiro J. Akashi d , Salvatore Novo a b
a Department of cardiology, University of Palermo, Italy Cardiology service, Department of Pathophysiology, La Sapienza University, Rome, Italy c Department of cardiology, “Cannizzaro” Hospital, Catania, Italy d Department of cardiology, University School of Medicine, Kawasaki-city, Japan
Received 28 June 2007; received in revised form 7 July 2007; accepted 8 July 2007 Available online 26 November 2007
Abstract Takotsubo Cardiomyopathy is characterized by a reversible systolic left ventricular apical ballooning. A new pattern of dyskinesia in the absence of angiographic evidence of coronary artery stenosis has been indicated like a variant of takotsubo cardiomiopathy: mid-ventricular akinesis with preservation of apical and basal contractilities revealed at echocardiograms and ventriculographies. We report the case of a 65 years old patient with this pattern, reverted in 4 weeks. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Takotsubo Cardiomyopathy; Mid-ventricular dyskinesia; Echocardiograms; Ventriculographies
Takotsubo Cardiomyopathy is characterized by a reversible systolic left ventricular apical ballooning [1] associated with chest pain. Electrocardiographic abnormalities and minimal rise of serum cardiac markers resembles acute myocardial infarction, but without evidence of myocardial ischemia or injury [2–7]. No angiographic evidence of coronary artery stenosis is noticed in these patients and the ventricular systolic function is usually recovered in few weeks [4–7]. Recently some authors [4–7] reported a new pattern of dyskinesia in absence of angiographic evidence of coronary artery stenosis, that they indicated while a variant of takotsubo cardiomiopathy: mid-ventricular akinesis with preservation of apical and basal contractilities revealed at echocardiograms ⁎ Corresponding author. Via santa maria di Gesu' 25, 90124 Palermo, Italy. Tel.: +39 3334439962. E-mail address:
[email protected] (G. Fazio). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.07.155
and ventriculographies [5–7]. A low incidence has been described for this one. About our casuistic, in 45 patients, only 1 presented a mid-ventricular dyskinesia. A 65 years old patients was admitted for acute chest pain. She did not show cardiovascular risk factors. The patient clinical history revealed an emotional stress event, the premature death of the husband, occurred only two days before admission. The E.C.G. showed ST segment elevation in DI and aVL and T wave inversion in all the leads. The blood tests revealed normal levels of myocardial enzymes. During in-hospital stay, ECG showed a progressive deepening of negative T wave in leads that explore the lateral segments of the left ventricle. Echocardiography, at that time, exhibited mid-ventricular akinesis of LV with basal and apical regional hyperkinesis and an EF of about 45%. Patient underwent cardiac catheterization that showed normal coronary arteries, the ventriculography confirmed the echocardiographic pattern (Fig. 1). A medical drug therapy
G. Fazio et al. / International Journal of Cardiology 129 (2008) 272–273
273
Fig. 1. Telesistolic and telediastolic frames of a mid-ventricular dyskinesia: an akinesis of the mid-ventricular segments can be observed.
with aspirin and enoxaparin was started. This pattern reverted in 4 weeks and therapy was suspended.
[4]
References [1] Donohue D, Movahed MR. Clinical characteristics, demographics and prognosis of transient left ventricular apical ballooning syndrome. Heart Fail Rev 2005;10:311–6. [2] Miyoshi S, Hara Y, Ogimoto A, Shigematsu Y, Okura T, Higaki J. Repeated changes of electrocardiogram caused by Takotsubo-type cardiomyopathy: a case with hypertrophic nonobstructive cardiomyopathy. Nippon Ronen Igakkai Zasshi 2005;42:112–5. [3] Ogura R, Hiasa Y, Takahashi T, et al. Specific findings of the standard 12-lead ECG in patients with ‘ Takotsubo’ cardiomyopathy: comparison
[5] [6]
[7]
with the findings of acute anterior myocardial infarction. Circ J 2003;67: 687–90. Matsuoka K, Okubo S, Fujii E, et al. Evaluation of the arrhythmogenecity of stress-induced “Takotsubo cardiomyopathy” from the time course of the 12-lead surface electrocardiogram. Am J Cardiol 2003;92: 230–3. Tamura A, Kawano Y, Watanabe T, et al. A report of 2 cases of transient mid-ventricular ballooning. Int J Cardiol 2007;122:e10–12. Yasu T, Tone K, Kubo N, Saito M. Transient mid-ventricular ballooning cardiomyopathy: a new entity of Takotsubo cardiomyopathy. Int J Cardiol 2006;110(1):100–1. Kurisu S, Inoue I, Kawagoe T, et al. Variant form of tako-tsubo cardiomyopathy. Int J Cardiol Jul 10 2007;119(2):e56–8 [Electronic publication 2007 Apr 25].
