[Clinical spectrum of tako-tsubo cardiomyopathy in Germany: results of the tako-tsubo registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)].

BACKGROUND: Tako-tsubo cardiomyopathy (TTC) was first described in 1990 in Japan. A TTC registry was initiated by the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) in order to evaluate the clinical spectrum and the management of patients with this syndrome in Germany.

METHODS: Patients from 37 hospitals were included in the registry if they fulfilled the following criteria: 1. acute chest symptoms or syncope, 2. new ischemic ECG changes with ST-segment elevation ± T-wave inversion, 3. reversible left ventricular regional wall motion abnormality not corresponding to a single coronary artery territory, 4. absence of significant coronary artery stenoses.

RESULTS: 296 of the 324 patients (age 68 ±  12) were women (91 %) and 28 men (9 %). Leading symptoms were angina pectoris (72 %), dyspnoea (16 %), syncope (3 %) or resuscitation/cardiogenic shock (2 %). An antecedent trigger was found in 77  %. Time from symptom onset to hospital admission was 7,6  ±  6,9 hours. An acute coronary syndrome (ACS) was clinically suspected in 87 %. The ECG showed ST-segment elevation in 85 %. Cardiac troponin was elevated in more than 90 % of patients. Left ventricular ejection fraction by angiography was reduced to 49 ± 14 %. Initial medical treatment corresponded to the working diagnosis of an ACS. Catecholamines or an intraaortic balloon pump were necessary in 5 % and 1 %, respectively. Seven patients (2.2 %) died in hospital.

CONCLUSION: TTC afflicts mainly women and presents clinically as an ACS in 87 %. Hospital mortality is low with symptomatic therapy.