Frequency of Takotsubo Cardiomyopathy in Postmenopausal Women Presenting With an Acute Coronary Syndrome

      Takotsubo cardiomyopathy (TC) may be more common than previously reported in postmenopausal women (PMW) presenting with acute coronary syndrome (ACS). TC often masquerades as an ACS with electrocardiographic changes, elevated troponins, and/or chest discomfort. Its exact incidence in ACS is unknown but most studies suggest it is 1% to 2.2%. As most patients with TC are PMW, it was hypothesized that the incidence would be greater in this population. A prospective evaluation was carried out in all middle-aged and older women (≥45 years of age) presumed to be peri- or postmenopausal with an elevated troponin presenting to a community hospital over a 1-year period (July 2011 to July 2012). Troponin results above the upper limit of normal were screened on a daily basis through a computerized system. The patients' in-hospital charts were reviewed and determined if they fulfilled the criteria for acute myocardial infarction according to the universal definition of myocardial infarction. Prespecified criteria were used to identify all patients with TC. Of the 1,297 PMW screened for positive troponins, 323 patients (24.9%) fulfilled the criteria for acute myocardial infarction and of these, 19 (5.9%) met the prespecified criteria for TC. Three additional patients with TC had acute neurologic events. Most patients (81.8%) had the apical variant. In conclusion, TC may be more common than reported in PMW with clinical and laboratory criteria suggesting acute myocardial infarction. Heightened awareness of TC in this population appears warranted.
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        • Pilliere R.
        • Mansencal N.
        • Digne F.
        • Lacombe P.
        • Joseph T.
        • Dubourg O.
        Prevalence of tako-tsubo syndrome in a large urban agglomeration.
        Am J Cardiol. 2006; 98: 662-665
        • Bybee K.A.
        • Prasad A.
        • Barsness G.W.
        • Lerman A.
        • Jaffe A.S.
        • Murphy J.G.
        • Wright R.S.
        • Rihal C.S.
        Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome.
        Am J Cardiol. 2004; 94: 343-346
        • Bybee K.A.
        • Kara T.
        • Prasad A.
        • Lerman A.
        • Barsness G.W.
        • Wright R.S.
        • Rihal C.S.
        Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction.
        Ann Intern Med. 2004; 141: 858-865
        • Kurowski V.
        • Kaiser A.
        • von Hof K.
        • Killermann D.P.
        • Mayer B.
        • Hartmann F.
        • Schunkert H.
        • Radke P.W.
        Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.
        Chest. 2007; 132: 809-816
        • Dorfman T.A.
        • Iskandrian A.E.
        Takotsubo cardiomyopathy: state-of-the-art review.
        J Nucl Cardiol. 2009; 16: 122-134
        • El-Sayed A.M.
        • Brinjikji W.
        • Salka S.
        Demographic and co-morbid predictors of stress (takotsubo) cardiomyopathy.
        Am J Cardiol. 2012; 110: 1368-1372
        • Akashi Y.J.
        • Goldstein D.S.
        • Barbaro G.
        • Ueyama T.
        Takotsubo cardiomyopathy: a new form of acute, reversible heart failure.
        Circulation. 2008; 118: 2754-2762
        • Thygesen K.
        • Alpert J.S.
        • White H.D.
        • Jaffe A.S.
        • Apple F.S.
        • Galvani M.
        • Katus H.A.
        • Newby L.K.
        • Ravkilde J.
        • Chaitman B.
        • Clemmensen P.M.
        • Dellborg M.
        • Hod H.
        • Porela P.
        • Underwood R.
        • Bax J.J.
        • Beller G.A.
        • Bonow R.
        • Van der Wall E.E.
        • Bassand J.P.
        • Wijns W.
        • Ferguson T.B.
        • Steg P.G.
        • Uretsky B.F.
        • Williams D.O.
        • Armstrong P.W.
        • Antman E.M.
        • Fox K.A.
        • Hamm C.W.
        • Ohman E.M.
        • Simoons M.L.
        • Poole-Wilson P.A.
        • Gurfinkel E.P.
        • Lopez-Sendon J.L.
        • Pais P.
        • Mendis S.
        • Zhu J.R.
        • Wallentin L.C.
        • Fernandez-Aviles F.
        • Fox K.M.
        • Parkhomenko A.N.
        • Priori S.G.
        • Tendera M.
        • Voipio-Pulkki L.M.
        • Vahanian A.
        • Camm A.J.
        • De Caterina R.
        • Dean V.
        • Dickstein K.
        • Filippatos G.
        • Funck-Brentano C.
        • Hellemans I.
        • Kristensen S.D.
        • McGregor K.
        • Sechtem U.
        • Silber S.
        • Tendera M.
        • Widimsky P.
        • Zamorano J.L.
        • Morais J.
        • Brener S.
        • Harrington R.
        • Morrow D.
        • Lim M.
        • Martinez-Rios M.A.
        • Steinhubl S.
        • Levine G.N.
        • Gibler W.B.
        • Goff D.
        • Tubaro M.
        • Dudek D.
        • Al-Attar N.
        Universal definition of myocardial infarction.
        Circulation. 2007; 116: 2634-2653
        • Madhavan M.
        • Prasad A.
        Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis.
        Herz. 2010; 35: 240-243
        • Bellandi B.
        • Salvadori C.
        • Parodi G.
        • Ebert A.G.
        • Petix N.
        • Del Pace S.
        • Boni A.
        • Pestelli F.
        • Fineschi M.
        • Giomi A.
        • Cresti A.
        • Giuliani G.
        • Venditti F.
        • Querceto L.
        • Gensini G.F.
        • Bolognese L.
        • Bovenzi F.
        [Epidemiology of Tako-tsubo cardiomyopathy: the Tuscany Registry for Tako-tsubo Cardiomyopathy ].
        G Ital Cardiol (Rome). 2012; 13: 59-66
        • Sharkey S.W.
        • Lesser J.R.
        • Zenovich A.G.
        • Maron M.S.
        • Lindberg J.
        • Longe T.F.
        • Maron B.J.
        Acute and reversible cardiomyopathy provoked by stress in women from the United States.
        Circulation. 2005; 111: 472-479
        • Deshmukh A.
        • Kumar G.
        • Pant S.
        • Rihal C.
        • Murugiah K.
        • Mehta J.L.
        Prevalence of Takotsubo cardiomyopathy in the United States.
        Am Heart J. 2012; 164: 66-71.e61

      Linked Article

      • Frequency of Takotsubo Cardiomyopathy in Postmenopausal Women Presenting With an Acute Coronary Syndrome: Still Underdiagnosed
        American Journal of CardiologyVol. 112Issue 3
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          The very interesting and timely study by Sy et al,1 published on May 16, 2013 online ahead of print in The American Journal of Cardiology, is an example of the underdiagnosis of Takotsubo syndrome (TTS), resulting from adherence to the currently prevailing Mayo Clinic diagnostic TTS criteria. The revised version of these criteria requires that obstructive coronary artery disease, based on coronary arteriography and pheochromocytoma, be ruled out before making the diagnosis of TTS.2 The investigators set out to evaluate prospectively the frequency of TTS in peri-, and postmenopausal women (age ≥45 years old) in a consecutive series of 1,297 patients with an increase in cardiac troponin I.
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