Authors:
R. Pilliere¹, N. Mansencal¹, F. Digne¹, P. Lacombe¹, T. Joseph¹, O. Dubourg¹, ¹Boulogne-Billancourt - France,

Background: Several studies have recently reported a new medical entity called Tako-Tsubo (TT) syndrome. The aim of our study was to determine the prevalence and the features of this syndrome in a large population presenting with ACS.

Methods: Among 4551 pts refereed to our cath-lab, this study consisted of 1613 pts who underwent coronary arteriography for suspicion of ACS over an 5-year study period. All pts underwent a coronary arteriography and a left ventricular angiogram < 48 hours after the onset of the chest pain. We defined TT syndrome as (1) an acute chest pain during stressful incident + ST-segment abnormalities and/or increased serum troponin level, (2) regressive LV systolic dysfunction, and (3) no coronary lesions. In-hospital and long-term follow-up was collected in all pts.

Results: 12 pts presented with TT syndrome. The prevalence of TT syndrome in our population was 0.7%. The mean peak of plasma CK and troponin I was respectively 366 ± 289 UI/l et 7.8 ± 6.2 µg/l. The mean LVEF by left ventricular angiogram and by echocardiography was respectively 44 ± 6% and 35 ± 6%. Ten pts presented a typical pattern (akinesia of the mid and apical segments of all walls). Two pts presented a partial and circular pattern of TT syndrome: 1 pt had an akinesia of the basal and mid segments of all walls and 1 pt had a limited akinesia of the mid segments of all walls. All pts had a recovery of wall motion abnormalities and LVEF was rapidly improved, as observed with echocardiographic follow-up (figure). No pts with TT syndrome died or presented a MACE.

Conclusion: The prevalence of TT syndrome in a population of ACS is 0.7%, reflecting a high underestimated prevalence. Several circumferential partial patterns of LV dysfunction may occur, probably playing a part in this misdiagnosis.