Long term sequelae of takotsubo cardiomyopathy
Generally everyone thinks of takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome) as a cause of reversible left ventricular dysfunction in response to a major lifetime stress. Initial reports which caught attention were in elderly women who had lost their spouses and hence the term broken heart syndrome. As it involved the apical segments of the left ventricle, not conforming to any single vascular territory, another eponym was apical ballooning syndrome. Recent work has questioned the complete reversal of cardiac pathology in this condition [1,2,3], though left ventricular ejection fraction rapidly returns to normal. They have noted long term mortality comparable to that of myocardial infarction. Hence Caroline Scally and colleagues  in the current issue of Circulation, studied the long term functional and metabolic changes after stress cardiomyopathy. Thirty seven of their patients who had stress cardiomyopathy one year or more earlier completed the Minnesota Living with Heart Failure Questionnaire. They also underwent detailed clinical evaluation, biomarker estimation, echocardiography, cardiac magnetic resonance imaging and 31P magnetic resonance spectroscopy. They demonstrated long lasting symptomatic and functional impairment in cardiac status after takotsubo cardiomyopathy even though left ventricular ejection fraction improved. This would suggest persistent long term subclinical cardiac dysfunction.
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- Scally C, Rudd A, Mezincescu A, Wilson H, Srivanasan J, Horgan G, Broadhurst P, Newby DE, Henning A, Dawson DK. Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy. Circulation. 2018 Mar 6;137(10):1039-1048. doi: 10.1161/CIRCULATIONAHA.117.031841. Epub 2017 Nov 11.