Prevalence and Clinical Features of Takotsubo Cardiomyopathy in Taiwanese Patients Presenting with Acute Coronary Syndrome

Background: Takotsubo cardiomyopathy (TCM), which has similar manifestations to acute coronary syndrome (ACS), was originally described in Japanese populations and has since been reported worldwide. However, sufficient epidemiological data from other Asian populations is lacking. The aim of this study was to evaluate the incidence of TCM and associated clinical features in patients presenting with ACS to a community hospital in southern Taiwan. Methods: Cases of 1338 patients who underwent coronary angiography for ACS between January 2003 and January 2009 were reviewed to identify TCM. Demographic characteristics, clinical histories, presenting symptoms, laboratory data, and electrocardiographic, echocardiographic and angiographic findings were noted. Results: Twelve patients met the criteria for clinical diagnosis of TCM (0.9%). All except for one were postmenopausal women. The initial presentation was chest pain in 8 patients. Seven patients developed symptoms after physical stress. Although ST-segment elevation was observed in 9 patients (75%) upon initial electrocardiography, all developed T-wave inversion. Nine patients presented with a typical pattern of apical ballooning, whereas 3 presented with atypical midventricular ballooning. All patients recovered from wall motion abnormalities, and the mean left ventricular ejection fraction increased from 4±10% to 67±6%. Six patients experienced complications such as pulmonary edema or ventricular tachycardia during acute phase; however there were no deaths during hospitalization or follow-up. Conclusion: The prevalence of TCM in our cohort of Taiwanese patients presenting with ACS was 0.9%. The prevalence was markedly higher in women. TCM should be inc1uded in the differential diagnosis of ACS, especially in postmenopausal woman following a stressful trigger.