Clinical spectrum of tako-tsubo cardiomyopathy in Germany: results of the tako-tsubo registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK)

Background: Tako-tsubo cardiomyopathy (TTC) was first described in 1990 in Japan. A TTC registry was initiated by the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (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.