Review of Cardiac Rupture in Takotsubo Cardiomyopathy

Cardiac rupture as a complication of Takotsubo cardiomyopathy could be more common than recognized.

Takotsubo cardiomyopathy (TSC) is characterized by transient left ventricular apical ballooning, electrocardiographic changes, and mild elevation in cardiac biomarkers without evidence of occlusive coronary artery disease.

Although the clinical outcome in these patients is usually good, a variety of complications such as cardiogenic shock, life-threatening arrhythmias, and cardiac rupture (CR) have been reported, but the underlying mechanism of CR in TSC is unclear.

A team of researchers from several leading medical centers in the United States headed by Sanjay Kumar, MD, of the department of cardiovascular medicine at the SUNY Downstate Medical Center in Brooklyn, N.Y., performed a systematic review of available literature.

The review, which was published in Clinical Cardiology, found that CR as a complication of TSC could be more common than recognized. “Higher double product and ejection fraction suggest higher fluctuation of intracardiac pressure and may cause CR in TSC. Use of beta blockers in TSC may provide protection against CR,” the researchers wrote in the study abstract.

In 2009, the researchers searched MEDLINE for all case reports of TSC with CR and identified 11. They included a patient with TSC with rupture as the 12th case in the TSC cohort with CR as the CR group. They selected 12 case reports of TSC without rupture to serve as controls using a random sampling method.

“All patients in the TSC group with rupture were female and were significantly older than controls. TSC group with rupture had significantly higher frequency of ST elevation in lead II and absence of T-wave inversion in lead V5 on hospital admission than controls,” the authors wrote.

“Mean ejection fraction, systolic blood pressure, and double product, a measure of oxygen demand, was significantly higher in the rupture group compared to controls. The CR group was associated with less frequent use of β-blocker as compared to controls.”

SourceCardiac Rupture in Takotsubo Cardiomyopathy: A Systematic Review [Clinical Cardiology]