A systematic review on focal takotsubo syndrome: a not-so-small matter
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A systematic review on focal takotsubo syndrome: a not-so-small matter Giacomo Tini 1 & Luca Rosario Limite 2 & Luca Arcari 2 & Luca Cacciotti 3 & Domitilla Russo 2 & Matteo Sclafani 2 & Claudio Brunelli 1 & Massimo Volpe 2,4 & Camillo Autore 2 & Maria Beatrice Musumeci 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A focal contraction pattern in takotsubo syndrome (TTS) is considered rare. Due to its peculiar presentation, which includes segmental left ventricular (LV) regional wall motion abnormalities (RWMA), the focal TTS pattern may be hardly differentiable from other entities, such as myocarditis or myocardial infarction. We performed a comprehensive systematic literature review researching for works in English published in Journals indexed in Embase, available online for consultation, using the following keywords (in Title and/or Abstract): (“takotsubo” OR “broken heart” OR “apical ballooning” OR “stress cardiomyopathy”) AND (“focal” OR “atypical” OR “variant” OR “segments”). Thirty-three papers were retrieved: 17 case reports, 6 case series, and 10 population studies—with a total of 166 focal TTS patients. Prevalence of focal TTS ranged between 0.1% and 14% (pooled mean: 2.8%). Mean age of onset (58 years), gender distribution (80% of females), and type of triggers appeared similar to those reported in typical TTS. RWMA more frequently involved the interventricular septum and the anterolateral LV segments, with often preserved LV ejection fraction. In the majority of focal TTS reports that included adequate ECG information (n = 13), abnormalities were localized and not diffuse, always matching RWMA, and in 3 cases, reciprocal changes were observed. No inhospital nor long-term deaths were reported. The focal TTS contraction pattern may be more prevalent than currently reported. Though possibly presenting with similar demographic background compared with typical TTS, the focal variant might be characterized by peculiar ECG modifications and better prognosis. Keywords Takotsubo syndrome . Focal variant . Electrocardiogram . Prognosis
Introduction The greater clinical awareness on takotsubo syndrome (TTS) has led to an increasing recognition and diagnosis of the socalled atypical variants [1–5]. Among these, the focal TTS pattern is of particular interest, due to its peculiar presentation with segmental—not diffuse/circumferential, i.e., expanding beyond a single coronary territory—left ventricular (LV)
regional wall motion abnormalities (RWMA) [6]. For this reason, the focal TTS pattern represents a clinical challenge and may be considerably difficult to identify and differentiate from myocarditis or myocardial infarction [1, 7]. To date, focal TTS has been specifically addressed in only one study [6], and its description mostly relies on case reports. Aim of the present study is to provide a systematic review of literature regarding focal TTS, in order to investigate its prevalence and clinical and instrumental features.
* Luca Rosario Limite [email protected]
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