J Cardiovasc Ultrasound.  2013 Sep;21(3):116-122. 10.4250/jcu.2013.21.3.116.

Different Characteristics between Patients with Apical and Non-Apical Subtypes of Stress-Induced Cardiomyopathy

• Lee SH
• Kim WH
• Lee SR
• Rhee KS
• Chae JK
• Ko JK

• KMID: 1500190
• DOI: http://doi.org/10.4250/jcu.2013.21.3.116

Abstract

BACKGROUND
Stress-induced cardiomyopathy (SCM) is characterized by apical ballooning on echocardiography, but some of SCM patients show non-apical involvement and their characteristics are not well defined.
METHODS
We investigated 56 patients that were diagnosed as SCM and divided them into 2 groups: apical ballooning syndrome (ABS, n = 49, 87.5%) and non-apical ballooning syndrome (N-ABS, n = 7, 12.5%) groups. Patients with N-ABS were significantly younger than those of the ABS group (52 +/- 11 vs. 73 +/- 10 years, p < 0.001).
RESULTS
Types of preceding stressors and clinical presentation including chest pain, pulmonary edema, cardiogenic shock and in-hospital mortality were comparable between the two groups. In the N-ABS group, wall motion score index was significantly lower than in the ABS group (1.61 +/- 0.35 vs. 1.93 +/- 0.31, p = 0.016). On electrocardiogram (ECG), T-wave inversion (57.1% vs. 95.8%, p < 0.001) were less frequent in the N-ABS than in the ABS group. Furthermore, maximum QT and corrected QT (QTc) intervals in the N-ABS patients were significantly shorter than the ABS patients (QT, 419.9 +/- 66.1 vs. 487.3 +/- 79.6 ms, p = 0.038; QTc, 479.0 +/- 61.9 vs. 568.0 +/- 50.5 ms, p < 0.001).
CONCLUSION
Patients with the N-ABS showed not only atypical echocardiographic findings, but also atypical clinical and ECG manifestations. Integrated consideration is needed to reach a diagnosis of the non-apical subtype of SCM.

Keyword

Stress cardiomyopathy; Echocardiography

MeSH Terms

Chest Pain
Echocardiography
Electrocardiography
Hospital Mortality
Humans
Pulmonary Edema
Shock, Cardiogenic
Takotsubo Cardiomyopathy*

Figure

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  Fig. 1 Three cases of stress-induced cardiomyopathy (SCM). Apical four-chamber views in diastole (A) and in systole (B) of a 75-year-old woman with apical ballooning SCM subtype and right ventricular (RV) involvement. Note ballooning of the mid to apical segments and hyperkinesis of the base of the left ventricle (LV). The arrow indicates concomitant ballooning of the RV apex during systole. Apical long-axis views in diastole (C) and in systole (D) of an 82-year-old woman with non-apical ballooning subtype of SCM involving midventricle. Apical four-chamber views in diastole (E) and in systole (F) of a 54-year-old man with non-apical ballooning subtype of SCM involving basal segments. Note ballooning of the LV base during systole.

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