Takotsubo Cardiomyopathy

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We thank Drs Pant et al for their interest in our paper on the diagnosis of Takotsubo cardiomyopathy.¹ The terms “(left ventricular) apical ballooning syndrome” and “Takotsubo cardiomyopathy” refer to the most frequent morphologic presentations (classic and mid-ventricular variants), accounting for the vast majority of cases. This is clearly implied in the first criterion of the revised Mayo Clinic diagnostic criteria which states: “Transient hypokinesis, akinesis, or dyskinesis of the left ventricular mid-segments with or without apical involvement…” The alternative terminology of stress (induced/related/mediated) cardiomyopathy is reasonable, but while it does not have the limitation of implying any specific pattern of regional wall motion abnormality, is also not all-encompassing. The pathogenic implication of this terminology seems desirable, but the fact that a trigger or stressful precipitant is absent in as many as one-third of cases, despite careful investigation, accounts for why this has not been universally accepted. Left ventricular apical ballooning syndrome and Takotsubo cardiomyopathy are the terms used in the European position statement on the classification of cardiomyopathies.²

The naming of medical conditions has often been contentious. One wonders if this debate would have been as prolonged if the Japanese authors of the first description of apical ballooning syndrome had named it after themselves as the Sato-Tateishi-Dote syndrome,³ instead of the somewhat whimsical choice of Takotsubo-like cardiomyopathy. The use of eponyms is widely accepted in medicine,⁴ but they describe neither the clinical presentation nor the pathophysiology of the condition in question. With the passage of time and association, however, the eponym becomes the accepted description for the condition.

After decades of use, we believe the terms Takotsubo cardiomyopathy and apical ballooning syndrome are as easily recognizable as, say, the tetralogy of Fallot. We agree that international consensus on nomenclature should be sought, but this will ultimately be best resolved by focusing our efforts on expanding the understanding of the pathophysiology of this condition.

Disclosures

None.

• Dawn C Scantlebury, MD
• Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
• Abhiram Prasad, MD
• Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Cardiac Research Centre, St. George’s, University of London, London, UK

(Released online October 8, 2014)

References

• 1.    Scantlebury  DC,  Prasad  A. Diagnosis of takotsubo cardiomyopathy: Mayo Clinic criteria. Circ J 2014; 78: 2129–2139.
• 2.    Elliott  P,  Andersson  B,  Arbustini  E,  Bilinska  Z,  Cecchi  F,  Charron  P, et al. Classification of the cardiomyopathies: A position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2008; 29: 270–276.
• 3.    Sato  H,  Tateishi  H,  Dote  K,  Uchida  T,  Ishihara  M. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K, Haze K, Hori M, editors. Clinical aspect of myocardial injury: From ischemia to heart failure. Tokyo, Japan: Kagakuhyoronsha Publishing Co., 1990; 56–64.
• 4.    Fargen  KM,  Hoh  BL. The debate over eponyms. Clin Anat 2014 April 23, doi:10.1002/ca.22409.