To the Editor:
I very much enjoyed reading the review article on takotsubo syndrome (TTS) by Sharkey and Maron,1
published in the August 2014 issue of the Journal, in which they covered comprehensively all the facets of TTS, based on their experience, and the large, daily expanding relevant literature. I would appreciate the response of the authors on 2 issues: (1) regarding their comment “Furthermore, left ventricular (LV) diastolic function is also acutely disturbed, with an upward shift in the LV diastolic pressure-volume curve, resulting in substantially elevated LV end-diastolic pressure (LVEDP) without significant increase in LV end-diastolic volume”, most authors report that the LVEDP is normal, or even low;2–4
and (2) regarding their comment “Persistence of mitral valve systolic anterior motion and outflow tract obstruction (with septal hypertrophy) after recovery may indicate coexisting hypertrophic cardiomyopathy (HCM)”; one should be careful not to prematurely diagnose HCM, because septal and apical “hypertrophy” may represent persisting myocardial edema, because of TTS.5–9
Disclosures
Conflicts of Interest: None.
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John E. Madias, MD
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Icahn School of Medicine at Mount Sinai, New York, NY;
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Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA
(Released online November 21, 2014)
References
- 1.
Sharkey SW, Maron BJ. Epidemiology and clinical profile of takotsubo cardiomyopathy. Circ J 2014; 78: 2119–2128.
- 2.
Redfors B, Shao Y, Omerovic E. Stress-induced cardiomyopathy (Takotsubo): Broken heart and mind? Vasc Health Risk Manag 2013; 9: 149–154.
- 3.
Chong CR, Neil CJ, Nguyen TH, Stansborough J, Law GW, Singh K, et al. Dissociation between severity of takotsubo cardiomyopathy and presentation with shock or hypotension. Clin Cardiol 2013; 36: 401–406.
- 4.
Redfors B, Shao Y, Ali A, Sun B, Omerovic E. Rat models reveal differences in cardiocirculatory profile between Takotsubo syndrome and acute myocardial infarction. J Cardiovasc Med (Hagerstown)
2014 August 8, doi:10.2459/JCM.0000000000000088.
- 5.
Kato T, Ban Y, Kuruma S, Ishida S, Doi C, Iura T, et al. Two cases of reversible left ventricular hypertrophy during recovery from Takosubo cardiomyopathy. Echocardiography 2013; 30: E92–E94, doi:10.1111/echo.12139.
- 6.
Madias JE. Two cases of reversible left ventricular hypertrophy during recovery from takotsubo cardiomyopathy: Hypertrophy or myocardial edema after an attack of takotsubo syndrome? Echocardiography 2013; 30: 989.
- 7.
Hwang HJ, Lee HM, Yang IH, Kim DH, Byun JK, Sohn IS. Evolutionary change mimicking apical hypertrophic cardiomyopathy in a patient with takotsubo cardiomyopathy. Echocardiography
2014 August 11, doi:10.1111/echo.12722.
- 8.
Roy RR, Hakim FA, Hurst RT, Simper D, Appleton CP. Two cases of apical ballooning syndrome masking apical hypertrophic cardiomyopathy. Tex Heart Inst J 2014; 41: 179–183.
- 9.
Madias JE. Apical hypertrophy is not due to “masked” apical hypertrophic cardiomyopathy, but to transient residual apical myocardial edema from Takotsubo syndrome. Tex Heart Inst J
2014 (in press).