Takotsubo cardiomyopathy, alternatively Takotsubo syndrome, is a primary acquired cardiomyopathy characterised by transient left ventricular dysfunction. Several sets of diagnostic criteria exist and are variably utile in various clinical and research settings.
International Takotsubo Diagnostic Criteria (2018)
- evidence of transient left ventricular dysfunction with abnormal wall motion in an apical, focal, midventricular, or basal distribution 2
- classic description as apical "ballooning" or dyskinesis
- typically involves more than one discrete coronary artery territory
- involvement of the right ventricle may also occur
- a preceding trigger, which may be physical and/or emotional, may be present but is not required
- triggers may also include neurologic conditions or a phaeochromocytoma
- subarachnoid haemorrhage, status epilepticus, and ischaemic stroke are potential culprits
- usually associated with new electrocardiographic abnormalities, may rarely be absent
- these include ST segment deviation, T wave inversion, and prolongation of the corrected QT interval
- moderate elevation of cardiac biomarkers such as creatine kinase and troponin common
- marked elevation of brain natriuretic peptide concentrations also common
- may exist concomitantly with significant coronary artery disease
- absence of factors suggestive of infectious myocarditis
- may be evaluated with cardiac magnetic resonance imaging (MRI)
- predilection to affect postmenopausal females
Revised Mayo Clinic diagnostic criteria (2008)
- transient wall motion abnormalities involving the left ventricular mid segments with or without apical involvement, involved territory extends beyond a discrete epicardial coronary artery vascular distribution, and a stressful trigger is typically (but not obligatorily) present 1
- absence of acute plaque rupture demonstrated on coronary angiography and absence of obstructive coronary artery disease
- new ST segment elevation and/or T wave inversion demonstrated on an electrocardiogram or a modest rise in troponin levels
- no evidence of myocarditis or a phaeochromocytoma