Takotsubo cardiomyopathy (diagnostic criteria)

Last revised by Bahman Rasuli on 29 Oct 2021

Takotsubo cardiomyopathy, alternatively Takotsubo syndrome, is a primary acquired cardiomyopathy characterized 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 pheochromocytoma
  • 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
  • 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 pheochromocytoma

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