Apical-sparing variant of Tako-Tsubo cardiomyopathy: prevalence and characteristics.

Background: Several patterns of Tako-Tsubo cardiomyopathy (TTC) have been described recently.

Aims: To assess the prevalence and characteristics of an apical-sparing variant of TTC.

Methods: This study included consecutive patients admitted to our catheterization laboratory for suspected acute coronary syndrome (ACS). All patients underwent coronary and left ventricular angiography systematically if no significant coronary lesions were found.

Results: Among 2893 patients with a suspected ACS, 38 had confirmed TTC. Nine patients presented with the apical-sparing variant, resulting in a 24% prevalence in our TTC population. At admission, mean left ventricular ejection fraction (LVEF) was significantly higher in patients with apical-sparing TTC (45+/-4% vs 35+/-7%, p=0.01). Patients with classic TTC were significantly older (74+/-10 years vs 63+/-14 years, p=0.01) and had a significantly higher mean heart rate and New York Heart Association functional class (p=0.04 and p=0.002, respectively). Surgical or disease-related stress was found more frequently among patients with the apical-sparing variant (p=0.02). At day 7, mean LVEF was significantly higher in patients with apical-sparing TTC (55+/-6% vs 48+/-6%, p=0.04). At 1-month and 1-year follow-up, no significant difference in LVEF was observed between the two patterns of TTC (p=0.60 and p=0.46, respectively).

Conclusions: The apical-sparing variant of TTC is not rare and differs in several ways from the classic pattern of TTC. Physicians should be aware of and recognize this partial pattern of TTC.