International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology

Jelena-Rima Ghadri, Ilan Shor Wittstein, Abhiram Prasad, Scott Sharkey, Keigo Dote, Yoshihiro John Akashi, Victoria Lucia Cammann, Filippo Crea, Leonarda Galiuto, Walter Desmet, Tetsuro Yoshida, Roberto Manfredini, Ingo Eitel, Masami Kosuge, Holger M Nef, Abhishek Deshmukh, Amir Lerman, Eduardo Bossone, Rodolfo Citro, Takashi Ueyama, Domenico Corrado, Satoshi Kurisu, Frank Ruschitzka, David Winchester, Alexander R Lyon, Elmir Omerovic, Jeroen J Bax, Patrick Meimoun, Guiseppe Tarantini, Charanjit Rihal, Shams Y-Hassan, Federico Migliore, John D Horowitz, Hiroaki Shimokawa, Thomas Felix Lüscher, Christian Templin, Jelena-Rima Ghadri, Ilan Shor Wittstein, Abhiram Prasad, Scott Sharkey, Keigo Dote, Yoshihiro John Akashi, Victoria Lucia Cammann, Filippo Crea, Leonarda Galiuto, Walter Desmet, Tetsuro Yoshida, Roberto Manfredini, Ingo Eitel, Masami Kosuge, Holger M Nef, Abhishek Deshmukh, Amir Lerman, Eduardo Bossone, Rodolfo Citro, Takashi Ueyama, Domenico Corrado, Satoshi Kurisu, Frank Ruschitzka, David Winchester, Alexander R Lyon, Elmir Omerovic, Jeroen J Bax, Patrick Meimoun, Guiseppe Tarantini, Charanjit Rihal, Shams Y-Hassan, Federico Migliore, John D Horowitz, Hiroaki Shimokawa, Thomas Felix Lüscher, Christian Templin

Abstract

Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.

Figures

Figure 1
Figure 1
Historical Japanese octopus trap (left). Courtesy of Dr Templin, University Hospital Zurich, Zurich, Switzerland. Left ventriculogram of the first reported case of takotsubo syndrome. Diastole (A) and systole (B) during the acute phase of takotsubo syndrome. Recovery of left ventricular wall motion abnormality two weeks after the event (C and D). Courtesy of Dr Dote, Hiroshima City Asa Hospital, Hiroshima, Japan.
Figure 2
Figure 2
Age and sex distribution of patients with takotsubo syndrome. Reprinted with permission from Templin et al.
Figure 3
Figure 3
Emotional and physical stress factors precipitating takotsubo syndrome. Reprinted, modified, and translated with permission from Schlossbauer et al. COPD, chronic obstructive pulmonary disease; PRES, posterior reversible encephalopathy syndrome; TIA, transient ischaemic attack.
Figure 4
Figure 4
The four different types of takotsubo syndrome during diastole (left column) and systole (middle column). The right column depicts diastole in red and systole in white. The blue dashed lines demonstrate the region of the wall motion abnormality. Reprinted and modified with permission from Templin et al.

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