Background: Takotsubo cardiomyopathy (TTC), also known as transient apical ballooning syndrome is characterized by sudden temporary systolic dysfunction of the apical and/or mid-segments of the left ventricle. It is hard to distinct it from acute myocardial infarction (MI), and hence its diagnosis is challenging.
Aim: To construct a score for the diagnosis of TTC in order to differentiate it from acute MI.
Methods: We enrolled 82 consecutive patients with a diagnosis of TTC and 56 ST elevation MI (STEMI) patients at the Chaim Sheba Medical Center. Clinical characteristics at baseline; past medical history were reviewed and recorded. TTC scoring included a total of 10 points: Female gender: 2 points; Age ≥ 65: 2 points; Stressful event: 2 points; positive Troponin on admission: 1 point; ECG with ST segment elevation in I,AVL on admission: 2 points and any other ST elevation: 1 point and EF≤35: 1 point.
Results: TTC patients were older (65.8 ±11 vs. 59.9 ±13 years old); consisted more of female gender (90% vs. 16%); presented less frequently with chest pain (75 % vs. 100%) and had less ST-segment elevation upon admission (70% vs. 100%). They had more positive troponin levels on admission (92% vs. 48%) and had suffered more frequently from severe lower left ventricular ejection fraction (i.e. <35%) (60% vs. 9%). Lastly, 30 days mortality rate was higher in the TTC (3.6% vs. 1.7%).
TTC scoring ≥ 5 was 85% vs. 14% in TTC and STEMI group respectively, (p<0.001). Moreover, no one in the STEMI group had a TCC score >6.
Conclusion: TTC score is a simple and a reliable tool that can assist in the diagnosis and differentiation of TCC from STEMI patients.
