Stress cardiomyopathy classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2] Arzu Kalayci, M.D. [3]

Overview

Stress cardiomyopathy can be divided into several types, depending on the location of regional wall motion abnormality. The area of motion abnormality (whether hypokinesia, dyskinesia or akinesia) can be detected on echocardiography or left ventriculography. The most common type is the apical type, resulting in apical ballooning. In a minority of patients reverse takotsubo have been described in which unlike apical ballooning the basal and mid ventricular segments of the left ventricle become akinetic.

Classification

Stress cardiomyopathy can affect different segments of the heart. The region of wall motion abnormality can be detected on echocardiography or left ventriculography. The most common type of stress cardiomyopathy is the apical type, which results in hypokinesia of the apical and mid-ventricular segments. Stress cardiomyopathy can be divided according to location of wall motion abnormality into:^[1]^[2]^[3]^[4]

Type of Stress Cardiomyopathy	Location of Wall Motion Abnormality	Incidence (%)	Properties
Typical Type(s)	Apical Type	81.7	Apical and mid-segment hypokinesia Hyperkinesia of the basal segment
Atypical Type(s)	Mid-ventricular Type	14.6	Mid-segment hypokinesia, with sparing of the apex
	Basal Type (Reverse Takotsubo)	2.2	Hypokinesia of the base
	Focal Type	1.5	Isolated hypokinesia of a segment of the heart, most commonly the anterolateral segment the left ventricle
	Global Type	Very rare	Global hypokinesia

References

↑ Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015). “Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy”. N. Engl. J. Med. 373 (10): 929–38. doi:10.1056/NEJMoa1406761. PMID 26332547.
↑ Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW (2007). “Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis”. Chest. 132 (3): 809–16. doi:10.1378/chest.07-0608. PMID 17573507.
↑ Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG (2011). “Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy”. JAMA. 306 (3): 277–86. doi:10.1001/jama.2011.992. PMID 21771988.
↑ Win CM, Pathak A, Guglin M (2011). “Not takotsubo: a different form of stress-induced cardiomyopathy–a case series”. Congest Heart Fail. 17 (1): 38–41. doi:10.1111/j.1751-7133.2010.00195.x. PMID 21272226.

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[pmid26332547-1] Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015). “Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy”. N. Engl. J. Med. 373 (10): 929–38. doi:10.1056/NEJMoa1406761. PMID 26332547.

[pmid17573507-2] Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW (2007). “Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis”. Chest. 132 (3): 809–16. doi:10.1378/chest.07-0608. PMID 17573507.

[pmid21771988-3] Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG (2011). “Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy”. JAMA. 306 (3): 277–86. doi:10.1001/jama.2011.992. PMID 21771988.

[pmid21272226-4] Win CM, Pathak A, Guglin M (2011). “Not takotsubo: a different form of stress-induced cardiomyopathy–a case series”. Congest Heart Fail. 17 (1): 38–41. doi:10.1111/j.1751-7133.2010.00195.x. PMID 21272226.

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Stress cardiomyopathy classification

Overview

Classification

References

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