Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review

Int J Cardiol. 2008 Mar 14;124(3):283-92. doi: 10.1016/j.ijcard.2007.07.002. Epub 2007 Jul 24.


Background: Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction characterized by transient wall-motion abnormalities involving apical and mid-portions of the left ventricle in the absence of significant obstructive coronary disease.

Methods: Searching the MEDLINE database 28 case series met the eligibility criteria and were summarized in a narrative synthesis of the demographic characteristics, clinical features and pathophysiological mechanisms.

Results: TLVABS is observed in 0.7-2.5% of patients with suspected ACS, affects women in 90.7% (95% CI: 88.2-93.2%) with a mean age ranging from 62 to 76 years and most commonly presents with chest pain (83.4%, 95% CI: 80.0-86.7%) and dyspnea (20.4%, 95% CI: 16.3-24.5%) following an emotionally or physically stressful event. ECG on admission shows ST-segment elevations in 71.1% (95% CI: 67.2-75.1%) and is accompanied by usually mild elevations of Troponins in 85.0% (95% CI: 80.8-89.1%). Despite dramatic clinical presentation and substantial risk of heart failure, cardiogenic shock and arrhythmias, LVEF improved from 20-49.9% to 59-76% within a mean time of 7-37 days with an in-hospital mortality rate of 1.7% (95% CI: 0.5-2.8%), complete recovery in 95.9% (95% CI: 93.8-98.1%) and rare recurrence. The underlying etiology is thought to be based on an exaggerated sympathetic stimulation.

Conclusion: TLVABS is a considerable differential diagnosis in ACS, especially in postmenopausal women with a preceding stressful event. Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Diagnosis, Differential
  • Echocardiography
  • Electrocardiography
  • Humans
  • Magnetic Resonance Imaging
  • Myocardial Contraction
  • Myocardial Infarction / diagnosis
  • Stroke Volume
  • Syndrome
  • Takotsubo Cardiomyopathy / complications
  • Takotsubo Cardiomyopathy / diagnosis*
  • Takotsubo Cardiomyopathy / physiopathology
  • Tomography, Emission-Computed, Single-Photon
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology