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Background: Takotsubo cardiomyopathy (TC) may be considered a form of myocardial infarction with non-obstructive CAD (MINOCA). TC incidence has been reported as 0.3-1.2% of MI events. The proportion of MINOCA patients with TC has not been studied previously. Cardiac MRI helps determine underlying causes in MINOCA with detection of late gadolinium enhancement (LGE), which may occur in a vascular, ischemic pattern or a non-ischemic pattern. Patients with TC are not expected to have LGE.
Methods: Consecutive patients with MI referred to angiography at NYU Langone Medical Center between 4/2014-9/2016 [n=833] were entered into a prospective registry. MI was defined based on the universal definition, which excludes an alternate explanation for troponin elevation (e.g., acute heart failure, hypertensive emergency, clinical diagnosis of myocarditis). 1 patient who received thrombolytic therapy and 2 with no left ventricular (LV) function imaging available were excluded. MINOCA was defined as <50% stenosis in all major epicardial vessels. Left ventricular (LV) wall motion pattern consistent with TC was defined as in the Mayo criteria. The Mayo criteria require normalization of wall motion in follow up. Thus the diagnosis of TC at the time of MI hospitalization is provisional.
Results: MINOCA was present in 125 patients (15%). An LV wall motion pattern consistent with TC was present on initial imaging in 20 patients. Seven of these patients underwent CMR for clinical indications, of whom 2 females had apical transmural (ischemic pattern) LGE on CMR. The remaining 18 patients with no LGE were given a provisional diagnosis of TC (14% of MINOCA). Patients with a provisional diagnosis of TC were more likely to be female than other MINOCA patients (79% vs. 51%, p=0.02) but age (64 ± 16 vs. 69 ± 10 years, p=0.15) and peak troponin (median [IQR]: 1.17 [0.3-2.72] vs 0.69 [0.16-2.29] ng/mL, p=0.38) were similar.
Conclusions: Sixteen percent of MINOCA patients had a TC wall motion pattern. Apical infarction was seen in 29% of patients with a TC wall motion pattern undergoing CMR, indicating a vascular cause of MINOCA rather than TC. CMR should be strongly considered in cases of presumed TC, to distinguish it from apical infarction.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-316
- 2017 American College of Cardiology Foundation