Prevalence of Tako-Tsubo Syndrome among patients with suspicion of acute coronary syndrome referred to our centre Antonio Facciorusso a, ⁎ , Carlo Vigna a , Cesare Amico a , Pompeo Lanna a , Giovanni Troiano a , Mario Stanislao a , Guido Valle b , Tiberio Santoro a , Raffaele Fanelli a a Department of Cardiology, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo (FG), Italy b Department of Nuclear Medicine, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo (FG), Italy Received 14 October 2007; accepted 16 December 2007 Available online 14 April 2008 Abstract Background: The Tako-Tsubo Syndrome is a clinical entity characterized by acute but rapidly reversible left ventricular systolic dysfunction and triggered by emotional or psychological stress. The aim of our study was to determine the prevalence and characteristics of this syndrome among the patients presenting to our Centre with suspicion of acute coronary syndrome. Methods and results: Over a 12-month period (May 2006 to April 2007), among 82 patients referred to our catheterization laboratory with suspicion of acute coronary syndrome, 4 confirmed Tako-Tsubo Syndrome (prevalence 4.87%). The patients referred to our Centre came from Foggia's province above all. The mean age of the population was 65.5 ± 18.48 years (range 49 to 82), with a ratio of men to women of 1:3. The syndrome characterized by acute chest pain with ST-segment elevation, absence of significant lesions in each of the 3 epicardial coronary arteries by angiography, systolic dysfunction (ejection fraction 35 ± 9.12%) with abnormal wall motion of the mid and distal LVand hyperkinesia of the basal LV, and emotional or psychological stress immediately preceding the cardiac events. Among markers of cardiac necrosis, only serum Troponin-I increased in each patients without significant elevation of CPK and with mild elevation of CK-mb and LDH. 2 patients developed hemodynamic instability. Each patient survived with normalized ejection fraction (54.25 ± 5.05%) and rapid restoration to previous functional cardiovascular status within 4 weeks. Conclusions: A reversible cardiomyopathy triggered by emotional or psychological stress occurs in elderly women above all and mimic acute coronary syndrome. The diagnosis of Tako-Tsubo Syndrome is based mainly on coronary and left ventricular angiography, which excludes the diagnosis of coronary artery disease and recognizes the pattern of wall-motion abnormalities. The different epidemiology of this Syndrome reported in literature demonstrates which this cardiomyopathy is underdiagnosed. © 2008 Elsevier Ireland Ltd. All rights reserved. ⁎ Corresponding author. Tel.: +39 225 0882410351. E-mail address: facciorusso@libero.it (A. Facciorusso). Keywords: Cardiomyopathy; Stress; Women 1. Introduction Several studies [1–12] have reported a new medical entity called Tako-Tsubo Syndrome or transient left ventricular (LV) apical ballooning, which mimics acute coronary syndrome. This entity is characterized by acute chest pain with ST-seg- ment elevation, absence of significant lesions in each of the 3 epicardial coronary arteries by angiography, systolic dysfunc- tion with abnormal wall motion of the mid and distal LVand hyperkinesia of the basal LV, and emotional or psychological stress immediately preceding the cardiac events. The knowl- edge of the Tako-Tsubo Syndrome’s physiopathology is not still clear; potential mechanisms are: microvascular spasm, impaired fatty acid metabolism, transient obstruction to LV outflow, catecholamine-mediated cardiotoxicity. The aim of our study was to determine the prevalence and characteristics of this syndrome among the patients presenting to our Centre with suspicion of acute coronary syndrome. 2. Methods From our database we reviewed retrospectly all patients with suspicion of acute coronary syndrome referred to our catheterization laboratory during a period of 12 months (May 2006 to April 2007). Among this patients we re- cognized the Tako-Tsubo Syndrome. We defined Tako- Tsubo Syndrome as acute chest pain with ST-segment elevation, absence of significant lesions in each of the 3 epicardial coronary arteries by angiography, systolic dys- function with abnormal wall motion of the mid and distal LV and hyperkinesia of the basal LV (apical ballooning), and emotional or psychological stress immediately preced- ing the cardiac events. Each of the 4 patients, at present- ation, was assessed with history and physical examination, 12-lead ECG, serum Troponin-I, CK, CK-mb and LDH. All patients underwent coronary arteriography and LV 255 Letters to the Editor