Background: Tako-Tsubo (TT) syndrome is a clinical entity mimicking acute coronary syndrome (ACS). Some cases have reported TT syndrome associated to significant dynamic intraventricular pressure gradient. The aim of our study was to determine the prevalence and the features of this syndrome in a large population presenting with ACS.

Methods: Among 8705 pts refereed to 2 catheterization laboratories, this study consisted of 2726 pts who underwent coronary arteriography for suspicion of ACS. All pts underwent an echocardiography, a coronary arteriography and a left ventricular angiogram < 48 hours after the symptom onset. We defined TT syndrome as (1) an acute chest pain during stressful incident associated with ST-segment abnormalities and/or increased serum troponin level, (2) regressive systolic dysfunction, and (3) no coronary lesions. In-hospital and long-term follow-up was collected in all patients.

Results: Among the 2726 pts, 23 pts (mean age: 68 ± 13 yo) presented with a TT syndrome. The prevalence of TT syndrome in our population was 0.8%. Five patients (22% of TT syndrome) exhibited a dynamic intraventricular pressure gradient. This finding was performed using echocardiography. The mean peak of plasma creatinine kinase and of troponin I was respectively 301 ± 263 UI/l et 5.6 ± 5.2 µg/l. The mean left ventricular ejection fraction (LVEF) by left ventricular angiogram and by echocardiography was respectively 45 ± 5% and 37 ± 6%. Twenty-one pts presented a typical pattern of TT syndrome with akinesia of the mid and distal segments of all walls, with compensatory hyperkinesia of the base. Two pts presented a partial and circular pattern of TT syndrome. No patient with dynamic intraventricular pressure gradient received inotropic agents, avoiding to worsen the degree of obstruction. All pts had a recovery of wall motion abnormalities and LVEF was rapidly improved, as observed with echocardiographic follow-up. No pts with TT syndrome died or presented a major adverse cardiovascular event.

Conclusion: This study suggests that the prevalence of TT syndrome in our population of ACS is 0.8% and 22% of TT syndrome exhibited a dynamic intraventricular pressure gradient. Echocardiography should be systematically performed, allowing to guide treatment, when dynamic intraventricular pressure gradient is found.