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Takotsubo cardiomyopathy in acute ischemic stroke

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Abstract

Objective

Takotsubo cardiomyopathy, which is characterized by transient left ventricular apical ballooning, is a known complication of subarachnoid hemorrhage. The aim of this study was to identify the clinical characteristics of acute ischemic stroke patients who experienced development of takotsubo cardiomyopathy.

Methods

Seven patients who were diagnosed as having takotsubo cardiomyopathy based on their electrocardiographic and echocardiographic findings were studied. They were selected from among 569 consecutive patients who were admitted to our stroke center within 24 hours after onset of acute ischemic stroke. The findings of nine previously published cases were also reviewed.

Results

All seven patients were women, and six were 75 years or older. The initial National Institutes of Health Stroke Scale score ranged from 3 to 28. The culprit infarcts included or were close to the insular cortex in six patients and were located extensively in the vertebrobasilar arterial territory in the other patient. Abnormal findings on electrocardiographic monitoring appeared within 10 hours after stroke onset in five patients and at 6 and 12 days, respectively, in the other two patients. The cardiomyopathy was symptomatic in only two patients. Plasma brain natriuretic peptide levels exceeded the upper normal limit by 10-fold in all patients. The previously published cases were mostly women and had mainly vertebrobasilar stroke.

Interpretation

Takotsubo cardiomyopathy is not a rare complication of acute ischemic stroke. It most often occurred soon after stroke onset and was commonly asymptomatic. Female sex and insular damage were predominant features of the stroke patients who experienced development of takotsubo cardiomyopathy. Ann Neurol 2008

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