Neurogenic stunned myocardium and takotsubo cardiomyopathy are the same syndrome: a pooled analysis

Abstract

Neurogenic stunned myocardium (NSM) and Takotsubo cardiomyopathy (TCM) are two syndromes that coexist in the medical literature. They share many common features. We hypothesized that they, in fact, represent the same syndrome. We collected and analyzed case reports of transient left ventricular (LV) dysfunction in neurologic conditions. Cases were compared based on the diagnosis and then based on the pattern of wall motion abnormality. Of 112 cases, 61 were diagnosed as TCM and 37 as NSM, and in 14 cases, the authors used both terms. Overall, the patients with NSM were younger, and the severity of LV systolic dysfunction and timing of recovery was similar, as well as the prevalence of cardiac enzyme elevation. Pulmonary edema on presentation was more prevalent in patients with NSM while chest pain and ST-segment elevation was more common in patients with TCM. While only regional, predominantly apical, wall motion abnormality was described in TCM, some patients in the NSM group had global LV dysfunction. NSM and TCM likely share the same mechanism and pathologic substrate. Their natural course is almost identical. They both likely represent the same syndrome of stress-induced cardiomyopathy. Current definition of stress-induced cardiomyopathy includes only regional wall motion abnormalities. It should be expanded to include all varieties of wall motion abnormalities including global hypokinesis.