Reverse or Inverted Takotsubo Cardiomyopathy (Reverse Left Ventricular Apical Ballooning Syndrome) Presents at a Younger Age Compared With the Mid or Apical Variant and Is Always Associated With Triggering Stress

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Abstract
Takotsubo cardiomyopathy is usually caused by triggering stress. It has 4 different subtypes. There has been no consensus to differentiate various types with regard to characteristics of the patient population. The goal of this study was to evaluate any clinical differences between the reverse type in comparison to common apical and mid-cavitary types using case series of reported cases. The authors searched published articles in PubMed and Medline on takotsubo or stress-induced cardiomyopathy. They included only cases that reported different types of takotsubo cardiomyopathy with baseline clinical characteristics. They identified 60 patients for the final analysis. The types of takotsubo cardiomyopathy seen in this study are classified as classic (66.7%), mid-cavitary (10%), or reverse (inverted) (23.3%). Patients with reverse-type takotsubo cardiomyopathy were significantly younger compared with those with other types (mean age, 36 for reverse vs 62 for other types; P<.001). Furthermore, all patients with the reverse type had physical or mental stress, whereas those with other types had no triggering stress in 02% of the reported cases (P<.0001). Among patients presenting with takotsubo cardiomyopathy, the reverse or inverted variant presents at a younger age and is always associated with a triggering of emotional or physical stress.