Why not just call it tako-tsubo cardiomyopathy: a discussion of nomenclature.

Reverse takotsubo syndrome Atypical basal type takotsubo cardiomyopathy To the Editor: In 1991, Dote et al. (1) reported 5 patients with a novel, acute cardiac condition characterized by distinctive regional left ventricular (LV) systolic dysfunction, in the absence of significant atherosclerotic coronary artery disease. Other Japanese investigators were intrigued by the unusual end-systolic shape of the LV, which resembled the “tako-tsubo,” a fisherman’s pot with a round bottom and narrow neck used for trapping octopuses (2–4). Consequently, the term tako-tsubo was introduced to describe a new cardiomyopathic syndrome characterized by reversible LV systolic dysfunction. Over the next 2 decades, this condition became widely recognized in Japan and subsequently gained international recognition with reports from 6 continents and 14 diverse countries: France, U.S., Belgium, Mexico, Australia, Spain, South Korea, China, Brazil, Germany, Israel, South Africa, Turkey, and Iceland. In the process, this condition acquired a remarkable multiplicity of 75 individual descriptive names (Table 1), emphasizing those disease features most impressive to individual investigators. As additional information emerged, new insights led to more names. With this dramatic surge in recognition, many reports were published (a total of 1,000; increasing to 300/year), and it became evident that this entity has a much more heterogeneous clinical presentation than initially considered (5–8). This is not unexpected when a “new” cardiac disease emerges, and is reminiscent of the circumstance in hypertrophic cardiomyopathy another diverse disease that acquired a myriad of names (9). Most reports of this novel nonischemic cardiomyopathy included several hallmarks (8,10): 1) acute clinical presentation: usually with substernal chest pain, triggered by stressful life circumstance, occurring in elderly women, and requiring differential diagnosis from acute coronary syndrome; 2) LV systolic dysfunction: unique regional contraction abnormalities usually involving the mid-to-distal chamber, not corresponding to the vascular distribution of a single coronary artery; and 3) reversibility: normalization of LV wall motion and global function over several days. However, it is now apparent that a number of these disease features do not apply universally to all patients (5,7,8,10,11). Notably, the commonly used term “stress cardiomyopathy” implies this condition is inevitably triggered by physical or emotional stress (5,8,10). However, in an important minority of patients, a detailed personal history does not elicit an antecedent event. Also, the initial impression that this cardiomyopathy is confined to women of advanced age is no longer tenable, with reports of men and patients 50 years (including children) becoming more frequent (5–8,10). Furthermore, disease reversibility has not proved characteristic of all patients, because a small proportion (approximately 2%) do not survive, even with emergent treatment, and 5% to 10% of patients incur repetitive episodes (8,12). Names Tabulated From Published Reports Table 1 Names Tabulated From Published Reports