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Li C, Li P, Lu X, Chen Y, Cai P, Teng C, Jing J, Zhang J, Jiang S, Liu Y, Liang J, Wang Y, Wang B. Comparing the in-hospital outcomes of patients with Takotsubo cardiomyopathy and chronic obstructive pulmonary disease. Heart Lung 2025; 70:43-49. [PMID: 39571492 DOI: 10.1016/j.hrtlng.2024.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 11/10/2024] [Accepted: 11/12/2024] [Indexed: 02/24/2025]
Abstract
BACKGROUND Secondary Takotsubo syndrome (TTS) differs from primary TTS in terms of clinical characteristics, management, and prognosis. COPD exacerbation has been recognized as a physical trigger for TTS, but its prognostic implications for secondary TTS are poorly understood. OBJECTIVES The purpose of this study was to examine the effects of COPD on in-hospital outcomes in TTS patients. METHODS Using data from the National Inpatient Sample, patients with a primary diagnosis of COPD and a secondary diagnosis of TTS were identified (COPD-TTS group). Patients with a primary diagnosis of TTS and comorbid COPD were selected as a control group (TTS-COPD group). Then, we compared the in-hospital mortality and the incidence of adverse events before and after propensity score matching. RESULTS 603 patients were included in each of the TTS-COPD and COPD-TTS groups after matching. In both groups, the average age of included patients was about 68 years, and more than 85 percent of them were female. There were no statistically significant differences in the in-hospital mortality or the incident of cardiac arrest, ventricular arrhythmias, and AKI, between the two groups (All, p > 0.05). Patients with COPD-TTS had a higher rate of acute respiratory failure (ARF) (p < 0.001), a lower rate of cardiogenic shock (p = 0.001), and a longer length of hospital stay (LOS) (p < 0.001) compared to patients with TTS-COPD. CONCLUSIONS Patients with COPD-TTS had a higher rate of ARF and a longer LOS but a lower risk of cardiogenic shock compared to patients with TTS-COPD.
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Affiliation(s)
- Chenlin Li
- Department of Cardiology, Jieyang People's Hospital, Jieyang, Guangdong, China
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yan Chen
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Catherine Teng
- Division of Cardiology, Department of Medicine, University of Texas San Antonio, San Antonio, TX, USA
| | - Jie Jing
- Jilin University, Changchun, Jilin, China
| | - Jingkun Zhang
- Cardiovascular Research Institute, University of California San Francisco, CA, USA
| | - Shiyan Jiang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yue Liu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Liang
- Human Anatomy Laboratory, School of Basic Medicine, Xinxiang Medical University, Henan, China
| | - Yanxuan Wang
- Human Anatomy Laboratory, School of International Education, Xinxiang Medical University, Henan, China
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China; Clinical Research Center, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
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Carbone A, Flacco ME, Manzoli L, Lamberti N, Pigazzani F, Rega S, Migliarino S, Ferrara F, Citro R, Manfredini R, Bossone E. Chronobiological variation in takotsubo syndrome: an updated systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102804. [PMID: 39163922 DOI: 10.1016/j.cpcardiol.2024.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/22/2024]
Abstract
Takotsubo syndrome (TTS) might exhibit particular chronobiological patterns in its onset, characterized by variations according to time of the day, day of the week, and month of the year. The aim of this study was to fully explore the temporal patterns (circadian, weekly and seasonal) in the onset of TTS. A systematic review and meta-analysis of literature were conducted for studies (2006-2024) reporting the temporal patterns (circadian, weekly and/or seasonal) in the onset of TTS. Among the 4257 studies retrieved, 20 (including 64,567 subjects) fulfilled all eligibility criteria. Data were aggregated used random effects model as pooled risk ratio and the attributable risk (AR). The proportion analysis (including 8 studies; n=853) showed a decreasing pattern of the pooled rates of TTS shifting from the morning to the night (pooled TTS rates: 34.0%; 32.1%; 21.7%; 12.7% in the morning, afternoon, evening and night, respectively). The same pattern was observed stratifying by type of preceding stressful factor or event, considering physical stressors (pooled rates in the morning and night: 37.6% and 9.8%, respectively), and also in case no event could be identified. The pooled rates of TTS onset peaked on Monday and Tuesday (17.3% and 18.4% respectively), then declined during the week, reaching the lowest rates on Friday and Saturday (10.6% and 10.8%, respectively), with no sex differences. TTS onset reached the highest values on summer, and the lowest in winter (27.9% versus 21.7% in summer and winter, respectively). The TTS morning peak based analyses (∼33% of all the registered events) account for a RR of 1.46 (95% CI: 1.38-1.54), the week-based for a RR of 1.26 (1.16-1.35), the season-based for a RR of 1.04 (1.04-1.05). TTS onset exhibits specific chronobiological patterns, characterized by a peak during the morning hours, and on Monday and Tuesday. Differing from other cardiovascular emergencies TTS was more frequent during summer. Further studies are needed to fully understand the underlying pathophysiological mechanisms in order to tailor relative management and preventive strategies.
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Affiliation(s)
- Andreina Carbone
- Department of Public Health, University of Naples "Federico II", Naples, Italy; Unit of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Elena Flacco
- Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Filippo Pigazzani
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, UK
| | - Salvatore Rega
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | | | | | - Rodolfo Citro
- Clinical Cardiology Unit Medicine and Health Science "V. Tiberio" Department, University of Molise Responsible Research Hospital, Campobasso, Italy
| | - Roberto Manfredini
- Clinical Medicine Unit, Department of Medical Sciences, University of Ferrara, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples "Federico II", Naples, Italy.
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Akhtar MM, Cammann VL, Templin C, Ghadri JR, Lüscher TF. Takotsubo syndrome: getting closer to its causes. Cardiovasc Res 2023:7161872. [PMID: 37183265 DOI: 10.1093/cvr/cvad053] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 05/16/2023] Open
Abstract
Takotsubo syndrome (TTS) accounts for between 1 and 4% of cases presenting clinically as an acute coronary syndrome. It typically presents as a transient cardiac phenotype of left ventricular dysfunction with spontaneous recovery. More dramatic presentations may include cardiogenic shock or cardiac arrest. Despite progress in the understanding of the condition since its first description in 1990, considerable questions remain into understanding underlying pathomechanisms. In this review article, we describe the current published data on potential underlying mechanisms associated with the onset of TTS including sympathetic nervous system over-stimulation, structural and functional alterations in the central nervous system, catecholamine secretion, alterations in the balance and distribution of adrenergic receptors, the additive impact of hormones including oestrogen, epicardial coronary or microvascular spasm, endothelial dysfunction, and genetics as potentially contributing to the cascade of events leading to the onset. These pathomechanisms provide suggestions for novel potential therapeutic strategies in patients with TTS including the role of cognitive behavioural therapy, beta-blockers, and endothelin-A antagonists. The underlying mechanism of TTS remains elusive. In reality, physical or emotional stressors likely trigger through the amygdala and hippocampus a central neurohumoral activation with the local and systemic secretion of excess catecholamine and other neurohormones, which exert its effect on the myocardium through a metabolic switch, altered cellular signalling, and endothelial dysfunction. These complex pathways exert a regional activation in the myocardium through the altered distribution of adrenoceptors and density of autonomic innervation as a protective mechanism from myocardial apoptosis. More research is needed to understand how these different complex mechanisms interact with each other to bring on the TTS phenotype.
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Affiliation(s)
- Mohammed Majid Akhtar
- Royal Brompton and Harefield Hospitals, Imperial College and King's College, London SW3 6NP, UK
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals, Imperial College and King's College, London SW3 6NP, UK
- Center for Molecular Cardiology, University of Zürich, Zürich 8952, Switzerland
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Lu X, Li P, Teng C, Cai P, Jin L, Li C, Liu Q, Pan S, Dixon RA, Wang B. Prognostic factors of Takotsubo cardiomyopathy: a systematic review. ESC Heart Fail 2021; 8:3663-3689. [PMID: 34374223 PMCID: PMC8497208 DOI: 10.1002/ehf2.13531] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by reversible ventricular dysfunction, has similar mortality to acute coronary syndrome. With the growing interest in the diagnosis of and interventions for TCM, many risk factors had been found to affect the prognosis of TCM patients, such as age, sex, and pre-existing diseases. Because of the incomplete understanding of the pathophysiologic mechanism in TCM, evidence-based medical therapy for this condition is lacking. Early intervention on risk factors may improve the outcomes of TCM. In this review, we sought to provide up-to-date evidence on risk factors and medical therapies that affect TCM outcome. We found that male sex, physical triggers, and certain comorbidities such as chronic kidney disease, malignant disease, higher body mass index, sepsis, chronic obstructive pulmonary disease, and anaemia were associated with poor TCM prognosis. In contrast, race, hyperlipidaemia, diabetes mellitus, and mood disorders were not clearly associated with TCM prognosis. We also reviewed the effect of medical therapies on TCM outcome, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, calcium channel blockers, and statins. The evidence that these medications confer a survival benefit on TCM patients is limited. Understanding these prognostic factors could help develop risk-stratification tools for TCM and establish effective prevention and interventions for this not-so-benign condition. Further multicentre clinical studies with large samples and meta-analyses of findings from previous studies are needed to address the inconsistent findings among the many potential risk factors for TCM.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Pengyang Li
- Division of CardiologyPauley Heart Center, Virginia Commonwealth UniversityRichmondVAUSA
| | - Catherine Teng
- Department of MedicineYale New Haven Health Greenwich HospitalGreenwichCTUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Ling Jin
- Department of MedicineMetrowest Medical CenterFraminghamMAUSA
| | - Chenlin Li
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Qi Liu
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Su Pan
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Richard A.F. Dixon
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
- Clinical Research Centerthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Yoshizawa M, Itoh T, Morino Y, Taniai S, Ishibashi Y, Komatsu T, Taguchi I, Nishinari M, Ako J, Kyono H, Furukawa T, Murakami T, Ikari Y, Kato R, Matsumoto K, Sakuma M, Sugimura H, J Akashi Y, Yoshino H. Gender Differences in the Circadian and Seasonal Variations in Patients with Takotsubo Syndrome: A Multicenter Registry at Eight University Hospitals in East Japan. Intern Med 2021; 60:2749-2755. [PMID: 33746167 PMCID: PMC8479227 DOI: 10.2169/internalmedicine.6910-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective The aim of this study was to clarify the circadian and seasonal variations in addition to identify sex-based differences in Japanese patients with Takotsubo syndrome (TTS). Methods The authors conducted a retrospective observational study to analyse the differences between the groups based on sex. Patients The patients were registered out of each institute registry of the acute coronary syndrome (ACS) which contains a total of 10,622 cases in eight academic hospitals in east Japan. Results Data for 344 consecutive TTS (73 male and 271 female) were extracted from each hospital registry. In-hospital mortality was higher in the male group than in the female group (18% vs. 7%; p=0.005). With regard to the circadian variations in all study patients, TTS events occurred most often in the afternoon and least often during the night. Moreover, the patterns of circadian variations in the female and male groups were the same as that of all study patients. TTS events occurred most frequently in the autumn and least often in the spring in the whole study cohort. Moreover, the seasonal variation in the female group showed the same pattern as that of the whole cohort. However, there were no significant seasonal differences in the incidence of TTS in the male group. Conclusion In a multicenter study in Japan, seasonal variation was observed in the female group but not in the male group. Circadian variation was observed in both groups. These results suggested that the pathogenesis and clinical features of TTS might therefore differ according to sex.
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Affiliation(s)
- Michiko Yoshizawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan
- Division of Community Medicine, Department of Medical Education, Iwate Medical University, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Seiichi Taniai
- Department of Cardiology, Kyorin University School of Medicine, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Takaaki Komatsu
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Makoto Nishinari
- Department of Cardiovascular Medicine, Kitasato University Hospital, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital, Japan
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, Japan
| | - Taiji Furukawa
- Department of Medicine, Teikyo University School of Medicine, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Ritsushi Kato
- Division of Cardiology, Saitama Medical University International Medical Center, Japan
| | - Kazuo Matsumoto
- Division of Cardiology, Saitama Medical University International Medical Center, Japan
| | - Masashi Sakuma
- Division of Cardiology, Dokkyo Medical University, Japan
| | - Hiroyuki Sugimura
- Division of Cardiology, Dokkyo Medical University Nikko Medical Center, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University School of Medicine, Japan
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Li P, Lu X, Teng C, Cai P, Kranis M, Dai Q, Wang B. The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy. Int J Chron Obstruct Pulmon Dis 2020; 15:2333-2341. [PMID: 33061351 PMCID: PMC7532913 DOI: 10.2147/copd.s267289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential triggering factor of TCM. The association between COPD and in-hospital outcomes and complications among TCM patients is not well established. We sought to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM. METHODS We conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD using the latest National Inpatient Sample from 2016-2017. We identified 3139 patients admitted with a primary diagnosis of TCM by the ICD-10-CM coding system; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis. RESULTS Before matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs 3.27±3.39 days, p<0.001), hospitalization charges ($55,242.68±47,637.40 vs $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs1.0%, p=0.005), longer LOS (4.02±3.00 days vs 3.40±3.54 days, p<0.001), higher hospitalization charges ($55,409.23±47,809.13 vs $46,469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs 8.2%, p<0.001) and cardiogenic shock (5.6% vs 3.3%, p=0.024), respectively. CONCLUSION Patients with COPD who are hospitalized for TCM have higher rates of inpatient mortality, ARF, cardiogenic shock, as well as a longer LOS, and higher charges of stay than those without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short- and long-term outcomes of TCM.
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Affiliation(s)
- Pengyang Li
- Department of Medicine, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
| | - Catherine Teng
- Department of Internal Medicine, Yale New Haven Health-Greenwich Hospital, Greenwich, CT06830, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA01609, USA
| | - Mark Kranis
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Qiying Dai
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
- Correspondence: Bin Wang Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong515041, People’s Republic of ChinaTel +86-75488905399Fax +86 75488259850 Email
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Khan M, Watti H, Dahal K, Dominic P. Utility of recognizing early electrocardiogram changes in bronchogenic Takotsubo cardiomyopathy: A case report. World J Cardiol 2019; 11:120-125. [PMID: 31040934 PMCID: PMC6475699 DOI: 10.4330/wjc.v11.i3.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/01/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is a transient reversible systolic dysfunction, estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome (ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram (EKG) findings; many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.
CASE SUMMARY This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology; this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6, and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM. Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.
CONCLUSION This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.
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Affiliation(s)
- Maria Khan
- Department of Internal Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States
| | - Husam Watti
- Department of Cardiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States
| | - Khagendra Dahal
- Department of Cardiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States
| | - Paari Dominic
- Department of Cardiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States
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Electrocardiographic and Seasonal Patterns Allow Accurate Differentiation of Tako-Tsubo Cardiomyopathy from Acute Anterior Myocardial Infarction: Results of a Multicenter Study and Systematic Overview of Available Studies. Biomolecules 2019; 9:biom9020051. [PMID: 30704132 PMCID: PMC6406531 DOI: 10.3390/biom9020051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 01/22/2023] Open
Abstract
Background. Though several studies about prevalence, etiology, clinical characteristics, preceding events, clinical management, and outcome of Tako-Tsubo cardiomyopathy (TTC) exist, the current knowledge of TTC remains limited. Objective. In 2006, TTC was classified among the acquired forms of cardiomyopathy. On the basis of pathophysiological implications, we analyzed whether the presence of ST-segment elevation in lead -aVR (i.e., ST-segment depression in aVR) and the simultaneous absence of ST-segment elevation in lead V1 allow a reliable differentiation of TTC from acute anterior ST-segment elevation myocardial infarction (STEMI). A further investigative feature is the seasonal variation of TTC. Since acute cardiovascular events exhibit definite chronobiological patterns, various small studies have tried to evaluate whether this is also the case for TTC. Because results are conflicting, we also conducted a multicenter study and analyzed the findings in context with a systematic overview of available studies. Methods. We compared the ECG patterns of 115 patients with TTC, who were admitted to five large acute cardiac care centers associated with university hospitals in Southwestern Germany between January 2001 and June 2011, with those of 100 patients with acute anterior ST-segment elevation myocardial infarction (STEMI) treated in one of these centers. In addition, we performed a computer-assisted MEDLINE search of the literature from January 2000 to September 2011 and analyzed the chronobiological patterns of available TTC cases, including our TTC cohort. Results. Testing the predefined diagnostic criteria was superior to any other electrocardiographic finding and differentiated TTC from anterior STEMI with a sensitivity of 73%, a specificity of 84%, a positive predictive value of 63%, and a negative predictive value of 89%. Beyond that, the onset of TTC showed a clear variation as a function of season and month. While events occurred most frequently during summer (38.4%, p < 0.01), the event rate was the lowest in autumn (16.4%) and winter (21.9%). Chronobiological analyses on a monthly basis identified a significant annual rhythmic pattern in TTC, which peaked in August (11.9%; p < 0.01) and had its nadir in November (6.3%). Conclusions. Our data illustrate that the ST-segment changes in leads aVR and V1 represent a simple and accurate ECG criterion to differentiate TTC from anterior STEMI in patients who are admitted within 12 h of symptom onset. Similarly, the results of our seasonal analysis indicate a distinct chronobiological variation in TTC occurrence. TTC, thereby, differs from major acute cardiovascular diseases, especially acute myocardial infarction (AMI), which is characterized by winter peaks and troughs in summer. If these results are confirmed in large independent cohorts, they may yield diagnostic implications, changing the regular invasive AMI management in TTC patients.
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Sick Sinus Syndrome and Takotsubo Cardiomyopathy. Case Rep Cardiol 2018; 2018:3868091. [PMID: 30210876 PMCID: PMC6120333 DOI: 10.1155/2018/3868091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/08/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background. Takotsubo cardiomyopathy is associated with increased risk of ventricular arrhythmias, atrial fibrillation, and bradyarrhythmias. However, sinus node dysfunction is relatively infrequent in the setting of takotsubo cardiomyopathy. Case Report. We are reporting a case of a 73-year-old woman with a history of asymptomatic sinus bradycardia who developed sick sinus syndrome complicated by takotsubo cardiomyopathy. Conclusion. Acute symptomatic sick sinus syndrome in patients with preexisting silent sinus node dysfunction can trigger takotsubo cardiomyopathy. Understanding precipitating factors of takotsubo cardiomyopathy and identifying the patients at risk of life-threatening arrhythmia can help in refining risk stratification and therapy planning. Patients with sick sinus syndrome complicated by takotsubo cardiomyopathy may benefit from pacemaker implantation. However, evaluation on a case-by-case basis is mandatory.
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10
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Katsa I, Christia P, Massera D, Faillace R. Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame? Cureus 2017; 9:e1166. [PMID: 28507838 PMCID: PMC5429155 DOI: 10.7759/cureus.1166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a variant of stress-induced cardiomyopathy, characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 51-year-old Caucasian female with severe chronic obstructive pulmonary disease (COPD) who presented with syncope and was found to have her second lifetime episode of stress-induced cardiomyopathy. Eight months prior, she had been admitted with a COPD exacerbation and was found to have left ventricular (LV) dysfunction with ejection fraction (EF) of 22% attributed to TCM with subsequent normalization of her left ventricular function. Recurrence of stress-induced cardiomyopathy associated with COPD is a rare phenomenon and its presentation raises the possibility of a common underlying mechanism.
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Affiliation(s)
- Ioanna Katsa
- Medicine, North Bronx Health Network Jacobi Medical Center
| | | | | | - Robert Faillace
- Cardiology, North Bronx Health Network Jacobi Medical Center
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Manfredini R, Manfredini F, Fabbian F, Salmi R, Gallerani M, Bossone E, Deshmukh AJ. Chronobiology of Takotsubo Syndrome and Myocardial Infarction: Analogies and Differences. Heart Fail Clin 2017; 12:531-42. [PMID: 27638023 DOI: 10.1016/j.hfc.2016.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Several pathophysiologic factors, not harmful if taken alone, are capable of triggering unfavorable events when presenting together within the same temporal window (chronorisk), and the occurrence of many cardiovascular events is not evenly distributed in time. Both acute myocardial infarction and takotsubo syndrome seem to exhibit a temporal preference in their onset, characterized by variations according to time of day, day of the week, and month of the year, although with both analogies and differences.
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Affiliation(s)
- Roberto Manfredini
- Clinica Medica Unit, School of Medicine, University of Ferrara, Via Lodovico Ariosto, 35, Ferrara 44121, Italy.
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, Vascular Diseases Center, School of Medicine, University of Ferrara, Via Lodovico Ariosto, 35, Ferrara 44121, Italy
| | - Fabio Fabbian
- Clinica Medica Unit, School of Medicine, University of Ferrara, Via Lodovico Ariosto, 35, Ferrara 44121, Italy
| | - Raffaella Salmi
- 2nd Internal Unit of Internal Medicine, General Hospital of Ferrara, Via Aldo Moro 8, Ferrara 44020, Italy
| | - Massimo Gallerani
- 1st Internal Unit of Internal Medicine, General Hospital of Ferrara, Via Aldo Moro 8, Ferrara 44020, Italy
| | - Eduardo Bossone
- 'Cava de' Tirreni and Amalfi Coast' Division of Cardiology, Heart Department, University Hospital of Salerno, Via San Leonardo 1, Salerno 84013, Italy
| | - Abhishek J Deshmukh
- Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
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Said SM, Saygili E, Rana OR, Genz C, Hahn J, Bali R, Varshney S, Albouaini K, Prondzinsky R, Braun-Dullaeus RC. Takotsubo Cardiomyopathy: What we have Learned in the Last 25 Years? (A Comparative Literature Review). Curr Cardiol Rev 2016; 12:297-303. [PMID: 26864096 PMCID: PMC5304252 DOI: 10.2174/1573403x12666160211125601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 01/07/2023] Open
Abstract
We performed a comparative literature review, to elucidate the major features of the Takotsubo (stress) cardiomyopathy (TCM) collected in last 25 years. TCM is characterized by left- or biventricular apical ballooning with a clinical presentation, electrocardiographic abnormalities, and biomarker profils similar to those seen in acute myocardial infarction. Epidemiological studies have shown that TCM is more common in postmenopausal women; however exact figures are not available. The underlying aetiology is still largely undetermined. Elevated catecholamine levels, lack of estrogen, disturbed myocardial fatty acid metabolism and plaque rupture with spontaneous thrombolysis are potentially discussed mechanisms responsible for inducing a prolonged stunned myocardium. Strong emotional or physical stress is the most frequently described trigger in the literature. Therapy recommendations include appropriate antiplatelet treatment, β-blockers and ACE inhibitors. The abnormal kinetics usually resolve or improve within a month and carry a favorable prognosis in most cases. However, all the suspected complications of an acute myocardial infarction, including cardiogenic shock or lethal arrhythmias, may still occur.
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Affiliation(s)
- Samir M Said
- Department of Cardiology, University Hospital Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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Drug treatment rates with beta-blockers and ACE-inhibitors/angiotensin receptor blockers and recurrences in takotsubo cardiomyopathy: A meta-regression analysis. Int J Cardiol 2016; 214:340-2. [PMID: 27085125 DOI: 10.1016/j.ijcard.2016.03.196] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND In a recent paper Singh et al. analyzed the effect of drug treatment on recurrence of takotsubo cardiomyopathy (TTC) in a comprehensive meta-analysis. The study found that recurrence rates were independent of clinic utilization of BB prescription, but inversely correlated with ACEi/ARB prescription: authors therefore conclude that ACEi/ARB rather than BB may reduce risk of recurrence. METHODS We aimed to re-analyze data reported in the study, now weighted for populations' size, in a meta-regression analysis. RESULTS After multiple meta-regression analysis, we found a significant regression between rates of prescription of ACEi and rates of recurrence of TTC; regression was not statistically significant for BBs. CONCLUSIONS On the bases of our re-analysis, we confirm that rates of recurrence of TTC are lower in populations of patients with higher rates of treatment with ACEi/ARB. That could not necessarily imply that ACEi may prevent recurrence of TTC, but barely that, for example, rates of recurrence are lower in cohorts more compliant with therapy or more prescribed with ACEi because more carefully followed. Randomized prospective studies are surely warranted.
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Núñez-Gil IJ, Mejía-Rentería HD, Martínez-Losas P. [Practical update of Tsaktubo syndrome]. Med Clin (Barc) 2016. [PMID: 26205669 DOI: 10.1016/j.medcli.2015.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Takotsubo syndrome, apical ballooning or «broken heart» syndrome, is a growing diagnostic entity which clinically mimics an acute coronary syndrome. Included into the stress cardiomyopathy group of cardiopathies, this condition is characterized by the absence of potentially responsible coronary lesions, while displaying a transient abnormal ventricular motion, usually affecting various coronary territories. It is generally observed in postmenopausal women and frequently seen in the presence of a stressful situation, both physical and emotional. With a prevalence of 1.2% among patients undergoing a cardiac catheterization with a suspected diagnosis of acute coronary syndromes, Takotsubo syndrome usually has a good prognosis. However, complications can occur in the acute phase, generally heart failure, which can even lead to death. In this review we discuss the latest available information on this disease and present it in a practical and useful way for the attending physician.
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Affiliation(s)
- Iván J Núñez-Gil
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, España.
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15
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Caracterización del síndrome de tako-tsubo en España: resultados del registro nacional RETAKO. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.07.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Abstract
Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, often in a circumferential apical, mid-ventricular, or basal distribution. Several pathophysiological explanations have been proposed for this syndrome and its intriguing appearance, and awareness is growing that these explanations might not be mutually exclusive. The reversible apical myocardial dysfunction observed might result from more than one pathophysiological phenomenon. The pathophysiology of Takotsubo syndrome is complex and integrates neuroendocrine physiology, potentially involving the cognitive centres of the brain, and including the hypothalamic-pituitary-adrenal axis. Cardiovascular responses are caused by the sudden sympathetic activation and surge in concentrations of circulating catecholamines. The multiple morphological changes seen in the myocardium match those seen after catecholamine-induced cardiotoxicity. The acute prognosis and recurrence rate are now known to be worse than initially thought, and much still needs to be learned about the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways.
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Affiliation(s)
- Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Holger M Nef
- Medizinische Klinik I, Kardiologie und Angiologie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 8, Gießen 35392, Germany
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, Sydney Street, London SW3 6NP, UK
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Núñez Gil IJ, Andrés M, Almendro Delia M, Sionis A, Martín A, Bastante T, Córdoba Soriano JG, Linares Vicente JA, González Sucarrats S, Sánchez-Grande Flecha A. Characterization of Tako-tsubo Cardiomyopathy in Spain: Results from the RETAKO National Registry. ACTA ACUST UNITED AC 2014; 68:505-12. [PMID: 25544669 DOI: 10.1016/j.rec.2014.07.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/07/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND AIMS The etiology and epidemiology of tako-tsubo cardiomyopathy remain uncertain. The symptoms of this condition are often similar to those of myocardial infarction and, although it usually has a good prognosis, it is not without complications. Our aim was to characterize this disease in our setting using a dedicated registry (Spanish REgistry for TAKOtsubo cardiomyopathy). METHODS The prospective registry included 202 incident patients in 23 hospitals from 2012 to 2013. The patients' clinical characteristics and analytical, echocardiographic, and imaging results were recorded, as were the events during follow-up. Patients were included when the attending physician considered the case proven, and incidence was calculated relative to the catheterizations requested for a presumptive diagnosis of acute coronary syndrome. RESULTS The patients were predominantly women (90%), with a mean age of 70 years, and many had cardiovascular risk factors, such as hypertension (67%), dyslipidemia (41%), diabetes mellitus (15%), and smoking (15%). The incidence of tako-tsubo cardiomyopathy was 1.2%, and there was no clear weekly or seasonal distribution pattern. Chest pain was the predominant symptom, a triggering factor (emotional, physical, or both) was present in 72%, and most patients consulted within the first 6h after symptom onset. The median duration of hospitalization was 7 days. There were heart failure symptoms in 34.0%, arrhythmia in 26.7%, and 2.4% of patients died. CONCLUSIONS The incidence of tako-tsubo cardiomyopathy is low. This disease primarily affects postmenopausal women, and occurs after a situation of emotional stress in more than half of affected individuals. It is characterized by anginal pain, shows no seasonal distribution, and has a good prognosis, although it is not without morbidity and mortality.
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Affiliation(s)
- Iván J Núñez Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Mireia Andrés
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ana Martín
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de la Princesa, Madrid, Spain
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Singh K, Carson K, Usmani Z, Sawhney G, Shah R, Horowitz J. Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy. Int J Cardiol 2014; 174:696-701. [DOI: 10.1016/j.ijcard.2014.04.221] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/17/2014] [Accepted: 04/19/2014] [Indexed: 12/17/2022]
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Manfredini R, Fabbian F, Giorgi AD, Pala M, Menegatti AM, Parisi C, Misurati E, Tiseo R, Gallerani M, Salmi R, Bossone E. Heart and lung, a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases: A systematic review. World J Cardiol 2014; 6:338-344. [PMID: 24944763 PMCID: PMC4062124 DOI: 10.4330/wjc.v6.i5.338] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/11/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the possible association between Tako-tsubo cardiomyopathy (TTC)-a reversible clinical condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mechanisms- and respiratory system diseases.
METHODS: We systematically searched PubMed and EMBASE medical information sources, to identify the different triggering causes, limiting our search to articles in English. The search keywords were: “tako-tsubo cardiomyopathy”, “takotsubo”, “takotsubo cardiomyopathy”, “broken heart syndrome”, “stress-induced cardiomyopathy”, “apical ballooning syndrome”, and “ampulla cardiomyopathy in combination with respiratory diseases, lung, pulmonary disease. For each kind of disease, we registered: author, year and country of study, patient sex, age, concurring situation, and outcome.
RESULTS: Out of a total of 1725 articles found, we selected 37 papers reporting a total of 38 patients. As expected, most patients were women (81.6%), mean age was 65 ± 10 years. Outcome was favorable in 100% of cases, and all the patients have been discharged uneventfully in a few days.
CONCLUSION: An association between respiratory diseases and TTC is likely to exist. Patients with severe respiratory diseases, due to the high dosages of β2-agonists used or to the need of invasive procedures, are highly exposed to the risk of developing TTC.
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Coupez E, Eschalier R, Pereira B, Pierrard R, Souteyrand G, Clerfond G, Citron B, Lusson JR, Mansencal N, Motreff P. A single pathophysiological pathway in Takotsubo cardiomyopathy: Catecholaminergic stress. Arch Cardiovasc Dis 2014; 107:245-52. [PMID: 24796853 DOI: 10.1016/j.acvd.2014.04.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 03/28/2014] [Accepted: 04/01/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) continues to be under-diagnosed, due to its varying presentation, with potentially serious consequences if treatment is delayed. AIMS To demonstrate the consistent involvement of catecholaminergic stress in TTC, regardless of the trigger. METHODS Between 01 July 2009 and 31 August 2013, patients managed in our centre for thoracic pain syndrome, with or without troponin release, were followed up prospectively. TTC was diagnosed from the apical ballooning seen on left ventricular imaging (angiography or transthoracic echocardiography) in the absence of a significant coronary artery lesion. Triggers (emotional trauma, surgical stress and β2-mimetic intoxication) were recorded; catecholamine-secreting tumours were screened for with a urinary methoxylate-derivative assay. RESULTS TTC was diagnosed in 40 out of 2754 (1.5%) patients with thoracic pain syndrome, with or without troponin release. Triggers were emotional trauma (n=29, 72.5%), surgical stress (n=5, 12.5%), adrenergic intoxication (n=3, 7.5%) and catecholaminergic tumour (n=3, 7.5%). Mean left ventricular ejection fraction at admission was 38.0 ± 15.7%. Eight (20%) patients initially showed cardiogenic shock. In-hospital mortality was 7.5%, with no deaths from cardiogenic causes. Thirty-five (94.6%) of the survivors had recovered a normal left ventricular ejection fraction (> 55%) by discharge. CONCLUSION Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early.
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Affiliation(s)
- Elisabeth Coupez
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France
| | - Romain Eschalier
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France.
| | - Bruno Pereira
- Biostatistics Unit (Clinical Research and Innovation Direction), CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Romain Pierrard
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Géraud Souteyrand
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France
| | - Bernard Citron
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-René Lusson
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France
| | - Nicolas Mansencal
- Department of Cardiology, Université de Versailles-Saint-Quentin, Ambroise-Paré Hospital, Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Pascal Motreff
- Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France
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Singh K, Carson K, Shah R, Sawhney G, Singh B, Parsaik A, Gilutz H, Usmani Z, Horowitz J. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy. Am J Cardiol 2014; 113:1420-8. [PMID: 24685327 DOI: 10.1016/j.amjcard.2014.01.419] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 12/27/2022]
Abstract
The incidence and clinical correlates of acute in-hospital mortality of takotsubo cardiomyopathy (TTC) are not clear. We performed a systematic review and meta-analysis to consolidate the current evidence on acute mortality in TTC. We then assessed the impact of "secondary" TTC, male gender, advancing age, and catecholamine use on mortality. A comprehensive search of 4 major databases (EMBASE, Ovid MEDLINE, PubMed, and Google Scholar) was performed from their inception to the first week of July 2013. We included original research studies, recruiting ≥10 participants, published in English language, and those that reported data on mortality and cause of death in patients with TTC. Of 382 citations, 37 studies (2,120 patients with TTC) from 11 different countries were included in the analyses. The mean age of the cohort was 68 years (95% confidence interval [CI] 67 to 69) with female predominance (87%). The in-hospital mortality rate among patients with TTC was 4.5% (95% CI 3.1 to 6.2, I2=60.8%). Among all deaths, 38% were directly related to TTC complications and rest to underlying noncardiac conditions. Male gender was associated with higher TTC mortality rate (odds ratio 2.6, 95% CI 1.5 to 4.6, p=0.0008, I2=0%) so was "secondary" TTC (risk difference -0.11, 95% CI -0.18 to -0.04, p=0.003, I2=84%). The mean age of patients dying tended to be greater than that in the whole cohort (72±7 vs 65±7 years). In conclusion, TTC is not as benign as once thought. To reduce the mortality rate, greater efforts need to be directed to the diagnosis, treatment, and ultimately prevention of "secondary" TTC.
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Affiliation(s)
- Kuljit Singh
- Department of Cardiology, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Kristin Carson
- Department of Respiratory Medicine, University of Adelaide, Queen Elizabeth Hospital, Basil Hetzel Institute, Woodville, South Australia, Australia
| | - Ranjit Shah
- Department of Cardiology, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | | | - Balwinder Singh
- Department of Clinical Neurosciences, University of North Dakota School of Medicine & Health Sciences, Fargo, North Dakota
| | - Ajay Parsaik
- Department of Cardiology, Soroka Medical Centre, Ben Gurion University of the Negev, Beersheba, Israel
| | - Harel Gilutz
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Texas
| | - Zafar Usmani
- Department of Respiratory Medicine, University of Adelaide, Queen Elizabeth Hospital, Basil Hetzel Institute, Woodville, South Australia, Australia
| | - John Horowitz
- Department of Cardiology, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Brenes Salazar JA. Recurrent transient apical cardiomyopathy (tako-tsubo-like left ventricular dysfunction) in a postmenopausal female with diffuse esophageal spasms. Heart Views 2014; 14:185-9. [PMID: 24695751 PMCID: PMC3970376 DOI: 10.4103/1995-705x.126888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transient apical cardiomyopathy, also known as Takot-tsubo-like left ventricular dysfunction, is a clinical syndrome characterized by reversible left ventricular dysfunction at the apex with preserved basal contractility, in the setting of new ST and T wave changes suggestive of ischemia but no evidence of obstructive coronary artery disease on angiography. The main mechanism appears to be intense neuroadrenergic myocardial stimulation with endothelial dysfunction of the coronary vasculature. It has been noted that patients with esophageal spasms also have a tendency for coronary spasms. We present the case of a postmenopausal female with documented severe esophageal spasms who presented with atypical angina and recurrent Tako-tsubo cardiomyopathy.
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Manfredini R, Salmi R, Fabbian F, Manfredini F, Gallerani M, Bossone E. Breaking heart: chronobiologic insights into takotsubo cardiomyopathy. Heart Fail Clin 2013; 9:147-56, vii-viii. [PMID: 23562115 DOI: 10.1016/j.hfc.2012.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A considerable amount of evidence has shown that the major acute cardiovascular diseases, ie, myocardial infarction, sudden cardiac death, stroke, pulmonary embolism, and rupture or dissection of aortic aneurysms do not occur randomly in time, but exhibit specific temporal patterns in their onset, according to time of day, month or season, and day of the week. This contributes to the definition of "chronorisk", where several factors, not harmful if taken alone, are capable of triggering unfavorable events when presenting all together within the same temporal window. This article reviews the actual knowledge about time of onset of takotsubo cardiomyopathy.
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Affiliation(s)
- Roberto Manfredini
- Clinica Medica, Department of Medicine, General and University Hospital of Ferrara, Via Aldo Moro, 44124 Cona, Ferrara, Italy.
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Bossone E, Savarese G, Ferrara F, Citro R, Mosca S, Musella F, Limongelli G, Manfredini R, Cittadini A, Perrone Filardi P. Takotsubo cardiomyopathy: overview. Heart Fail Clin 2013; 9:249-66, x. [PMID: 23562126 DOI: 10.1016/j.hfc.2012.12.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Takotsubo cardiomyopathy (TTC) is a unique acute syndrome characterized by transient left ventricular systolic dysfunction in the absence of significant coronary artery disease, occurring mostly in postmenopausal women after emotional and/or physical stress. Given the nonspecific symptoms and signs, a high clinical index of suspicion is necessary to detect the disease in different clinical settings and scenarios. Noninvasive multimodality imaging may be useful to distinguish this cardiomyopathy from other acute cardiac and thoracic diseases. Coronary angiography remains, however, mandatory to differentiate TTC from acute coronary syndromes. This article reviews the clinical features and management of TTC and some new insights.
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Affiliation(s)
- Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, 20097 San Donato Milanese, Italy
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Jaguszewski M, Osipova J, Ghadri JR, Napp LC, Widera C, Franke J, Fijalkowski M, Nowak R, Fijalkowska M, Volkmann I, Katus HA, Wollert KC, Bauersachs J, Erne P, Lüscher TF, Thum T, Templin C. A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction. Eur Heart J 2013; 35:999-1006. [PMID: 24046434 PMCID: PMC3985061 DOI: 10.1093/eurheartj/eht392] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aims Takotsubo cardiomyopathy (TTC) remains a potentially life-threatening disease, which is clinically indistinguishable from acute myocardial infarction (MI). Today, no established biomarkers are available for the early diagnosis of TTC and differentiation from MI. MicroRNAs (miRNAs/miRs) emerge as promising sensitive and specific biomarkers for cardiovascular disease. Thus, we sought to identify circulating miRNAs suitable for diagnosis of acute TTC and for distinguishing TTC from acute MI. Methods and results After miRNA profiling, eight miRNAs were selected for verification by real-time quantitative reverse transcription polymerase chain reaction in patients with TTC (n = 36), ST-segment elevation acute myocardial infarction (STEMI, n = 27), and healthy controls (n = 28). We quantitatively confirmed up-regulation of miR-16 and miR-26a in patients with TTC compared with healthy subjects (both, P < 0.001), and up-regulation of miR-16, miR-26a, and let-7f compared with STEMI patients (P < 0.0001, P < 0.05, and P < 0.05, respectively). Consistent with previous publications, cardiac specific miR-1 and miR-133a were up-regulated in STEMI patients compared with healthy controls (both, P < 0.0001). Moreover, miR-133a was substantially increased in patients with STEMI compared with TTC (P < 0.05). A unique signature comprising miR-1, miR-16, miR-26a, and miR-133a differentiated TTC from healthy subjects [area under the curve (AUC) 0.835, 95% CI 0.733–0.937, P < 0.0001] and from STEMI patients (AUC 0.881, 95% CI 0.793–0.968, P < 0.0001). This signature yielded a sensitivity of 74.19% and a specificity of 78.57% for TTC vs. healthy subjects, and a sensitivity of 96.77% and a specificity of 70.37% for TTC vs. STEMI patients. Additionally, we noticed a decrease of the endothelin-1 (ET-1)-regulating miRNA-125a-5p in parallel with a robust increase of ET-1 plasma levels in TTC compared with healthy subjects (P < 0.05). Conclusion The present study for the first time describes a signature of four circulating miRNAs as a robust biomarker to distinguish TTC from STEMI patients. The significant up-regulation of these stress- and depression-related miRNAs suggests a close connection of TTC with neuropsychiatric disorders. Moreover, decreased levels of miRNA125a-5p as well as increased plasma levels of its target ET-1 are in line with the microvascular spasm hypothesis of the TTC pathomechanism.
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Affiliation(s)
- Milosz Jaguszewski
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistr. 100, Zurich 8091, Switzerland
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A temporal high-risk frame for occurrence of Tako-Tsubo cardiomyopathy. Am J Cardiol 2013; 111:627. [PMID: 23375254 DOI: 10.1016/j.amjcard.2012.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/15/2012] [Indexed: 11/21/2022]
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Manfredini R, Fabbian F, Manfredini F, Eagle KA, Bossone E. Takotsubo cardiomyopathy and summer: a dangerous liaison? Am Heart J 2013; 165:e5. [PMID: 23237143 DOI: 10.1016/j.ahj.2012.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sharkey SW, Lesser JR, Garberich RF, Pink VR, Maron MS, Maron BJ. Comparison of circadian rhythm patterns in Tako-tsubo cardiomyopathy versus ST-segment elevation myocardial infarction. Am J Cardiol 2012; 110:795-9. [PMID: 22651882 DOI: 10.1016/j.amjcard.2012.04.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/29/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
Abstract
Tako-tsubo cardiomyopathy (TTC) is an acute reversible cardiac condition usually triggered by stressful events, with a predilection for older women and clinical presentation often confused with acute coronary syndrome. Definition of the diurnal hourly pattern of TTC events may contribute to understanding the pathogenesis of this complex entity. We prospectively enrolled 186 consecutive patients with TTC (68 ± 14 years old, 95% women) and, for comparison, 2,975 patients with ST-segment elevation myocardial infarction (STEMI) at the Minneapolis Heart Institute over the same period. Circadian periodicity was analyzed for hourly occurrence of events throughout the day and for days of the week and months of the year. Occurrence of TTC showed a nonuniform distribution with a distinctive afternoon peak from 12:00 (noon) to 4:00 p.m., comprising 28% (n = 52) of all events, and with the nadir at 12 to 4 a.m. (chi-square 25.6, p <0.001). Patients with events within the peak were older (73 ± 13 years) than other patients (66 ± 13 years, p = 0.0025). Events were uniformly distributed over days of the week and months (p = 0.2 and 0.47, respectively). In contrast, patients with STEMI showed peak occurrence in the early morning hours, 8:00 a.m. to 12:00 p.m., comprising 24% of all events (chi-square 248, p <0.001). In conclusion, TTC events occurred in a circadian pattern with a peak in the afternoon hours, distinctive from the predilection of STEMI for morning hours. This timing of TTC events is most consistent with mechanisms underlying stressful life situations that usually trigger this condition.
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Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J 2012; 164:66-71.e1. [PMID: 22795284 DOI: 10.1016/j.ahj.2012.03.020] [Citation(s) in RCA: 284] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/19/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to describe the prevalence of Takotsubo cardiomyopathy (TTC), age-gender interaction, and various comorbidities associated with it based on nationwide hospitalization records. Takotsubo cardiomyopathy is an increasingly reported clinical syndrome; however, there are no data on its prevalence in the general US population. METHODS The Nationwide Inpatient Sample discharge records were queried for the year 2008 using the International Classification of Diseases, Ninth Revision, code 429.83. RESULTS There were 6,837 patients diagnosed with TTC among 33,506,402 hospitalizations in the Nationwide Inpatient Sample database. Women were found to have higher odds of developing TTC (odds ratio 8.8). Women >55 years old had 4.8 times higher odds for developing TTC when compared with women <55 years old. Smoking, alcohol abuse, anxiety states, and hyperlipidemia were commonly associated with TTC. The peak incidence of hospitalization for TTC was in summer. CONCLUSION Takotsubo cardiomyopathy was diagnosed in about 0.02% of all hospitalizations in the United States, mostly in elderly women with history of smoking, alcohol abuse, anxiety states, and hyperlipidemia.
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Chandraratna PAN, Mohar DS, Sidarous PF, Bhardwaj R, Clause CR, Boehling NS, Handapangoda I, Mohar P, Shah P, Wijegunaratne K. Implications of acute left ventricular remodeling during squatting stress echocardiography. Echocardiography 2012; 29:700-5. [PMID: 22494181 DOI: 10.1111/j.1540-8175.2012.01678.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We previously demonstrated that squatting induces left ventricular (LV) wall motion abnormalities (WMA) in areas subtended by stenotic coronary arteries. In addition, it was observed that some subjects developed acute changes in LV shape (acute left ventricular remodeling [ALVRM]) during squatting. OBJECTIVE This study tested the hypothesis that patients with ALVRM during squatting echocardiography have higher incidences of severe coronary artery disease (CAD). METHODS Echocardiography was performed in all standard views during standing and squatting. End-systolic frames in the apical four-chamber view were analyzed. RESULTS The subjects were divided into three groups. Group 1 consisted of 12 subjects who developed squatting-induced ALVRM with apical and distal posterior septal akinesis, dilation of the apex and marked LV shape change at end-systole. Group 2 consisted of 20 subjects with distal posterior septal and apical akinesis without ALVRM, during squatting. Group 3 consisted of 64 subjects who developed WMA in areas other than the apex (n = 49), or normal wall motion (n = 15) during squatting. Coronary angiography in group 1 revealed that 6 subjects had left main coronary artery stenosis (LMCAS ≥ 50%), two had severe three vessel disease (≥ 90% stenosis), and one had 100% left anterior descending coronary artery occlusion. Severe CAD was defined for purpose of this study as the presence of LMCAS, or severe three vessel disease (≥ 90% stenosis). Six subjects in group 2 had LMCAS and none had severe three vessel disease (P < 0.05 vs. group 1 for LMCAS and/or three vessel disease). In group 3, eight had LMCAS and none had severe three vessel disease (P < 0.0001 vs. group 1). CONCLUSION Patients with ALVRM have severe CAD. Therefore, patients who develop ALVRM during squatting require urgent evaluation for revascularization therapy.
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Szardien S, Möllmann H, Elsässer A, Hamm CW, Nef HM. [Historical and current pathophysiological concepts of stress (Tako-Tsubo) cardiomyopathy]. Herz 2012; 35:258-64. [PMID: 22086477 DOI: 10.1007/s00059-011-3446-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Tako-Tsubo cardiomyopathy (TTC), also referred to as stress cardiomyopathy (SCM), was first described in the 1990s and is characterized by transient left ventricular dysfunction. Its incidence represents 1-2% of all acute coronary syndromes (ACS). In most cases extreme emotional or physical stress precedes this syndrome. The majority of patients affected are postmenopausal women. Since its first description, various hypotheses regarding the pathophysiology of TTC have been discussed. From a historical perspective, coronary vasospasm has often been proposed as a possible cause of this disorder. However, reviews from numerous registries were able to demonstrate that coronary vasospasm plays only a minor role in the pathogenesis of TTC. Several groups showed disturbances in myocardial microcirculation and energy metabolism in the acute phase of TTC. Nevertheless, with regard to the data currently available, it cannot be differentiated whether these changes are the cause or rather the result of TTC. However, recent concepts include an excessive catecholamine overload and morphological changes which are unequivocally documented in TTC. The relation between elevated catecholamine levels and myocardial dysfunction analogous to TTC could be confirmed in animal experiments.In summary, it can be assumed that TTC is caused by an excessive cardiotoxic release of catecholamines. Ventricular dysfunction can be explained by increased numbers of β-adrenergic receptors in the apex, leading to greater vulnerability to catecholamine overload. Individual anatomical differences in the sympathoadrenergic system and distribution from β-adrenergic receptors are presumably responsible for the interindividual occurrence of wall motion abnormalities in TTC.
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Affiliation(s)
- S Szardien
- Abteilung Kardiologie, Kerckhoff-Klinik Herz- und Thoraxzentrum, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
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Castillo Rivera AM, Ruiz-Bailén M, Rucabado Aguilar L. Takotsubo cardiomyopathy--a clinical review. Med Sci Monit 2011; 17:RA135-47. [PMID: 21629203 PMCID: PMC3539553 DOI: 10.12659/msm.881800] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.
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Affiliation(s)
- Ana María Castillo Rivera
- Department of Critical Care and Emergency, Intensive Medicine Unit, Jaén Hospital Complex, Jaén, Spain.
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Stöllberger C, Wegner C, Finsterer J. Seizure-induced Takotsubo syndrome is more frequent than reported. Int J Cardiol 2011; 150:359-60. [DOI: 10.1016/j.ijcard.2011.05.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 05/13/2011] [Indexed: 11/27/2022]
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Abstract
Takotsubo cardiomyopathy is characterized by chest pain, dyspnea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall-motion abnormalities without identifiable coronary culprit lesion explaining the wall-motion abnormality. Takotsubo cardiomyopathy occurs frequently after emotional or physical stress. Seizures have been reported as triggers of takotsubo cardiomyopathy. It is unknown if seizure-associated takotsubo cardiomyopathy differs from takotsubo cardiomyopathy associated with other triggers. Seizure-associated takotsubo cardiomyopathy cases from the literature were compared with takotsubo cardiomyopathy series comprising 30 or more patients. Thirty-six seizure-associated takotsubo cardiomyopathy cases (6 male, mean-age 61.5 years) were found. Seizure-type were tonic-clonic (n = 13), generalized (n = 5), status epilepticus (n = 6), grand mal (n = 2), or not reported (n = 13). Twelve patients had a history of epilepsy, in 15 patients takotsubo cardiomyopathy-associated seizure was the first or the information was not given (n = 9). In 17 patients takotsubo cardiomyopathy occurred immediately after the seizure, in 9 patients 1-72 h postictally, and in 10 patients, the interval was not reported. In 20 patients neurologic disorders were reported and in 14 psychiatric disorders were reported. There were medical comorbidities in 17 patients, arterial hypertension (n = 11), hyponatremia (n = 2), and cancer (n = 2). Compared with 974 patients reported in takotsubo cardiomyopathy -series, patients with seizure-associated takotsubo cardiomyopathy were younger (61.5 vs. 68.5 years, p < 0.0001), more frequently males (17 vs. 9%, p = 0.004), had less frequent chest pain (6 vs.76%, p < 0.005), more frequent cardiogenic shock (25 vs. 8%, p = 0.003), and more frequent recurrency (14 vs. 3%, p = 0.004). Seizure-associated takotsubo cardiomyopathy manifests frequently as sudden hemodynamic deterioration, which could result in death in the absence of adequate help. Probably some cases of sudden unexpected death in epilepsy are attributable to takotsubo cardiomyopathy.
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Bossone E, Citro R, Eagle KA, Manfredini R. Tako-tsubo cardiomyopathy: is there a preferred time of onset? Intern Emerg Med 2011; 6:221-6. [PMID: 21082291 DOI: 10.1007/s11739-010-0480-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/29/2010] [Indexed: 12/30/2022]
Abstract
The occurrence of major cardiovascular events is not randomly distributed over time, but exhibits chronobiological patterns, i.e., circadian, weekly, or seasonal. No systematic studies on the temporal preference of onset of Tako-tsubo cardiomyopathy (TTC) are known. We performed a computer-assisted search of the literature (from 2000 to January 2010), with the following search terms: transient left ventricular apical ballooning syndrome, takotsubo-like left ventricular dysfunction, ampulla cardiomyopathy, tako-tsubo or takotsubo cardiomyopathy, tako-tsubo, apical ballooning. Criteria for publication inclusion were (a) reporting of original data, (b) inclusion of at least 30 or more cases, (c) adherence to the requested diagnostic criteria for TTC. We focused on studies including in their purposes the "time of onset" of events. Out of the 19 studies found, 7 (4 from Europe, 1 each from Asia, Australia and USA) specifically addressed this aspect. A circadian (morning) and a seasonal (summer) higher frequency of events was found. TTC seems to exhibit a temporal variation of onset, with preferred peaks during morning and summer. Stress and catecholamines, also according to their temporal organization, might play a pivotal role. The demonstration of time frames characterized by highest frequency of occurrence might help to try to ensure maximal protection during particularly vulnerable periods.
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Affiliation(s)
- Eduardo Bossone
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy.
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Sudden cardiac arrest due to puerperal transient left ventricular apical ballooning syndrome. Int J Cardiol 2011; 149:e12-3. [DOI: 10.1016/j.ijcard.2009.03.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/04/2009] [Indexed: 11/23/2022]
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Pontillo D, Patruno N, Stefanoni R. The tako-tsubo syndrome and bronchial asthma: the chicken or the egg dilemma. J Cardiovasc Med (Hagerstown) 2011; 12:149-50. [PMID: 21228690 DOI: 10.2459/jcm.0b013e32833cdbb0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Syed FF, Asirvatham SJ, Francis J. Arrhythmia occurrence with takotsubo cardiomyopathy: a literature review. Europace 2010; 13:780-8. [PMID: 21131373 DOI: 10.1093/europace/euq435] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Takotsubo cardiomyopathy (TC) or the apical ballooning syndrome is a reversible cardiomyopathy mimicking acute myocardial infarction (AMI). Although malignant arrhythmia is considered less likely to occur in TC than with AMI, sporadic reports of malignant arrhythmia with TC, however, have been reported. We reviewed the medical literature on TC and arrhythmias and describe in the summary the reported findings and discuss possible specific scenarios where arrhythmia may be more likely in patients with TC. METHODS AND RESULTS Articles were identified on PubMed using the MeSH terms 'Takotsubo Cardiomyopathy' or 'Apical Ballooning Syndrome'. Seventy-four unique case series with five or more TC patients were identified, with a cumulative total of 1876 cases. Twelve series (242 cases) were excluded because Mayo criteria were not met. Twenty-five series (816 cases, 43.5%) reported on arrhythmia and were included in the analysis. CONCLUSION Areas for further prospective study include the duration and mechanism of residual risk and optimal risk stratification and modification. The current state of evidence would support beta-blockers in the acute setting to control tachyarrhythmia, although there is little evidence to support their use beyond convalescence when used for this indication alone. Those in heart failure and cardiogenic shock should be managed with established evidence-based therapies for these conditions. The use of internal defibrillators in TC requires consideration only on a case-by-case basis.
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Affiliation(s)
- Faisal F Syed
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Therapeutic challenges in combined apical ballooning syndrome and acute pulmonary decompensation. Am J Ther 2010; 17:e126-30. [PMID: 19829094 DOI: 10.1097/mjt.0b013e3181ba3320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Apical ballooning syndrome (ABS) is increasingly diagnosed in critical care settings. Widespread application of echocardiography and cardiac enzyme testing has increased its recognition. Our experience of 4 subjects illustrates the association of ABS with a wide spectrum of acute pulmonary disorders seen in critical care settings. All had ABS proven by normal coronary angiogram and subsequent normalization of left ventricular dysfunction. Bronchospasm due to chronic obstructive pulmonary disease exacerbation or cardiac failure warrants the use of beta agonists. ABS, on the other hand, being caused by excess sympathetic activity could potentially improve with beta blockade. Coexistence of ABS and pulmonary disease in critical-care settings presents unique therapeutic challenges and outcomes can be optimized by judicious use of available medical options.
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Al-Moghairi A, Al-Harfi Z, Al-Shouli S. Stress-induced cardiomyopathy (Tako-Tsubo) in a premenopausal woman: A case report from Saudi Arabia. J Saudi Heart Assoc 2010; 22:219-21. [PMID: 23960624 DOI: 10.1016/j.jsha.2010.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/01/2010] [Accepted: 07/13/2010] [Indexed: 01/26/2023] Open
Abstract
Tako-Tsubo cardiomyopathy (TTC) is a nonischemic cardiomyopathy characterized by reversible left ventricular dysfunction that is seen predominantly in postmenopausal women (>80%). The syndrome has symptoms that are similar to acute myocardial infarction, such as electrocardiogram changes (ST-segment elevation and subsequent giant T wave inversion) and abnormal cardiac enzymes. The clinical prognosis is usually benign. This article reports the first case of a TTC in a premenopausal Saudi woman. Early diagnosis of TTC excludes the use of stents, thrombolytics, and long-term coronary heart disease medications.
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Hessel EA, London MJ. Takotsubo (Stress) Cardiomyopathy and the Anesthesiologist: Enough Case Reports. Let's Try to Answer Some Specific Questions! Anesth Analg 2010; 110:674-9. [DOI: 10.1213/ane.0b013e3181c9fa22] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Citro R, Previtali M, Bossone E, Manfredini R. Reply. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2009.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Griffin S, Logue B. Takotsubo cardiomyopathy: a nurse's guide. Crit Care Nurse 2009; 29:32-42; quiz 1 p following 42. [PMID: 19797493 DOI: 10.4037/ccn2009907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Clinical characteristics of tako-tsubo cardiomyopathy. Am J Cardiol 2009; 104:578-82. [PMID: 19660615 DOI: 10.1016/j.amjcard.2009.04.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 04/02/2009] [Accepted: 04/02/2009] [Indexed: 01/22/2023]
Abstract
Tako-tsubo cardiomyopathy (TTC) is increasingly diagnosed in the United States, especially in the Caucasian population. To evaluate the clinical features and outcome of patients with TTC, we evaluated 34 patients (32 women and 2 men) 22 to 88 years of age (mean 66 +/- 14) who fulfilled the following criteria: (1) akinesia or dyskinesia of the apical and/or midventricular segments of the left ventricle with regional wall motion abnormalities that extended beyond the distribution of a single epicardial vessel and (2) absence of obstructive coronary artery disease. Twenty-five patients (74%) presented with chest pain, 20 patients (59%) presented with dyspnea, and 8 patients (24%) presented with cardiogenic shock. Twenty-two patients (65%) had ST-segment elevation and 14 patients (41%) had T-wave inversion on presentation. Twenty-five patients (74%) reported a preceding stressful event. Cardiac biomarkers were often mildly increased, with a mean troponin I (peak) of 13.9 +/- 24. Mean +/- SD left ventricular ejection fractions were 28 +/- 10% at time of presentation and 51 +/- 14 at time of follow-up (p <0.0001). Two patients (6%) died during the hospital stay. Average duration of hospital stay was 6.6 +/- 6.2 days. In conclusion, TTC is common in postmenopausal women with preceding physical or emotional stress. It predominantly involves the apical portion of the left ventricle and patients with this condition have a favorable outcome with appropriate medical management. The precise cause remains unclear.
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Das Takotsubo-Syndrom von der Erstbeschreibung bis heute. ACTA ACUST UNITED AC 2009; 104:434-40. [DOI: 10.1007/s00063-009-1092-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 03/09/2009] [Indexed: 12/21/2022]
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Panigada S, Camporotondo R, Repetto A, Previtali M. Role of dynamic intraventricular obstruction and protective effect of beta-blocking therapy in left ventricular apical ballooning syndrome: A case report. Int J Cardiol 2009; 132:e37-9. [DOI: 10.1016/j.ijcard.2007.07.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 07/07/2007] [Accepted: 07/07/2007] [Indexed: 10/22/2022]
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Heitz JW. Takotsubo Syndrome and the Cardiac Surgery Patient. Ann Thorac Surg 2009; 87:674; author reply 674-5. [DOI: 10.1016/j.athoracsur.2008.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 06/20/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
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Jefic D, Koul D, Boguszewski A, Martini W. Transient left ventricular apical ballooning syndrome caused by abrupt metoprolol withdrawal. Int J Cardiol 2008; 131:e35-7. [DOI: 10.1016/j.ijcard.2007.07.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 07/04/2007] [Accepted: 07/07/2007] [Indexed: 12/17/2022]
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