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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports
Aditi Bhanushali, Muskan Kohli, Ananya Prakash, Svaapnika Rao Sarvepalli, Anchal Pandey, Olufemi Odugbemi, Nafisa Reyaz, Bansi Trambadia, Sadhu Aishwarya Reddy, Shaylika Chauhan, Rupak Desai
Aditi Bhanushali, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
Muskan Kohli, Svaapnika Rao Sarvepalli, Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
Ananya Prakash, Department of Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore 560066, Karnataka, India
Anchal Pandey, Department of Medicine, G.S.V.M. Medical College, Kanpur 208002, Uttar Pradesh, India
Olufemi Odugbemi, Department of Internal Medicine, Lincoln Medical and Mental Health Centre, Bronx, NY 10451, United States
Nafisa Reyaz, Department of Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh 202002, UP, India
Bansi Trambadia, Master of Public Health, Mount Sinai, New York, NY 10029, United States
Sadhu Aishwarya Reddy, Department of Medicine, Osmania Medical College, Hyderabad 500095, Telangana, India
Shaylika Chauhan, Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
Rupak Desai, Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States
Author contributions: Trambadia B, Reddy SA, Chauhan S, Desai R, and Bhanushali A contributed to resources; Trambadia B, Reddy SA, Chauhan S, Desai R, and Bhanushali A, Pandey A, Odugbemi O, and Chauhan S contributed to visualization; Trambadia B, Reddy SA, Chauhan S, Desai R, Bhanushali A, Kohli M, Prakash A, Sarvepalli SR, Odugbemi O, and Reyaz N contributed to writing-original draft; Kohli M, Prakash A, Sarvepalli SR, Pandey A, Odugbemi O, Reyaz N, Trambadia B, Reddy SA, Chauhan S, and Desai R contributed to writing - review & editing; Pandey A, Chauhan S, and Desai R, and Desai R contributed to supervision; Odugbemi O, Reyaz N contributed to formal analysis; Chauhan S contributed to conceptualization, methodology, writing - original draft; Desai R contributed to conceptualization, methodology, software, writing original draft; administration; All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors do not have a conflict of Interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Shaylika Chauhan, MD, FACP Clinical Assistant Professor Department of Internal Medicine, Geisinger Health System, 1000 E Mountain Blvd, Wikes-Barre, PA 18702, United States.
drshaylikachauhan@gmail.com
Received: May 22, 2023
Peer-review started: May 22, 2023
First decision: June 14, 2023
Revised: June 24, 2023
Accepted: July 19, 2023
Article in press: July 19, 2023
Published online: August 26, 2023
Processing time: 90 Days and 24 Hours
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports.
AIM
To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.
METHODS
SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results.
RESULTS
Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived.
CONCLUSION
Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
Core Tip: This study highlights the coexistence and clinical similarities of takotsubo syndrome and spontaneous coronary artery dissection, therefore emphasizing the importance of further research, awareness as well as comprehensive angiographic testing for effective diagnosis and management.
