451
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Dabir D, Luetkens J, Kuetting DLR, Feisst A, Isaak A, Schild HH, Thomas D. Cardiac magnetic resonance including parametric mapping in acute Takotsubo syndrome: Preliminary findings. Eur J Radiol 2019; 113:217-224. [PMID: 30927950 DOI: 10.1016/j.ejrad.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION T1 and T2 mapping have been shown to be reliable markers of interstitial myocardial fibrosis, edema, and inflammation. The aim of this study was to evaluate myocardial involvement in acute phase Takotsubo syndrome using native and post-contrast T1 mapping, ECV fraction, and T2 mapping. MATERIAL AND METHODS We investigated 14 patients with acute Takotsubo syndrome and 14 healthy controls. CMR included cine imaging, black-blood STIR imaging, early and late gadolinium enhancement imaging, native and post-contrast T1 mapping, and T2 mapping. Wall motion, T2 ratio, early gadolinium enhancement ratio, extracellular volume fraction, T1 and T2 relaxation times were analyzed. RESULTS Patients had significantly impaired left ventricular function (46 ± 10%) and acute wall motion abnormalities compared with controls (62 ± 2%). Native T1 and T2 values, T2 ratio, and ECV fraction were significantly higher in patients compared with controls. In patients, native T1 and T2 values as well as T2 ratio were significantly higher in segments with abnormal wall motion compared with normokinetic segments. Native T1 values, T2 relaxation times, T2 ratio, and ECV fraction were significantly higher, post-contrast T1 relaxation times significantly lower in segments with abnormal wall motion compared with segments of controls; except for T2 ratio and post-contrast T1 relaxation times this also held true for patients' segments with normal wall motion. CONCLUSIONS Native T1 and T2 mapping, as well as ECV fraction, discriminate between visually affected vs. unaffected segments in patients with acute Takotsubo syndrome and reveal significant T1 and T2 tissue changes even in visually unaffected segments. Thus, mapping may allow for better detection in convalescent stages of disease and additionally may have the potential to serve as a marker of disease progress. These preliminary findings warrant further investigation in a larger patient cohort.
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Affiliation(s)
- Darius Dabir
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Julian Luetkens
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Daniel L R Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Andreas Feisst
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Alexander Isaak
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Hans H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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452
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Manfredini R, Cappadona R, Fabbian F. Is Takotsubo Syndrome Still a Benign Disease? Complications (and Gender) Make the Difference. Angiology 2019; 70:795-796. [DOI: 10.1177/0003319719830011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Roberto Manfredini
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Rosaria Cappadona
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
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453
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Akashi YJ. Long-term prognosis in patients with Takotsubo syndrome. Eur J Heart Fail 2019; 21:790-791. [PMID: 30714665 DOI: 10.1002/ejhf.1417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 12/06/2018] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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454
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Physiologic Adaptation or Cirrhotic Cardiomyopathy: It Is Time for New Definitions! J Card Fail 2019; 25:173-175. [PMID: 30716399 DOI: 10.1016/j.cardfail.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/24/2023]
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455
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Senecal C, Lerman A. Reply: The challenge of risk stratification in Takotsubo stress cardiomyopathy. Int J Cardiol 2019; 276:207. [DOI: 10.1016/j.ijcard.2018.11.089] [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: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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456
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457
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Tavazzi G, Mojoli F, Iotti GA, Via G. Does Levosimendan Have Room in Takotsubo Syndrome? JACC-HEART FAILURE 2019; 7:174. [DOI: 10.1016/j.jchf.2018.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/24/2023]
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458
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Mechanical Circulatory Support With Impella Percutaneous Ventricular Assist Device as a Bridge to Recovery in Takotsubo Syndrome Complicated by Cardiogenic Shock and Left Ventricular Outflow Tract Obstruction. JACC Cardiovasc Interv 2019; 12:e31-e32. [PMID: 30711550 DOI: 10.1016/j.jcin.2018.10.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/23/2018] [Indexed: 01/24/2023]
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459
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Cardiogenic shock induced by Takotsubo cardiomyopathy in early postoperative adrenalectomy period. ACTA ACUST UNITED AC 2019; 66:288-291. [PMID: 30665798 DOI: 10.1016/j.redar.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/24/2023]
Abstract
Takotsubo cardiomyopathy is part of the group of diseases called stress-induced cardiomyopathies. Its usual clinical presentation is indistinguishable from an acute coronary syndrome. However, early diagnosis is important, as it may debut as a cardiogenic shock in approximately 8% of cases, with morbidity and mortality rates comparable to those of acute coronary syndrome. For this reason, although it is a relatively infrequent condition, the perioperative period is a stress factor that can act as a trigger of this pathology. A case is presented of the onset of Takotsubo cardiomyopathy as a cardiogenic shock during admission in a Postoperative Recovery Unit.
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460
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Frequently Recurrent Takotsubo Syndrome in COPD. Case Rep Cardiol 2019; 2019:6706935. [PMID: 30729044 PMCID: PMC6343172 DOI: 10.1155/2019/6706935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease is common among patients with chronic obstructive pulmonary disease (COPD). Takotsubo syndrome (TTS) is a transient cardiac disorder that, in its typical form, involves left ventricular dysfunction with apical ballooning and mimics acute coronary syndrome (ACS). “Bronchogenic TTS” has been proposed as a specific form of TTS (during severe acute dyspnea in asthma or COPD) with atypical presentation. Recurrent TTS in COPD seems to be exceptionally rare since only a handful of clinical cases have previously been reported in the literature. Here, we present a unique case of a frequently recurrent TTS during COPD exacerbation in a 70-year-old woman, with at least 4 different episodes of TTS within 5 years. This case report exemplifies the difficulties of the diagnosis of TTS at the onset of acute COPD exacerbation. Potential pathophysiological mechanisms and therapeutic strategies are also briefly discussed.
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461
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Y-Hassan S, Holmin S, Abdula G, Böhm F. Thrombo-embolic complications in takotsubo syndrome: Review and demonstration of an illustrative case. Clin Cardiol 2019; 42:312-319. [PMID: 30565272 DOI: 10.1002/clc.23137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/15/2018] [Indexed: 12/16/2022] Open
Abstract
Thrombo-embolism is one of the serious complications of takotsubo syndrome (TS) in addition to heart failure, pulmonary edema, cardiogenic shock, cardiac arrest, life-threatening arrhythmias, left ventricular outlet tract obstruction, mitral regurgitation, cardiac rupture, and death. The most common cardio-embolic events in TS are cerebral, renal, and peripheral embolism. Approximately, one-third of patients with left ventricular thrombus (LVT) in TS develop embolic complications. Cardio-embolism in TS may occur with or without the presence of detectable LVT. In the present report, the thrombo-embolic complications in TS with the emphasis on the association of TS to both acute coronary syndrome (ACS) including coronary embolism and ischemic stroke including cerebral embolism are reviewed. This serious complication is elucidated by demonstration of the case of a 67-year-woman with mid-apical TS complicated by LVT, left anterior descending artery (LAD) and left middle cerebral artery (segment M2) thrombo-embolic occlusions. The cerebral artery thrombotic occlusion was treated successfully with endovascular thrombectomy with complete resolution of the neurological deficits. There was spontaneous recanalization of the apical LAD occlusion verified by cardiac computed tomography angiography.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroradiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Goran Abdula
- Department of Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Felix Böhm
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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462
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Schlitt A, Rauschenberg S, Stoevesandt D, Thiele H. [Cardiomyopathy]. MMW Fortschr Med 2019; 161:48-55. [PMID: 30671862 DOI: 10.1007/s15006-019-0001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Axel Schlitt
- Abteilung für Kardiologie und Diabetologie, Paracelsus-Harz-Klinik Bad Suderode, Paracelsusstr. 1, D-06485, Quedlinburg, Deutschland.
- Medizinische Fakultät der Martin Luther-Universität, Halle-Wittenberg, Deutschland.
| | - Sophie Rauschenberg
- Medizinische Fakultät der Martin Luther-Universität, Halle-Wittenberg, Deutschland
| | - Dietrich Stoevesandt
- Universitätsklinik und Poliklinik für Diagnostische Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Holger Thiele
- Universitätsklinik für Kardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
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463
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Takotsubo cardiomyopathy and Parkinson's disease: An exceptionally uncommon clinical duet. Hellenic J Cardiol 2018; 60:334-335. [PMID: 30572116 DOI: 10.1016/j.hjc.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/03/2018] [Indexed: 01/24/2023] Open
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464
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Jha S, Zeijlon R, Shekka Espinosa A, Alkhoury J, Oras J, Omerovic E, Redfors B. Clinical management in the takotsubo syndrome. Expert Rev Cardiovasc Ther 2018; 17:83-93. [DOI: 10.1080/14779072.2019.1556098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Internal Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jessica Alkhoury
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Laboratory, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY, USA
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465
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Abstract
RATIONALE Takotsubo syndrome (TTS) most commonly occurs in postmenopausal women who have been exposed to a triggering event such as acute physical or emotional distress. Sepsis-induced TTS in young premenopausal women were rarely reported. In particular, the relationship between sepsis-induced TTS and sepsis-induced cardiomyopathy (SIC) remains to be illuminated. PATIENT CONCERNS Two young premenopausal women were admitted to the hospital with sepsis and myocardial involvement. DIAGNOSIS Both patients fully met the Mayo Clinic criteria for TTS. INTERVENTIONS Both patients received anti-infection and fluid infusion treatment. OUTCOMES Both patients were discharged without complications and the follow-up ultrasonic echocardiography showed normal results. LESSONS In this report, we describe 2 young premenopausal women with sepsis-induced TTS. There is an overlap between sepsis-induced TTS and SIC, and SIC could be a special type of TTS, which occurs under the stress of sepsis.
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466
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Namasivayam M, McEniery CM, Wilkinson IB, Yasmin, Cockroft JR, McDonnell BJ, Adji A, O’Rourke MF. Different Effects of Vascular Aging on Ischemic Predisposition in Healthy Men and Women. Hypertension 2018; 72:1294-1300. [DOI: 10.1161/hypertensionaha.118.11642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mayooran Namasivayam
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - Yasmin
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (C.M.M., I.B.W., Y.)
| | - John R. Cockroft
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Barry J. McDonnell
- School of Health Sciences, Cardiff Metropolitan University, United Kingdom (J.R.C., B.J.M.)
| | - Audrey Adji
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia (A.A.)
| | - Michael F. O’Rourke
- From the Faculty of Medicine, University of New South Wales, Sydney, Australia (M.N., M.F.O.)
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467
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Scheitz JF, Nolte CH, Doehner W, Hachinski V, Endres M. Stroke–heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol 2018; 17:1109-1120. [DOI: 10.1016/s1474-4422(18)30336-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/14/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023]
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468
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Y-Hassan S. Plasma Epinephrine Level and its Causal Link to Takotsubo Syndrome Revisited: Critical Review with a Diverse Conclusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:907-914. [PMID: 30446399 DOI: 10.1016/j.carrev.2018.10.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 01/22/2023]
Abstract
Takotsubo syndrome (TS) is a recognized acute cardiac syndrome with a clinical presentation resembling that of an acute coronary syndrome (ACS). The defining feature of TS is the reversible left ventricular wall motion abnormality (LVWMA), which has a unique circumferential pattern resulting in a conspicuous ballooning of the left ventricle during systole, and extending beyond the coronary artery supply territory. The pathogenesis of TS is still elusive and several pathophysiological mechanisms have been proposed. A common portrayal of the syndrome in the literature is that the disease is characterized by massive surge of plasma catecholamines including epinephrine. Based on the assumption of massive plasma epinephrine elevation, some investigators hypothesized that the circulatory plasma epinephrine plays a pivotal role in the pathogenesis of TS. One typical such hypothesis is epinephrine induced switch in signal trafficking causing apical or mid-apical ballooning in TS. In-depth analysis of the literature reveals that no study with certainty has shown "massive" plasma epinephrine elevations in TS. Furthermore, the literature evidences challenging the epinephrine-induced switch in signal trafficking are substantial. In this review, sufficient data, indicating that the plasma epinephrine in TS is either normal or moderately elevated in all studies, are provided. Noteworthy, epinephrine may act as a trigger factor for TS-induction but there is no evidence for a direct causal link between epinephrine and TS.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
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469
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Abstract
Stress-induced cardiomyopathy (SCM), is a reversible cardiomyopathy characterized by transient systolic dysfunction following an acute physiologic stress. Thromboembolism occurs at a high frequency in patients with intracardiac thrombus secondary to SCM, with one systematic review reporting a rate of 33.3%. The risk of thrombus formation following SCM has been associated with left-ventricular (LV) contraction abnormalities, catecholaminergic surge, and other associated comorbidities. However, established guidelines for screening and management of intracardiac thrombus in the setting of SCM do not exist at present due to a lack of sufficient clinical trial data. The purpose of this article is to discuss the pathophysiological theory and previously documented evidence from cases of LV thrombus secondary to SCM, and to present our recommendations for management of intracardiac thrombus secondary to SCM.
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Affiliation(s)
- Saagar K Sanghvi
- Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way, ML 0542, Cincinnati, OH, 45267-0542, USA.
| | - David M Harris
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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470
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Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, Moeller FG, Berrocal D, Abbate A. Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:1955-1971. [PMID: 30309474 PMCID: PMC7058348 DOI: 10.1016/j.jacc.2018.07.072] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
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Affiliation(s)
- Horacio Medina de Chazal
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lori Keyser-Marcus
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Liangsuo Ma
- Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - F Gerard Moeller
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia; Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Berrocal
- Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.
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471
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Rellini G, Piazza R, Loiudice E, Cassin M, Bernardi G, Pavan D, Cervesato E, Nicolosi GL. Heterogeneity of clinical presentation in Tako-Tsubo syndromes: the prevalence of normal segmental wall motion and normal ECG pattern. J Cardiovasc Med (Hagerstown) 2018; 19:717-724. [PMID: 30320724 DOI: 10.2459/jcm.0000000000000729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to report the heterogeneity of clinical presentation in Tako-Tsubo syndrome (TTS), including a significant prevalence of normal ECG and echocardiographic patterns in a series of consecutive patients from a single center. METHODS AND RESULTS From our database we selected a total of 168 cases of TTS. A total of 140 of these (Group A); 14 men (10%), mean age 60.3 years, range 39-87; 126 women (90%), mean age 66.1 years, range 43-93; matched the following reported criteria: typical stenocardic pain immediately following an emotional acute stress, or acute medical or surgical event within the preceding 12 h; acute rise and fall of troponin release; absence of significant coronary disease at coronary angiography. ECG findings at presentation ranged from T wave abnormalities (41 cases, 29.3%) to ST elevation (52 cases, 37.1%) and ST depression (11 cases, 7.9%), whereas in 36 cases (25.7%) the ECG was normal. Echocardiography at presentation showed akinesia of the total apical or medium-apical segments in 74 patients (53%), whereas it showed akinesia of left ventricular wall segments in other locations in 30 patients (21%) and even normal regional wall motion and thickening in 36 patients (26%). We described also a series of 13 female patients (mean age 70.2 years; age range 45-85 years) (Group B) who did not complain of chest pain at presentation, but showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography. Finally we selected 15 female patients (mean age 69.3 years; age range 49-89 years) (Group C) who formally did not report acute stress immediately preceding their presentation to the hospital for chest pain. They showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography and only one case of normal ECG pattern at presentation. CONCLUSION In this series of acute TTS, a wide variability of ECG and echocardiographic patterns are observed, ranging from ST elevation with coexisting segmental wall motion abnormalities of the typical TTS to a clinical presentation characterized by normal ECG and normal segmental wall motion pattern.
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Affiliation(s)
| | | | | | | | | | | | | | - Gian L Nicolosi
- Cardiology Department, ARC, Ospedale Civile.,Cardiology Clinic, Policlinico San Giorgio, Pordenone, Italy
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472
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Lüscher TF. Acute and chronic coronary syndromes: coronary dissection, intraplaque haemorrhage, and late lumen loss. Eur Heart J 2018; 39:3339-3342. [DOI: 10.1093/eurheartj/ehy589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Consultant and Director of Research, Education & Development, Royal Brompton and Harefield Hospital Trust and Imperial College, London, UK
- Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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473
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474
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Desai R, Singh S, Goyal H, Dhoble A, Deshmukh A, Kumar G, Sachdeva R. Reply to "Low prevalence of diabetes with chronic complications in patients with Takotsubo syndrome". Clin Cardiol 2018; 41:1036-1037. [PMID: 29998519 DOI: 10.1002/clc.23024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | - Sandeep Singh
- Institute of Human Behavior and Allied Sciences, New Delhi, India
| | - Hemant Goyal
- Division of Internal Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Abhijeet Dhoble
- Division of Cardiology, University of Texas McGovern Medical School, Houston, Texas
| | | | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia.,Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Rajesh Sachdeva
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia
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Lüscher TF. Takotsubo syndrome: the Cinderella compared with common acute coronary syndromes. Eur Heart J 2018; 39:2017-2020. [PMID: 29878170 DOI: 10.1093/eurheartj/ehy312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Consultant and Director of Research, Education & Development, Royal Brompton and Harefield Hospital Trust and Imperial College, London, UK.,Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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