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Wang T, Xiong T, Yang Y, Chen X, Ma Z, Zuo B, Ning D, Zhou B, Song R, Liu X, Wang D. Estradiol-mediated small GTP-binding protein GDP dissociation stimulator induction contributes to sex differences in resilience to ferroptosis in takotsubo syndrome. Redox Biol 2023; 68:102961. [PMID: 38007983 PMCID: PMC10719533 DOI: 10.1016/j.redox.2023.102961] [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: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Declining beneficial cardiovascular actions of estradiol (E2) have been associated with disproportionate susceptibility to takotsubo syndrome (TTS) in postmenopausal women. However, the underlying mechanisms between E2 and this marked disproportion remain unclear. SmgGDS (small GTP-binding protein GDP dissociation stimulator), as a key modulator of cardiovascular disease, plays protective roles in reducing oxidative stress and exerts pleiotropic effects of statins. Whether SmgGDS levels are influenced by E2 status and the effect of SmgGDS on sex differences in TTS are poorly understood. METHODS Clinical data were reviewed from TTS inpatients. Echocardiography, immunofluorescence, and immunohistochemistry were performed together with expression analysis to uncover phenotypic and mechanism changes in sex differences in TTS-like wild-type (WT) and SmgGDS± mice. HL-1 cardiomyocytes were used to further examine and validate molecular mechanisms. RESULTS In 14 TTS inpatients, TTS had a higher incidence in postmenopausal women as compared to premenopausal women and men. In murine TTS, female WT mice exhibited higher cardiac SmgGDS levels than male WT mice. Ovariectomy reduced SmgGDS expression in female WT mice similar to that observed in male mice, whereas E2 replacement in these ovariectomized (OVX) female mice reversed this effect. The physiological importance of this sex-specific E2-mediated SmgGDS response is underscored by the disparity in cardiac adaptation to isoproterenol (ISO) stimulation between both sexes of WT mice. E2-mediated SmgGDS induction conferred female protection against TTS-like acute cardiac injury involving ferritinophagy-mediated ferroptosis. No such cardioprotection was observed in male WT mice and OVX female. A causal role for SmgGDS in this sex-specific cardioprotective adaptation was indicated, inasmuch as SmgGDS deficiency abolished E2-modulated cardioprotection against ferritinophagy and aggravates TTS progression in both sexes. Consistently, knockdown of SmgGDS in HL-1 cardiomyocytes exacerbated ferroptosis in a ferritinophagy-dependent manner and abrogated the protective role of E2 against ferritinophagy. Mechanistically, our findings revealed that SmgGDS regulated E2-dependent cardioprotective effects via AMPK/mTOR signaling pathway. SmgGDS deficiency abolished E2-conferred protection against ferritinophagy through activating AMPK/mTOR pathway, while treatment with recombinant SmgGDS in HL-1 cells significantly mitigated this pathway-associated ferritinophagy activity. CONCLUSIONS These results demonstrate that SmgGDS is a central mediator of E2-conferred female cardioprotection against ferritinophagy-mediated ferroptosis in TTS.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China; Cardiology Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Ting Xiong
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Ziwei Ma
- Clinical Medical College, Dalian Medical University, Dalian, Liaoning, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Dong Ning
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Beibei Zhou
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Ruilong Song
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xuesong Liu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China.
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Pogran E, Zweiker D, Gargiulo L, El‐Razek AA, Lechner I, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Zirlik A, Bauer A, Metzler B, Lambert T, Steinwender C, Huber K. Takotsubo syndrome before and during the COVID-19 pandemic in Austria: a retrospective cohort study (TOSCA-19). ESC Heart Fail 2023; 10:3667-3676. [PMID: 37803874 PMCID: PMC10682936 DOI: 10.1002/ehf2.14536] [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: 05/24/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
AIMS This study aims to investigate the prevalence of Takotsubo syndrome (TTS) as a percentage of the total number of acute coronary syndrome (ACS), including non-STE-elevation myocardial infarction and ST-elevation myocardial infarction, as well as the short-term outcome of TTS patients before and during the COVID-19 pandemic. METHODS AND RESULTS We compared patients from two different periods: (i) Period 1 (before the COVID-19 pandemic): 1 March to 30 December 2019, and (ii) Period 2 (during the COVID-19 pandemic): 1 March to 30 December 2020. The retrospective database was created from the archives of the participating hospitals or electronic hospital systems by trained medical personnel. The subjects' medical history, cardiovascular risk factors, laboratory values, echocardiography findings, and an in-hospital outcome were variables of interest. Furthermore, propensity score matching analysis was performed to evaluate the short-term prognosis in TTS and ACS patients. Altogether six Austrian centres-(i) 3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring, Vienna, Austria; (ii) 5th Medical Department of Cardiology, Clinic Favoriten, Vienna, Austria; (iii) 2nd Medical Department, Hanusch Hospital, Vienna, Austria; (iv) University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria; (v) Department of Cardiology, University Hospital Graz, Graz, Austria; (vi) Department of Cardiology and Intensive Medicine, Kepler University Clinic, Linz, Austria-participated in the study. During period 1, 87 (3.5%) patients out of 2482 ACS patients had TTS in all participating centres. During period 2, 71 (2.7%) patients out of 2572 ACS patients had TTS in all participating centres. Accordingly, the prevalence of TTS remained stable irrespective of potential psychologic stress during the COVID pandemic. Furthermore, the baseline characteristics of TTS patients did not change during the COVID-19 pandemic. The prevalence of in-hospital complications [cardiogenic shock (4.6% vs. 4.3%, P = 0.925), ventricle thrombus (1.1% vs. 1.4%, P = 0.885) and in-hospital bleeding (3.4% vs. 1.4%, P = 0.417)] remained stable. The all-cause in-hospital mortality of TTS patients did not change during the COVID-19 pandemic [χ2 (2) = 0.058, P = 0.810]. Moreover, a propensity score matching analysis of all-cause in-hospital mortality between matched TTS and ACS patients showed higher in-hospital mortality in ACS patients during COVID-19 pandemic (P = 0.043). CONCLUSIONS Despite the well-known increased psychologic stress during the COVID-19 pandemic, the prevalence of TTS during the COVID-19 pandemic and the short-term clinical outcome in Austria remained unimpacted.
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Affiliation(s)
- Edita Pogran
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
- Doctoral Programme Meduni ViennaMedical University of ViennaViennaAustria
| | - David Zweiker
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
| | - Laura Gargiulo
- School of MedicineSigmund Freud Private UniversityViennaAustria
| | | | - Ivan Lechner
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Ivan Vosko
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Stefan Rechberger
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Heiko Bugger
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Günter Christ
- 5th Medical Department of CardiologyClinic FavoritenViennaAustria
| | - Diana Bonderman
- 5th Medical Department of CardiologyClinic FavoritenViennaAustria
| | | | - Andreas Zirlik
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Axel Bauer
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Bernhard Metzler
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Thomas Lambert
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Clemens Steinwender
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Kurt Huber
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
- School of MedicineSigmund Freud Private UniversityViennaAustria
- Ludwig Boltzmann Institute for Interventional Cardiology and RhythmologyMedical University of ViennaViennaAustria
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53
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Theofilis P, Vlachakis PK, Mantzouranis E, Sakalidis A, Chrysohoou C, Leontsinis I, Lazaros G, Dimitriadis K, Drakopoulou M, Vordoni A, Oikonomou E, Tsioufis K, Tousoulis D. Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics. Angiology 2023:33197231218331. [PMID: 37995282 DOI: 10.1177/00033197231218331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis K Vlachakis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Mantzouranis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Sakalidis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Leontsinis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Drakopoulou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Vordoni
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Citro R, Bellino M, Merli E, Di Vece D, Sherrid MV. Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning? J Am Heart Assoc 2023; 12:e032028. [PMID: 37889174 PMCID: PMC10727392 DOI: 10.1161/jaha.123.032028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply-demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.
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Affiliation(s)
- Rodolfo Citro
- Cardio‐Thorax‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
- Department of Vascular PhysiopathologyIRCCS NeuromedPozzilliItaly
| | - Michele Bellino
- Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | - Elisa Merli
- Department of CardiologyOspedale per gli InfermiFaenzaItaly
| | - Davide Di Vece
- Department of CardiologyUniversity Hospital ZurichZurichSwitzerland
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Vendrov AE, Xiao H, Lozhkin A, Hayami T, Hu G, Brody MJ, Sadoshima J, Zhang YY, Runge MS, Madamanchi NR. Cardiomyocyte NOX4 regulates resident macrophage-mediated inflammation and diastolic dysfunction in stress cardiomyopathy. Redox Biol 2023; 67:102937. [PMID: 37871532 PMCID: PMC10598408 DOI: 10.1016/j.redox.2023.102937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
In acute sympathetic stress, catecholamine overload can lead to stress cardiomyopathy. We tested the hypothesis that cardiomyocyte NOX4 (NADPH oxidase 4)-dependent mitochondrial oxidative stress mediates inflammation and diastolic dysfunction in stress cardiomyopathy. Isoproterenol (ISO; 5 mg/kg) injection induced sympathetic stress in wild-type and cardiomyocyte (CM)-specific Nox4 knockout (Nox4CM-/-) mice. Wild-type mice treated with ISO showed higher CM NOX4 expression, H2O2 levels, inflammasome activation, and IL18, IL6, CCL2, and TNFα levels than Nox4CM-/- mice. Spectral flow cytometry and t-SNE analysis of cardiac cell suspensions showed significant increases in pro-inflammatory and pro-fibrotic embryonic-derived resident (CCR2-MHCIIhiCX3CR1hi) macrophages in wild-type mice 3 days after ISO treatment, whereas Nox4CM-/- mice had a higher proportion of embryonic-derived resident tissue-repair (CCR2-MHCIIloCX3CR1lo) macrophages. A significant increase in cardiac fibroblast activation and interstitial collagen deposition and a restrictive pattern of diastolic dysfunction with increased filling pressure was observed in wild-type hearts compared with Nox4CM-/- 7 days post-ISO. A selective NOX4 inhibitor, GKT137831, reduced myocardial mitochondrial ROS, macrophage infiltration, and fibrosis in ISO-injected wild-type mice, and preserved diastolic function. Our data suggest sympathetic overstimulation induces resident macrophage (CCR2-MHCII+) activation and myocardial inflammation, resulting in fibrosis and impaired diastolic function mediated by CM NOX4-dependent ROS.
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Affiliation(s)
- Aleksandr E Vendrov
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Han Xiao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China; Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Andrey Lozhkin
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Takayuki Hayami
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Guomin Hu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China; Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Matthew J Brody
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Junichi Sadoshima
- Rutgers New Jersey Medical School, Department of Cell Biology and Molecular Medicine, Rutgers Biomedical and Health Sciences, Newark, NJ, 07101, USA
| | - You-Yi Zhang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China; Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Marschall S Runge
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Nageswara R Madamanchi
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.
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Singh T, Mishra AK, Vojjala N, John KJ, George AA, Jha A, Hadley M. Cardiovascular complications following medical termination of pregnancy: An updated review. World J Cardiol 2023; 15:518-530. [PMID: 37900907 PMCID: PMC10600792 DOI: 10.4330/wjc.v15.i10.518] [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: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described. AIM To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP. METHODS We performed a literature search in PubMed, Medline, RCA, and google scholar, using the search terms "abortions" or "medical/legal termination of pregnancy" and "cardiac complications" or "cardiovascular complications". RESULTS The most common complications described in the literature following MTP were infective endocarditis (IE) (n = 16), takotsubo cardiomyopathy (TTC) (n = 7), arrhythmias (n = 5), and sudden coronary artery dissection (SCAD) (n = 4). The most common valve involved in IE was the tricuspid valve in 69% (n = 10). The most observed causative organism was group B Streptococcus in 81% (n = 12). The most common type of TTC was apical type in 57% (n = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications. CONCLUSION In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.
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Affiliation(s)
- Tejveer Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States.
| | - Nikhil Vojjala
- Department of Internal Medicine, Post-Graduation Institute of Medical Education and Research, Chandigarh 00000, India
| | - Kevin John John
- Department of Internal Medicine, Tufts Medical Center, Boston, MA 01212, United States
| | - Anu A George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anil Jha
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Lim KRQ, Mann DL, Kenzaka T, Hayashi T. The Immunology of Takotsubo Syndrome. Front Immunol 2023; 14:1254011. [PMID: 37868970 PMCID: PMC10588665 DOI: 10.3389/fimmu.2023.1254011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Takotsubo syndrome (TTS) is a disorder characterized by transient cardiac dysfunction with ventricular regional wall motion abnormalities, primarily thought to be caused by the effects of a sudden catecholamine surge on the heart. Although the majority of patients exhibit prompt recovery of their cardiac dysfunction, TTS remains associated with increased mortality rates acutely and at long-term, and there is currently no cure for TTS. Inflammation has been shown to play a key role in determining outcomes in TTS patients, as well as in the early pathogenesis of the disorder. There are also cases of TTS patients that have been successfully treated with anti-inflammatory therapies, supporting the importance of the inflammatory response in TTS. In this article, we provide a comprehensive review of the available clinical and pre-clinical literature on the immune response in TTS, in an effort to not only better understand the pathophysiology of TTS but also to generate insights on the treatment of patients with this disorder.
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Affiliation(s)
- Kenji Rowel Q. Lim
- Division of Cardiology, Department of Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO, United States
| | - Douglas L. Mann
- Division of Cardiology, Department of Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO, United States
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Tomohiro Hayashi
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
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58
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Alonzo A, Di Fusco SA, Castello L, Matteucci A, Spinelli A, Marino G, Aquilani S, Imperoli G, Colivicchi F. Tako-Tsubo syndrome in patients with COVID-19: a single-center retrospective case series. Monaldi Arch Chest Dis 2023; 94. [PMID: 37675931 DOI: 10.4081/monaldi.2023.2675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Growing evidence shows that COVID-19 is associated with an increase in Tako-Tsubo syndrome (TTS) incidence. We collected data from patients hospitalized in our multidisciplinary COVID-19 department who had a diagnosis of TTS during the second and third waves of the pandemic in Italy. We reported four cases of TTS associated with COVID-19. Except for COVID-19, no patient had any classical TTS triggers. The mean age was 72 years (67-81) and all patients had COVID-19-related interstitial pneumonia confirmed by computed tomography. Typical apical ballooning and transitory reduction in left ventricle (LV) systolic function with a complete recovery before discharge were observed in all patients. The mean LV ejection fraction at TTS onset was 42% (40-48%). The electrocardiogram showed ST-segment elevation in two cases, while an evolution with negative T waves and corrected QT prolongation was observed in all patients. Three patients underwent coronary angiography. Two patients had Alzheimer's disease. The time interval from hospital admission to TTS onset was 4 (2-6) days, and the time interval from COVID-19 symptom onset to TTS diagnosis was 10 (8-12) days. COVID-19 may be a trigger for TTS, though TTS pathophysiology in COVID-19 patients remains unclear, likely due to its multifactorial nature.
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Affiliation(s)
- Alessandro Alonzo
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | | | - Lorenzo Castello
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Andrea Matteucci
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Antonella Spinelli
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Gaetano Marino
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Stefano Aquilani
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
| | - Giuseppe Imperoli
- Medicine Unit, Emergency Department, San Filippo Neri Hospital, Rome.
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome.
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Bhanushali A, Kohli M, Prakash A, Sarvepalli SR, Pandey A, Odugbemi O, Reyaz N, Trambadia B, Reddy SA, Chauhan S, Desai R. Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports. World J Cardiol 2023; 15:406-414. [PMID: 37771341 PMCID: PMC10523194 DOI: 10.4330/wjc.v15.i8.406] [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: 05/22/2023] [Revised: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023] Open
Abstract
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.
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Affiliation(s)
- Aditi Bhanushali
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Muskan Kohli
- 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
| | - Svaapnika Rao Sarvepalli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - 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
| | | | - 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
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Srdanović I, Dabović D, Ivanović V, Čanković M, Pantić T, Stefanović M, Dimić S, Crnomarković B, Bjelobrk M, Govedarica M, Zdravković M. Takotsubo Cardiomyopathy Occurring Simultaneously with Acute Myocardial Infarction. Life (Basel) 2023; 13:1770. [PMID: 37629626 PMCID: PMC10455998 DOI: 10.3390/life13081770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TCM) is a reversible form of cardiomyopathy characterized by transient regional systolic dysfunction of the left ventricle. CASE OUTLINE A 78-year-old woman was admitted to the general hospital due to acute inferior STEMI late presentation. Two days after admission, the patient reported intense chest pain and an ECG registered diffuse ST-segment elevation in all leads with ST-segment denivelation in aVR. The patient also showed clinical signs of cardiogenic shock and was referred to a reference institution for further evaluation. Echocardiography revealed akinesia of all medioapical segments, dynamic obstruction of the left ventricular outflow tract (LVOT), moderate mitral regurgitation, and pericardial effusion. Coronary angiography showed the suboccluded right coronary artery, and a primary percutaneous coronary intervention was performed, which involved implanting a drug-eluting stent. The patient's condition worsened as pericardial effusion increased and led to tamponade. Pericardiocentesis was performed, resulting in the patient's stabilization. At this point, significant gradients at the LVOT and pericardial effusion were not registered. After eight days without symptoms and stable status, the patient was discharged. CONCLUSIONS The simultaneous presence of AMI and TCM increases the risk of developing cardiogenic shock. The cardio-circulatory profile of these patients is different from those with AMI.
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Affiliation(s)
- Ilija Srdanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Dragana Dabović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Vladimir Ivanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Teodora Pantić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Maja Stefanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Dimić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Branislav Crnomarković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Marija Bjelobrk
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Miljana Govedarica
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Department of Obstetrics and Gynaecology, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Marija Zdravković
- University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Dell’Aversana F, Tedeschi C, Comune R, Gallo L, Ferrandino G, Basco E, Tamburrini S, Sica G, Masala S, Scaglione M, Liguori C. Advanced Cardiac Imaging and Women's Chest Pain: A Question of Gender. Diagnostics (Basel) 2023; 13:2611. [PMID: 37568974 PMCID: PMC10416986 DOI: 10.3390/diagnostics13152611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Awareness of gender differences in cardiovascular disease (CVD) has increased: both the different impact of traditional cardiovascular risk factors on women and the existence of sex-specific risk factors have been demonstrated. Therefore, it is essential to recognize typical aspects of ischemic heart disease (IHD) in women, who usually show a lower prevalence of obstructive coronary artery disease (CAD) as a cause of acute coronary syndrome (ACS). It is also important to know how to recognize pathologies that can cause acute chest pain with a higher incidence in women, such as spontaneous coronary artery dissection (SCAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) gained a pivotal role in the context of cardiac emergencies. Thus, the aim of our review is to investigate the most frequent scenarios in women with acute chest pain and how advanced cardiac imaging can help in the management and diagnosis of ACS.
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Affiliation(s)
- Federica Dell’Aversana
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Carlo Tedeschi
- Operational Unit of Cardiology, Presidio Sanitario Intermedio Napoli Est, ASL-Napoli 1 Centro, 80144 Napoli, Italy;
| | - Rosita Comune
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Giovanni Ferrandino
- Department of Radiology, Ospedale del Mare-ASL Napoli 1, 80147 Napoli, Italy; (G.F.)
| | - Emilia Basco
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL Napoli 1, 80147 Napoli, Italy; (G.F.)
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital Azienda dei Colli, 80131 Napoli, Italy
| | - Salvatore Masala
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Mariano Scaglione
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare-ASL Napoli 1, 80147 Napoli, Italy; (G.F.)
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Luo Y, Ye X, Zhang L, Yang Y, Liang Q. A rare case of cardiogenic shock caused by takotsubo syndrome associated with SARS-CoV-2 infection: The value of echocardiography in the diagnosis and monitoring of the efficacy of extracorporeal membrane oxygenation. Echocardiography 2023; 40:866-874. [PMID: 37229563 DOI: 10.1111/echo.15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly invades the respiratory system, but may also cause various cardiovascular complications. We report a rare case of myocarditis associated with SARS-CoV-2 infection. A 61-year-old man was admitted to the hospital with a positive nucleic acid test for SARS-CoV-2. A sudden increase in troponin level (up to .144 ng/mL) was observed on the 8th day after admission. He developed symptoms of heart failure and progressed rapidly to cardiogenic shock. Echocardiography on the same day showed reduced left ventricular ejection fraction, reduced cardiac output, and segmental ventricular wall motion abnormalities. Takotsubo cardiomyopathy associated with SARS-CoV-2 infection was considered based on the typical echocardiography findings. We immediately started veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment. The patient was successfully withdrawn from VA-ECMO after 8 days following recovery of ejection fraction to 65% and all indicators qualifying the withdrawal criteria. Echocardiography plays an important role in dynamic monitoring of cardiac changes in such cases and can help determine the timing of extracorporeal membrane oxygenation treatment and withdrawal.
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Affiliation(s)
- Yiran Luo
- Department of Cardiology Cardiac Function Room, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xianwei Ye
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Lu Zhang
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yang Yang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou, Zunyi, China
| | - Qin Liang
- Department of Cardiology Cardiac Function Room, Guizhou Provincial People's Hospital, Guiyang, China
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Reza RR, Parajuli A, Padullaparthi T, Aloori S, Baddam A, Parajuli A, Karnati SS, Nasir H. Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report. Cureus 2023; 15:e43295. [PMID: 37692656 PMCID: PMC10492645 DOI: 10.7759/cureus.43295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Although the efficacy and safety of the coronavirus disease 2019 (COVID-19) vaccine have been established, side effects and adverse events related to the COVID-19 vaccine are still coming out. COVID-19 vaccine also has the potential to cause acute and long-term cardiovascular effects, which include myocarditis, pericarditis, myopericarditis, myocardial infarction, pulmonary embolism, thrombotic thrombocytopenia, and pulmonary hemorrhage. Although uncommon, takotsubo cardiomyopathy (TCM) has also been reported following COVID-19 vaccination. We report a case of TCM following the COVID-19 vaccine in a 59-year-old female who presented with intermittent chest pain and dyspnea following the COVID-19 vaccine booster dose. She had no identifiable triggers for TCM, no risk factors for cardiovascular disease, and normal cardiac enzyme levels, ruling out other causes of cardiac dysfunction. The diagnosis of TCM was supported by imaging findings and the absence of obstructive or thrombotic lesions on angiography.
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Affiliation(s)
- Rezaur Rahman Reza
- Internal Medicine, Jalalabad Ragib Rabeya Medical College, Victorville, USA
| | - Aalok Parajuli
- Medicine and Surgery, Prime Health Care/Desert Valley Hospital, Victorville, USA
| | | | - Swetha Aloori
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | - Anusha Baddam
- Internal Medicine, Malla Reddy Medical College for Women, Hyderabad, IND
| | - Aakriti Parajuli
- Epidemiology and Biostatistics, Benedictine University, Chicago, USA
| | | | - Hira Nasir
- Internal Medicine, Mayo Hospital, Lahore, PAK
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van Weperen VYH, Ripplinger CM, Vaseghi M. Autonomic control of ventricular function in health and disease: current state of the art. Clin Auton Res 2023; 33:491-517. [PMID: 37166736 PMCID: PMC10173946 DOI: 10.1007/s10286-023-00948-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. METHODS Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. RESULTS A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. CONCLUSIONS Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
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Affiliation(s)
- Valerie Y H van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | | | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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Chung D, Hong S, Lee J, Chung J, Bang OY, Kim G, Seo W, Park S. Topographical Association Between Left Ventricular Strain and Brain Lesions in Patients With Acute Ischemic Stroke and Normal Cardiac Function. J Am Heart Assoc 2023; 12:e029604. [PMID: 37522166 PMCID: PMC10492978 DOI: 10.1161/jaha.123.029604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Background Although it is well known that the disordered brain provokes cardiac autonomic dysfunction, the detailed location of brain lesions related to cardiac function warrants further investigation. We aimed to elucidate the brain lesions topographically associated with left ventricular (LV) systolic function measured by myocardial strain in patients with acute ischemic stroke without preexisting primary cardiac dysfunction by using support vector regression lesion-symptom mapping. Methods and Results Subjects were those with LV ejection fraction of 50% or more among patients with acute ischemic stroke registered in the Samsung Medical Center stroke registry between 2016 and 2017. To evaluate LV systolic performance and contractility, we measured LV ejection fraction and LV global and regional longitudinal strain using 2-dimensional speckle-tracking echocardiography. The association between stroke lesion location and cardiac strain was assessed using support vector regression lesion-symptom mapping. Of a total of 776 patients, 286 subjects (mean age of 67.0 years, 65.4% men) were finally enrolled in this study. The mean global longitudinal strain was -17.0±3.4%, and the mean LV ejection fraction was 64.7±5.7%. The support vector regression lesion-symptom mapping analysis revealed that the right insula and peri-insular regions and left parietal cortex were associated with impaired LV global longitudinal strain in patients with acute ischemic stroke. In addition, impaired regional longitudinal strain showed topographical associations with these regions. Conclusions This study suggests that brain lesions in the right insula and peri-insular regions and left parietal cortex are topographically associated with impaired LV strain in patients with acute ischemic stroke without preexisting cardiac dysfunction.
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Affiliation(s)
- Darda Chung
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Suk‐Woo Hong
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Program in Brain Science, College of Natural SciencesSeoul National UniversitySeoulRepublic of Korea
| | - Jieun Lee
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Jong‐Won Chung
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Gyeong‐Moon Kim
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Woo‐Keun Seo
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & TechnologySungkyunkwan UniversitySeoulRepublic of Korea
| | - Sung‐Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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Zhang Z, Guo X, Wang J, Wang S, Wang Y. A case report and literature review: pheochromocytoma-mediated takotsubo cardiomyopathy, which is similar to acute myocardial infarction. Front Cardiovasc Med 2023; 10:1194814. [PMID: 37424925 PMCID: PMC10327548 DOI: 10.3389/fcvm.2023.1194814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
A 52-year-old Chinese woman was admitted to a cardiac intensive care unit (CCU) due to nausea, vomiting, and dyspnea, which began a day before her hospitalization. Metoprolol succinate and conventional treatment for acute myocardial infarction (AMI) were initially administered to the patient based on electrocardiogram (ECG) findings and elevated cardiac troponin I (cTnI). However, the following day, she developed aggravated nausea, vomiting, fever, sweating, a flushed face, a rapid heart rate, and a significant rise in blood pressure. Furthermore, ultrasonic cardiography (UCG) displayed takotsubo-like changes; nevertheless, ECG indicated inconsistent cTnI peaks with extensive infarction. After coronary computed tomography angiography (CTA) ruled out (AMI), and in conjunction with the uncommon findings, we strongly suspected that the patient had a secondary condition of pheochromocytoma-induced takotsubo cardiomyopathy (Pheo-TCM). In the meanwhile, the use of metoprolol succinate was promptly discontinued. This hypothesis was further supported by the subsequent plasma elevation of multiple catecholamines and contrast-enhanced computed tomography (CECT). After one month of treatment with high-dose Phenoxybenzamine in combination with metoprolol succinate, the patient met the criteria for surgical excision and successfully underwent the procedure. This case report demonstrated that pheochromocytoma could induce TCM and emphasized the significance of distinguishing it from AMI (in the context of beta-blocker usage and anticoagulant management).
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Stiermaier T, Reil JC, Sequeira V, Rawish E, Mezger M, Pätz T, Paitazoglou C, Schmidt T, Frerker C, Steendijk P, Reil GH, Eitel I. Hemodynamic Assessment in Takotsubo Syndrome. J Am Coll Cardiol 2023; 81:1979-1991. [PMID: 37197841 DOI: 10.1016/j.jacc.2023.03.398] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is a reversible form of heart failure with incompletely understood pathophysiology. OBJECTIVES This study analyzed altered cardiac hemodynamics during TTS to elucidate underlying disease mechanisms. METHODS Left ventricular (LV) pressure-volume loops were recorded in 24 consecutive patients with TTS and a control population of 20 participants without cardiovascular diseases. RESULTS TTS was associated with impaired LV contractility (end-systolic elastance 1.74 mm Hg/mL vs 2.35 mm Hg/mL [P = 0.024]; maximal rate of change in systolic pressure over time 1,533 mm Hg/s vs 1,763 mm Hg/s [P = 0.031]; end-systolic volume at a pressure of 150 mm Hg, 77.3 mL vs 46.4 mL [P = 0.002]); and a shortened systolic period (286 ms vs 343 ms [P < 0.001]). In response, the pressure-volume diagram was shifted rightward with significantly increased LV end-diastolic (P = 0.031) and end-systolic (P < 0.001) volumes, which preserved LV stroke volume (P = 0.370) despite a lower LV ejection fraction (P < 0.001). Diastolic function was characterized by prolonged active relaxation (relaxation constant 69.5 ms vs 45.9 ms [P < 0.001]; minimal rate of change in diastolic pressure -1,457 mm Hg/s vs -2,192 mm Hg/s [P < 0.001]), whereas diastolic stiffness (1/compliance) was not affected during TTS (end-diastolic volume at a pressure of 15 mm Hg, 96.7 mL vs 109.0 mL [P = 0.942]). Mechanical efficiency was significantly reduced in TTS (P < 0.001) considering reduced stroke work (P = 0.001), increased potential energy (P = 0.036), and a similar total pressure-volume area compared with that of control subjects (P = 0.357). CONCLUSIONS TTS is characterized by reduced cardiac contractility, a shortened systolic period, inefficient energetics, and prolonged active relaxation but unaltered diastolic passive stiffness. These findings may suggest decreased phosphorylation of myofilament proteins, which represents a potential therapeutic target in TTS. (Optimized Characterization of Takotsubo Syndrome by Obtaining Pressure Volume Loops [OCTOPUS]; NCT03726528).
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Affiliation(s)
- Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
| | - Jan-Christian Reil
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Vasco Sequeira
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Elias Rawish
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Matthias Mezger
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Toni Pätz
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | | | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gert-Hinrich Reil
- Department of Cardiology, University Hospital Oldenburg, Oldenburg, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
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Salamanca J, Alfonso F. Novel Hemodynamic Insights in Takotsubo Syndrome. J Am Coll Cardiol 2023; 81:1992-1995. [PMID: 37197842 DOI: 10.1016/j.jacc.2023.03.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Jorge Salamanca
- Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBER-CV, Madrid, Spain.
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBER-CV, Madrid, Spain
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69
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Goodarzynejad H, Sheikh Fathollahi M, Shafiee A. Editorial: The role of sex in coronary artery disease. Front Cardiovasc Med 2023; 10:1220439. [PMID: 37332593 PMCID: PMC10275334 DOI: 10.3389/fcvm.2023.1220439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Hamidreza Goodarzynejad
- Family Medicine Teaching Unit, North York General Hospital, Toronto, Canada
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Sheikh Fathollahi
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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70
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Tachibana Y, Yamada T, Tsuji T, Murai J, Takayama K. A Case of Takotsubo Cardiomyopathy Triggered by Asthma Exacerbation After mRNA-based Vaccination for COVID-19. Cureus 2023; 15:e39499. [PMID: 37362462 PMCID: PMC10290556 DOI: 10.7759/cureus.39499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
It is recommended to get the multiple coronavirus disease 2019 (COVID-19) vaccinations for almost all people including asthma patients. A 70-year-old Japanese woman with asthma experienced worsening of respiratory symptoms after the second dose of the mRNA-based COVID-19 vaccine BNT162b2. The patient had hypercapnic respiratory failure and cardiac-apex ballooning and was diagnosed with takotsubo cardiomyopathy induced by asthma exacerbation. Therapies for asthma exacerbation resulted in prompt improvement of respiratory failure and cardiac-apex ballooning. Our findings suggest that asthma patients are prone to exacerbations after receiving the COVID-19 vaccination; therefore, stratification of the patients at risk is required.
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Affiliation(s)
- Yusuke Tachibana
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Taisuke Tsuji
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, JPN
| | - Junji Murai
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, JPN
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JPN
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71
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Pushparaji B, Donisan T, Balanescu DV, Park JK, Monlezun DJ, Ali A, Inanc IH, Caballero J, Cilingiroglu M, Marmagkiolis K, Iliescu C. Coronary Revascularization in Patients With Cancer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2023; 25:143-158. [PMID: 37143711 PMCID: PMC10119009 DOI: 10.1007/s11936-023-00982-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
Purpose of review The treatment of coronary artery disease (CAD) in cancer patients is an evolving landscape. Recent data emphasizes the importance of aggressive management of cardiovascular risk factors and diseases in improving cardiovascular health in this unique group of patients regardless of cancer type or stage. Recent findings Novel cancer therapeutics such as immune therapies and proteasome inhibitors have been associated with CAD. Recent stent technologies may safely allow for shorter duration (< 6 months) of dual antiplatelet therapy post-percutaneous coronary interventions. Intracoronary imaging may be useful in the decision making process in terms of stent positioning and healing. Summary Large registry studies have partially filled a gap left by the lack of randomized controlled trials in the treatment of CAD in cancer patients. Cardio-oncology is gaining traction as a major sub-specialty in the cardiology field given the release of the first European Society of Cardiology - Cardio-oncology guidelines in 2022.
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Affiliation(s)
- Bala Pushparaji
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY USA
| | - Teodora Donisan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | | | - Jong Kun Park
- Deparment of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Dominique J. Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Abdelrahman Ali
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Research and Training Hospital, Kirikkale, Turkey
| | - Jaime Caballero
- Interventional Cardiology, Department of Internal Medicine, University of South Florida, Tampa, FL USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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72
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Abuelazm M, Saleh O, Hassan AR, Ahmad S, Albarakat MM, Abdalshafy H, Katamesh BE, Abdelazeem B, Paul TK. Sex Difference in Clinical and Management Outcomes in Patients With Takotsubo Syndrome: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101545. [PMID: 36563919 DOI: 10.1016/j.cpcardiol.2022.101545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome (TTS) is being increasingly recognized globally with a female sex predilection. However, sex-related differences in clinical outcomes are yet to be identified. Therefore, we aim to investigate the sex differences in clinical outcomes in patients with TTS. We included cohort studies retrieved from the Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until September 14, 2022. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42022363349. Thirteen retrospective cohort studies, with a total of 104,410 patients were included. Men had a higher risk of in-hospital mortality (RR: 2.42 with 95% CI [1.53, 3.83], P = 0.0002), long-term mortality (RR: 1.59 with 95% CI [1.40, 1.80], P = 0.00001), cardiogenic shock (RR: 1.65 with 95% CI [1.52, 1.79], P = 0.00001), arrhythmia (RR: 1.70 with 95% CI [1.56, 1.86], P = 0.00001), and acute kidney injury (RR: 1.71 with 95% CI [1.50, 1.96]. P = 0.00001), as compared with women. However, no significant difference was observed in stroke (RR: 1.22 with 95% CI [0.78, 1.89], P = 0.39), left ventricular thrombus (RR: 0.96 with 95% CI [0.40, 2.33], P = 0.93), and TTS recurrence (RR: 1.11 with 95% CI [0.68, 1.82], P = 0.67) between men and women. Despite women having a higher incidence of TTS, men have higher morbidity and mortality rates. Hence, further studies are necessary to identify the pathophysiological factors of this sex difference in clinical outcomes, including hormonal and psychological variables.
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Affiliation(s)
| | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC
| | - Majd M Albarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI; Department of Internal Medicine, Michigan State University, East Lansing, MI
| | - Timir K Paul
- Department of Clinical Medical Education, The University of Tennessee Health Sciences Center at Nashville, Nashville, TN
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73
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Wu H, Su H, Zhu C, Wu S, Cui S, Zhou M. Establishment and effect evaluation of a stress cardiomyopathy mouse model induced by different doses of isoprenaline. Exp Ther Med 2023; 25:166. [PMID: 36936708 PMCID: PMC10015318 DOI: 10.3892/etm.2023.11865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
The optimum dose of isoprenaline (ISO) required to induce stress cardiomyopathy (SC) in mice is not known. The present study aimed to investigate the dose-response association and determine the optimum dose of ISO to establish a high-morbidity/low-mortality SC mouse model to simulate the clinical symptoms of SC. A total of 72 6-week-old wild-type female mice (C57BL/6) were randomly divided into control mice administered normal saline and mice treated with increasing ISO concentrations (5, 10, 25, 50 and 100 mg/kg ISO intraperitoneal injections daily for 14 consecutive days). All mice were analysed by body weight assessment, open field test (OFT), echocardiography (Echo), electrocardiogram (ECG), assessment of myocardial pathology and quantification of cortisol, brain natriuretic peptide (BNP), cardiac troponin T (cTnT), catecholamine (CA) and C-reactive protein (CRP). Compared with the control group, the 25 and 50 mg/kg ISO groups exhibited the most prominent weight changes and lower mortality. The open-field test showed a significant decrease in autonomous activity behaviour in the 25 and 50 mg/kg ISO groups compared with the control group (P<0.05). Echo revealed that the apex of the heart was balloon-like in the 25 and 50 mg/kg ISO groups, along with prominent left ventricular dyskinesia. ECG showed a significant increase in ST segment amplitude, QT interval and Q amplitude (P<0.05) in the 25 and 50 mg/kg ISO group compared with the control group. Haematoxylin and eosin staining of heart tissue showed a disordered arrangement of myocardial cells, dissolution of myocardial fibres and cytoplasm, notable widening of myocardial cell space, oedema and hyperaemia of the interstitium, whereas heart tissue of the control group was structurally intact. Compared with the control group, the 25 and 50 mg/kg ISO groups exhibited significantly higher levels of cortisol, BNP, cTNT, CA and CRP (P<0.05). A high-incidence low-mortality SC model was successfully and stably developed by administration of 25 and 50 mg/kg ISO. Such models may provide a basis for the development of other animal models of SC.
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Affiliation(s)
- Haosheng Wu
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Hang Su
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Chao Zhu
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Shengbing Wu
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
- College of Acupuncture and Massage, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Shuai Cui
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
- College of Acupuncture and Massage, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Meiqi Zhou
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
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74
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Ural KG, Trusheim JE. Reverse Takotsubo Cardiomyopathy During Liver Transplantation: Expert Commentary. J Cardiothorac Vasc Anesth 2023; 37:657-658. [PMID: 36621370 DOI: 10.1053/j.jvca.2022.12.010] [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: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Kelly G Ural
- Ochsner Clinic Foundation, Department of Anesthesiology and Perioperative Medicine, New Orleans, LA; The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
| | - Jay E Trusheim
- Ochsner Clinic Foundation, Department of Anesthesiology and Perioperative Medicine, New Orleans, LA; The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA
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75
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Sanchez-Amaya DJ, Lopez-Lizarraga MA, Gutierrez Castañeda M, Araiza-Garaygordobil D, Arias-Mendoza A. Reverse Takotsubo Cardiomyopathy During Immediate Post-partum: A Case Report. Cureus 2023; 15:e36700. [PMID: 37113368 PMCID: PMC10129040 DOI: 10.7759/cureus.36700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Takotsubo cardiomyopathy or stress-induced cardiomyopathy is a particular entity with a transient left ventricular dysfunction without significant coronary artery obstruction, preceded by a stressful circumstance. Clinical presentation may mimic myocardial infarction, acute heart failure among the most common conditions. If suspected, the integration of clinical aspects, imaging results, and laboratory tests allows its diagnosis and proper management. Once described as a post-menopausal women's disease, is now recognized as a more frequent condition of young women, especially after stressful conditions such as post-surgical status and peripartum period, rendering as a disease with a certain predisposition to female patients, with a not always benign evolution. This case remarks an atypical presentation experiencing a first nigh fatal evolution but a later satisfactory recuperation.
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76
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Pathangey G, Moudgal R, Lee C, Henkin S. Myocardial stunning secondary to erroneous administration of intravenous epinephrine. SAGE Open Med Case Rep 2023; 11:2050313X231159732. [PMID: 36950049 PMCID: PMC10026126 DOI: 10.1177/2050313x231159732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
Epinephrine is a commonly used medication for emergent conditions, such as anaphylaxis, respiratory distress, and shock. However, its versatility can also lead to iatrogenic errors in dosages, concentrations, and routes of administration. In this case, a 47-year-old female experiencing anaphylaxis received an intravenous dose of 0.3 mg (1:1000) epinephrine formulated for intramuscular injection, resulting in cardiac arrest and acute heart failure due to myocardial stunning, as diagnosed by echocardiography. Management included invasive ventilation and hemodynamic support until cardiac function recovered. This case highlights the potential dangers of epinephrine overdose, and to our knowledge, is the first reported case of iatrogenic epinephrine-induced Takotsubo cardiomyopathy in a rural area. In addition, we review the literature on iatrogenic epinephrine toxicity-associated cardiomyopathy and the epidemiology of epinephrine errors. Safety measures must be considered for improving communication in emergencies, increasing awareness via training, and changing epinephrine's antiquated packaging design.
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Affiliation(s)
- Girish Pathangey
- Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rohitha Moudgal
- Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christopher Lee
- Heart and Vascular Center,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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77
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Al Khodari K, Alhaj Tahtouh R, Abdullatef WK, Al Khodari M. Takotsubo (stress) cardiomyopathy induced by acute asthma exacerbation in elderly woman. Clin Case Rep 2023; 11:e7074. [PMID: 36911627 PMCID: PMC9995802 DOI: 10.1002/ccr3.7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/02/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
A 73-year-old patient who was admitted secondary to acute asthma exacerbation that required frequent salbutamol and adrenaline nebulization. Takotsubo cardiomyopathy (TTC) was diagnosed after the new onset of chest pain with modest troponin elevation and normal coronary angiogram. Low ejection fraction and apical akinesia were completely resolved after her symptoms got improved.
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78
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Takuma S, Asaka T, Kitagawa Y, Fujisawa T. Takotsubo syndrome after a minimally invasive tooth extraction in a patient without dental phobia: A case report. SPECIAL CARE IN DENTISTRY 2023; 43:281-285. [PMID: 35934843 DOI: 10.1111/scd.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Takotsubo syndrome (TTS) is a rare, stress-induced acute cardiac disorder. Its precipitating factors include emotionally or physically stressful events and exogenous and endogenous adrenaline. In this report, we describe a case of atypical TTS in a 73-year-old woman who reported no dental fear and required acute cardiac care in an outpatient setting. She underwent routine extraction of an upper left premolar under local anesthesia. She reported heart palpitations after the injection, and the procedure was completed in 15 min. After presenting symptoms of sweating, pale skin, vomiting, low blood pressure, and ST-segment elevation, cardiologists ordered echocardiography, coronary angiography, and ventriculography. Upon receiving a TTS diagnosis, the patient was hospitalized and administered an intra-aortic balloon pump and beta-blocker. Her symptoms resolved, and she was discharged with no sequelae. We found no precipitating factors in the progression of TTS in this case, which suggests that TTS can develop in the absence of precipitating factors. All general dentists and oral surgeons should recognize the possible risk of TTS, even during minimally invasive dental procedures, such as routine extractions in patients without dental phobia.
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Affiliation(s)
- Shigeru Takuma
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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79
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Fitzgibbons TP, Gottbrecht MF, Aurigemma GP. The Pathophysiology and Assessment of Diastolic Dysfunction: Important Clues From Stress Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:500-503. [PMID: 36863946 DOI: 10.1016/j.echo.2023.01.012] [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: 01/09/2023] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Timothy P Fitzgibbons
- Division of Cardiovascular Medicine, Department of Medicine, UmassChan Medical School, Worcester, Massachusetts
| | - Matthew F Gottbrecht
- Division of Cardiovascular Medicine, Department of Medicine, UmassChan Medical School, Worcester, Massachusetts
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UmassChan Medical School, Worcester, Massachusetts.
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80
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Bachayev M, Brereton B, Mondal A, Alli-Ramsaroop BA, Dhakal R, Leon MCB, Quinones CM, Abdelal MEO, Jain A, Dhaduk K, Desai R. Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports. Transplant Proc 2023:S0041-1345(22)00778-3. [PMID: 36858907 DOI: 10.1016/j.transproceed.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) has been reported in solid-organ transplant recipients. However, the pooled data regarding TTS after liver transplant remain limited. METHODS A systematic review was performed through February 2022 using PubMed, Embase, Scopus, and Google Scholar to review case reports/series and original studies on liver transplant-associated TTS. Descriptive analysis was performed for case reports and pooled analysis for the prevalence using random effects models. RESULTS A total of 56 case reports were included from 30 articles (51.8 % male; mean age, 53 years; India 56%, US 27%, and Europe 8.93%) and 10 original studies (US 88.65%, India 10.92%) revealing liver transplant-associated TTS. The pooled prevalence of TTS was 1.1% (95% Cl, 0.6%-1.7%) of all liver transplants with comparable rates in studies from India and the US (P = .92). Indications for liver transplant included end-stage liver disease due to alcohol-related cirrhosis (25%), hepatitis C virus infection (17.9%), hepatocellular carcinoma (10.7%), and non-alcohol-related steatohepatitis (8.9%); the average Model for End-Stage Liver Disease score was 24.75. TTS commonly presented as hypotension (30%), dyspnea (14%), and oliguria, occurring mostly post-transplant (82%), whereas 14% were intraoperative. Common electrocardiogram findings were ST changes, ventricular tachycardia, and atrial fibrillation. Common echocardiogram findings showed left ventricular apical ballooning in 46.5% of cases and reduced ejection fraction < 20% in 41.9% of cases. Common complications were cardiogenic shock (32.1 %), acute kidney injury (12.5%), arrhythmia, stroke, cardiac arrest, and hepatic artery thrombosis. Mechanical circulatory support was required in 30.3%. Recurrence was reported in 15, and mortality in 30.4% of patients. CONCLUSIONS Takotsubo syndrome prevalence after liver transplant is significantly higher than TTS prevalence in general US hospitalizations with potentially worse outcomes. Prospective registries reporting TTS in liver transplant recipients are warranted.
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Affiliation(s)
- Milana Bachayev
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Brian Brereton
- Department of Medicine, Jersey General Hospital, Saint Helier, Jersey
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, Pennsylvania
| | | | - Roshan Dhakal
- Department of Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Maria C Buhl Leon
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Camila M Quinones
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Mohamed Eyad O Abdelal
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Kartik Dhaduk
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pennsylvania.
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81
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Zeijlon R, Jha S, Le V, Chamat J, Shekka Espinosa A, Poller A, Thorleifsson S, Bobbio E, Mellberg T, Pirazzi C, Gudmundsson T, Martinsson A, Angerås O, Råmunddal T, Omerovic E, Redfors B. Temporal electrocardiographic changes in anterior ST elevation myocardial infarction versus the Takotsubo syndrome. IJC HEART & VASCULATURE 2023; 45:101187. [PMID: 36861065 PMCID: PMC9969279 DOI: 10.1016/j.ijcha.2023.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
Background Electrocardiography (ECG) on admission is similar in ST elevation myocardial infarction (STEMI) and Takotsubo syndrome (TTS). ECG on admission has been extensively investigated and compared between STEMI and TTS, however, only a few studies have compared temporal ECG. Our aim was to compare ECG in anterior STEMI versus female TTS from admission to day 30. Methods Adult patients with anterior STEMI or TTS treated at Sahlgrenska University Hospital (Gothenburg, Sweden) from December 2019 to June 2022 were prospectively enrolled. Baseline characteristics, clinical variables and ECGs from admission to day 30 were analyzed. Using a mixed effects model, we compared temporal ECG between female patients with anterior STEMI or TTS, as well as between female and male patients with anterior STEMI. Results A total of 101 anterior STEMI patients (31 female, 70 male) and 34 TTS patients (29 female, 5 male) were included. The temporal pattern of T wave inversion was similar between female anterior STEMI and female TTS, as well as between female and male anterior STEMI. ST elevation was more common, whereas QT prolongation was less common, in anterior STEMI compared with TTS. Q wave pathology was more similar between female anterior STEMI and female TTS than between female and male anterior STEMI. Conclusions The pattern of T wave inversion and Q wave pathology from admission to day 30 was similar in female patients with anterior STEMI and female patients with TTS. Temporal ECG in female patients with TTS may be interpreted as following a "transient ischemic" pattern.
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Affiliation(s)
- Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden,Corresponding author at: Department of Internal Medicine, Sahlgrenska University Hospital/S, 413 45 Gothenburg, Sweden.
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Vina Le
- Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Jasmina Chamat
- Department of Cardiology, Sahlgrenska University Hospital/Ö, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Aaron Shekka Espinosa
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Angela Poller
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Sigurdur Thorleifsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Tomas Mellberg
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Carlo Pirazzi
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | | | - Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Molecular and Clinical Medicine/Wallenberg laboratory, Institute of Medicine, Sahlgrenska Academy/University of Gothenburg, Sweden,Clinical Trial Center, Cardiovascular Research Foundation, NY, USA,Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA
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82
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Endogenous Catecholamine Release in COVID-19 Related Acute Respiratory Distress Syndrome: Link between Enhanced Sympathetic Stimulation, Cardiac Dysfunction and Outcome. J Clin Med 2023; 12:jcm12041557. [PMID: 36836097 PMCID: PMC9965663 DOI: 10.3390/jcm12041557] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
The aim of this study was to measure the serum levels of catecholamines in patients admitted to intensive care unit (ICU) with COVID-19-related acute respiratory distress syndrome (ARDS) and describe their relation with clinical, inflammatory and echocardiographic parameters. Serum levels of endogenous catecholamines (norepinephrine, epinephrine and dopamine) were measured at ICU admission. We enrolled 71 patients consecutively admitted to ICU due to moderate to severe ARDS. 11 patients (15.5%) died during the admission in ICU. Serum levels of endogenous catecholamines were significantly elevated. Norepinephrine levels were higher in those with RV and LV systolic dysfunction, higher CRP, and higher IL-6. Patients with higher mortality rate were those with norepinephrine values ≥ 3124 ng/mL, CRP ≥ 17.2 mg/dL and IL-6 ≥ 102 pg/mL. Univariable analysis by Cox proportional hazards regression modelling showed that norepinephrine, IL-6 and CRP had the highest risk of acute mortality. Multivariable analysis showed that only norepinephrine and IL-6 retained in the model. Marked increase of serum catecholamine levels is present during acute phase of critically ill COVID-19 and it is associated with inflammatory and clinical parameters.
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83
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Microwave Ablation of Adrenal Metastasis after Resistance to Stereotactic Body Radiation Therapy: Don't Forget the Takotsubo! Cardiovasc Intervent Radiol 2023; 46:280-281. [PMID: 36175654 DOI: 10.1007/s00270-022-03285-x] [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: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 02/04/2023]
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84
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Hurley M, Kaur S, Walton R, Power A, Haïssaguerre M, Bernus O, Ward ML, White E. Endocardial role in arrhythmias induced by acute ventricular stretch and the involvement of Purkinje fibres, in isolated rat hearts. Curr Res Physiol 2023; 6:100098. [PMID: 36814643 PMCID: PMC9939534 DOI: 10.1016/j.crphys.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Purkinje fibres (PFs) play an important role in some ventricular arrhythmias and acute ventricular stretch can evoke mechanically-induced arrhythmias. We tested whether PFs and specifically TRPM4 channels, play a role in these mechanically-induced arrhythmias. Pseudo-ECGs and left ventricular (LV) activation, measured by optical mapping, were recorded in isolated, Langendorff-perfused, rat hearts. The LV endocardial surface was irrigated with experimental agents, via an indwelling catheter. The number and period of ectopic activations was measured during LV lumen inflation via an indwelling fluid-filled balloon (100 μL added over 2 s, maintained for 38 s). Mechanically-induced arrhythmias occurred during balloon inflation: they were multifocal, maximal in the first 5 s and ceased within 20 s. Optical mapping revealed activation patterns indicating PF-mediated and ectopic focal sources. Irrigation of the LV lumen with Lugol solution (IK/I2) for 10s reduced ectopics by 93% (n = 16, P < 0.001); with ablation of endocardial PFs confirmed by histology. Five min irrigation of the LV lumen with 50 μM 9-Phenanthrol, a blocker of TRPM4 channels, reduced ectopics by 39% (n = 15, P < 0.01). Immunohistochemistry confirmed that TRPM4 was more abundant in PFs than myocardium. Our results show that the endocardial surface plays an important role in these mechanically-induced ectopic activations. Ectopic activation patterns indicate a participation of PFs in these arrhythmias, with a potential involvement of TRPM4 channels, shown by the reduction of arrhythmias by 9-Phenanthrol.
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Affiliation(s)
- Miriam Hurley
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarbjot Kaur
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Richard Walton
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France
| | - Amelia Power
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Michel Haïssaguerre
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, Pessac, France
| | - Olivier Bernus
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France
| | - Marie-Louise Ward
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ed White
- School of Biomedical Sciences, University of Leeds, Leeds, UK,Corresponding author. Garstang Building, School of Biomedical Sciences, University of Leeds, LS29JT, Leeds, UK.
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85
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Abstract
Takotsubo syndrome (TTS), triggered by intense emotional or physical stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4-5%) owing to cardiogenic shock, myocardial rupture, or life-threatening arrhythmias. Thus, its prognosis is not as benign as previously thought, as it may cause mechanical complications (cardiac rupture) and potentially lethal arrhythmias and sudden cardiac death (SCD). Similar to MI, some patients may perish before reaching the hospital due to out-of-hospital cardiac arrest; this may lead to underestimation of the actual SCD risk. Furthermore, after discharge, some patients may develop late SCD and/or TTS recurrence that may result in SCD. There are risk factors for SCD in TTS patients, such as severe/persistent QT-interval prolongation inciting torsade-de-pointes, other ECG abnormalities (diffuse giant negative T-waves, widened QRS-complex), bradyarrhythmias, comorbidities, concurrent obstructive coronary artery disease or vasospasm, male gender, older age, severe left ventricular dysfunction, and use of sympathomimetic drugs. All these issues are herein reviewed, case reports/series and data from large cohort studies and meta-analyses are analyzed, risk factors are tabulated, and proarrhythmic effects and management strategies are discussed and pictorially illustrated.
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Affiliation(s)
| | | | - Helen Melita
- 69106Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
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86
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Etuk AS, Odigwe CI, Nyange C, Thornton S, Pursley M. Atypical Takotsubo Cardiomyopathy Precipitated by Gastrointestinal Bleeding: Review of the Pathophysiology. Cureus 2023; 15:e34515. [PMID: 36874316 PMCID: PMC9981546 DOI: 10.7759/cureus.34515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Stress-induced cardiomyopathy, otherwise known as takotsubo cardiomyopathy, typically presents with chest pain and acute left ventricular failure with unobstructed coronary arteries. There is an increase in disease incidence as clinicians are becoming more aware of this clinical entity. An atypical variant exists where there is left ventricular dysfunction with apical sparing. Various precipitants have been described in the literature, however, there has not been any documented case following massive gastrointestinal bleeding. We report an atypical variant of takotsubo cardiomyopathy following a gastrointestinal bleed with review of the pathophysiologic mechanisms behind the disease process.
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Affiliation(s)
- Aniekeme S Etuk
- Internal Medicine, Thomas Hospital - Infirmary Health, Fairhope, USA
| | | | | | - Stanley Thornton
- Cardiovascular Disease, Thomas Hospital - Infirmary Health, Fairhope, USA
| | - Michael Pursley
- Cardiovascular Disease, Thomas Hospital - Infirmary Health, Fairhope, USA
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87
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Mishra AK, George AA, John KJ, Arun Kumar P, Dasari M, Afraz Pasha M, Hadley M. Takotsubo cardiomyopathy following envenomation: An updated review. World J Cardiol 2023; 15:33-44. [PMID: 36714368 PMCID: PMC9850669 DOI: 10.4330/wjc.v15.i1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation.
AIM This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC.
METHODS In this review, we included all studies on “TTC” and “envenomation “published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation
RESULTS A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure.
CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.
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Affiliation(s)
- Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anu A George
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Kevin John John
- Department of Medicine, Tufts Medical Center, Boston, MA 02111, United States
| | - Pramukh Arun Kumar
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mahati Dasari
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mohammed Afraz Pasha
- Department of Medicine, North Alabama Medical Center, Florence, AL 35630, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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88
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Abstract
Driven by autonomous molecular clocks that are synchronized by a master pacemaker in the suprachiasmatic nucleus, cardiac physiology fluctuates in diurnal rhythms that can be partly or entirely circadian. Cardiac contractility, metabolism, and electrophysiology, all have diurnal rhythms, as does the neurohumoral control of cardiac and kidney function. In this review, we discuss the evidence that circadian biology regulates cardiac function, how molecular clocks may relate to the pathogenesis of heart failure, and how chronotherapeutics might be applied in heart failure. Disrupting molecular clocks can lead to heart failure in animal models, and the myocardial response to injury seems to be conditioned by the time of day. Human studies are consistent with these findings, and they implicate the clock and circadian rhythms in the pathogenesis of heart failure. Certain circadian rhythms are maintained in patients with heart failure, a factor that can guide optimal timing of therapy. Pharmacologic and nonpharmacologic manipulation of circadian rhythms and molecular clocks show promise in the prevention and treatment of heart failure.
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Affiliation(s)
- Nadim El Jamal
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sarah L. Teegarden
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tilo Grosser
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Translational Pharmacology, Bielefeld University, Bielefeld, Germany
| | - Garret FitzGerald
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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89
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Liu H, Cai K, Wang J, Zhang H. The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis. Front Public Health 2023; 10:1045642. [PMID: 36699873 PMCID: PMC9869042 DOI: 10.3389/fpubh.2022.1045642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women. Methods A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers. Results A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women. Conclusion MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails.
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90
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Helman TJ, Headrick JP, Stapelberg NJC, Braidy N. The sex-dependent response to psychosocial stress and ischaemic heart disease. Front Cardiovasc Med 2023; 10:1072042. [PMID: 37153459 PMCID: PMC10160413 DOI: 10.3389/fcvm.2023.1072042] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.
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Affiliation(s)
- Tessa J. Helman
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Sydney, Australia
- Correspondence: Tessa J. Helman
| | - John P. Headrick
- Schoolof Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia
| | | | - Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, NSW, Sydney, Australia
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91
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Autoimmune polyendocrine syndrome II presenting paradoxically as Takotsubo cardiomyopathy: a case report and reappraisal of pathophysiology. Egypt Heart J 2022; 74:82. [PMID: 36512261 PMCID: PMC9748007 DOI: 10.1186/s43044-022-00321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is a rare disease entity characterized by acute, non-ischemic, reversible myocardial dysfunction that mimics acute myocardial infarction. Activation and excessive outflow of sympathetic nervous system are believed to be central to the figure in the disease pathogenesis. Adrenocortical hormones potentiate the systemic actions of sympathetic nervous system and accordingly are essential for regulation of myocardial function. We present an unusual case of a middle-aged woman with primary adrenal insufficiency who presented paradoxically with TCM. CASE PRESENTATION A 50-year-old woman with past history of hypothyroidism presented to emergency department with history of acute chest pain and syncope. There was no significant drug history or history of an emotional or physical stimulus prior to admission. Prominent pigmentation over the tongue and skin creases of hands were noted. On presentation, she was in shock and had ventricular tachycardia which required electrical cardioversion. The subsequent electrocardiogram demonstrated diffuse T-wave inversions with prolonged QTC. There was apical hypokinesia on echocardiogram, and cardiac biomarkers were elevated. There was persistent inotropic requirement. She had marked postural symptoms, and a postural blood pressure drop of 50 mm Hg was present. Initial laboratory parameters were significant for hyperkalemia (7.8 mEq/L) and hyponatremia (128 mEq/L). These findings prompted evaluation for adrenal insufficiency which was confirmed with appropriate tests. Autoimmune polyendocrine syndrome II was thus diagnosed based on the above findings. Coronary angiography revealed normal coronaries. The diagnoses of TCM was established in accordance with the International Takotsubo Diagnostic Criteria. She was started on stress dose steroid replacement therapy and improved dramatically. At one month of follow-up, the patient is asymptomatic, and there was normalization of her left ventricular function. CONCLUSIONS Intricate relationship and interplay exist between the steroid hormones and catecholamines in the pathogenesis of TCM. Steroid hormones not only potentiate the actions of catecholamines, but they also regulate and channelize catecholaminergic actions preventing their deleterious effects on the cardiac tissue. Hence, both steroid deficiency and exogenous steroid replacement may precipitate TCM. Evidence from more such cases and larger perspective studies in future will further improve our understanding of this complex disease process and its myriad associations.
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92
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The Role of Stress in Stable Patients with Takotsubo Syndrome-Does the Trigger Matter? J Clin Med 2022; 11:jcm11247304. [PMID: 36555921 PMCID: PMC9787463 DOI: 10.3390/jcm11247304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is a unique type of reversible cardiomyopathy that predominantly affects elderly women. The role of physical and emotional stress in the pathophysiology of TTS is well established. However, the association between preceding emotional triggers and clinical outcomes in stable patients has not yet been fully investigated. We aimed to investigate the association between emotional triggers before symptom onset and clinical outcomes in stable patients with TTS. METHODS This is a retrospective cohort study based on the data of patients with ICD-9 discharge diagnosis of TTS between 2017 and 2022. Patients were divided into two groups: with and without obvious emotional trigger before symptom onset. Demographic, laboratory, echocardiographic, and clinical outcomes were obtained and compared between the two groups. RESULTS We included 86 patients (93% were women, mean age 68.8 ± 12.3 years). Of them, 64 (74.4%) reported an emotional trigger before symptom onset. Patients with a previous emotional trigger had a longer hospital stay (4.3 + 2.0 days vs. 3.0 + 1.4, p = 0.002) with no difference in in-hospital complications (32.8% vs. 13.6%, p = 0.069), with no difference in 30-day mortality, readmissions, or recurrence rate between the groups. CONCLUSIONS Patients with TTS related to an emotional trigger may represent a different population from patients without a preceding trigger by having more symptomatic disease and longer hospital stay, yet with no difference in the 30-day outcomes.
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93
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Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis 2022; 363:8-21. [PMID: 36423427 PMCID: PMC9840845 DOI: 10.1016/j.atherosclerosis.2022.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Myocardial ischemia with no obstructive coronary arteries (INOCA) is a chronic coronary syndrome condition that is increasingly being recognized as a substantial contributor to adverse cardiovascular mortality and outcomes, including myocardial infarction and heart failure with preserved ejection fraction (HFpEF). While INOCA occurs in both women and men, women are more likely to have the finding of INOCA and are more adversely impacted by angina, with recurrent hospitalizations and a lower quality of life with this condition. Abnormal epicardial coronary vascular function and coronary microvascular dysfunction (CMD) have been identified in a majority of INOCA patients on invasive coronary function testing. CMD can co-exist with obstructive epicardial coronary artery disease (CAD), diffuse non-obstructive epicardial CAD, and with coronary vasospasm. Epicardial vasospasm can also occur with normal coronary arteries that have no atherosclerotic plaque on intravascular imaging. While all predisposing factors are not clearly understood, cardiometabolic risk factors, and endothelium dependent and independent mechanisms that increase oxidative stress and inflammation are associated with microvascular injury, CMD and INOCA. Cardiac autonomic dysfunction has also been implicated in abnormal vasoreactivity and persistent symptoms. INOCA is under-recognized and under-diagnosed, partly due to the heterogenous patient populations and mechanisms. However, diagnostic testing methods are available to guide INOCA management. Treatment of INOCA is evolving, and focuses on cardiac risk factor control, improving ischemia, reducing atherosclerosis progression, and improving angina and quality of life. This review focuses on INOCA, relations to HFpEF, available diagnostics, current and investigational therapeutic strategies, and knowledge gaps in this condition.
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Affiliation(s)
- Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jingwen Huang
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca D Levit
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Waddah Malas
- Cardiovascular Disease Fellowship Training Program, Loyola Medical Center, Chicago, IL, USA
| | - Nida Waheed
- Cardiovascular Disease Fellowship Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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94
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Mikail N, Rossi A, Bengs S, Haider A, Stähli BE, Portmann A, Imperiale A, Treyer V, Meisel A, Pazhenkottil AP, Messerli M, Regitz-Zagrosek V, Kaufmann PA, Buechel RR, Gebhard C. Imaging of heart disease in women: review and case presentation. Eur J Nucl Med Mol Imaging 2022; 50:130-159. [PMID: 35974185 PMCID: PMC9668806 DOI: 10.1007/s00259-022-05914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging - Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, Strasbourg, France
- Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin, Berlin, Berlin, Germany
- University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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95
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Li M, Nguyen CN, Toleva O, Mehta PK. Takotsubo syndrome: A current review of presentation, diagnosis, and management. Maturitas 2022; 166:96-103. [PMID: 36108540 DOI: 10.1016/j.maturitas.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome is a syndrome of acute heart failure due to left ventricular systolic dysfunction that is associated with increased cardiovascular morbidity and mortality. It occurs in both sexes and at all ages, but predominates in post-menopausal women for reasons that are unclear. In a patient who presents with cardiac symptoms, electrocardiographic changes, and/or biomarker elevation indicating myocardial stress (i.e. troponin elevation), this condition should be considered in the differential diagnosis. Cardiac imaging is critical for a timely diagnosis of this condition and has management implications. This syndrome can occur with or without underlying coronary artery disease, and while there are various characteristic myocardial patterns described on imaging, the most common one is left ventricular dysfunction due to apical stunning with basal hyperkinesis. In the acute phase, Takotsubo syndrome can lead to life-threatening sequelae, including cardiogenic shock, pulmonary edema, thromboembolism, and arrhythmias. Multiple pathophysiologic mechanisms are implicated, including an acute increase in left ventricular afterload in the setting of sympathetic activation with a catecholamine storm, multi-vessel coronary vasospasm, coronary endothelial microvascular dysfunction, and inflammation. In this review, we discuss the current knowledge surrounding presentation, diagnosis, and treatment of this under-diagnosed condition.
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Affiliation(s)
- Monica Li
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Christopher N Nguyen
- Northside Hospital Gwinnett Internal Medicine Residency Program, Lawrenceville, GA, United States of America
| | - Olga Toleva
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, United States of America; Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
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96
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Wu KC, Wittstein IS. Ventricular Arrhythmic Risk in Takotsubo Syndrome: Clinical Subtype Matters. JACC Clin Electrophysiol 2022; 8:1511-1514. [PMID: 36543500 PMCID: PMC10112505 DOI: 10.1016/j.jacep.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Katherine C Wu
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, Maryland, USA.
| | - Ilan S Wittstein
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, Maryland, USA
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97
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Wang T, Xiong T, Yang Y, Zuo B, Chen X, Wang D. Metabolic remodeling in takotsubo syndrome. Front Cardiovasc Med 2022; 9:1060070. [PMID: 36505375 PMCID: PMC9729286 DOI: 10.3389/fcvm.2022.1060070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
The heart requires a large and constant supply of energy that is mainly the result of an efficient metabolic machinery that converges on mitochondrial oxidative metabolism to maintain its continuous mechanical work. Perturbations in these metabolic processes may therefore affect energy generation and contractile function directly. Metabolism characteristics in takotsubo syndrome (TTS) reveals several metabolic alterations called metabolic remodeling, including the hyperactivity of sympathetic metabolism, derangements of substrate utilization, effector subcellular dysfunction and systemic metabolic disorders, ultimately contributing to the progression of the disease and the development of a persistent and long-term heart failure (HF) phenotype. In this review, we explore the current literature investigating the pathological metabolic alterations in TTS. Although the metabolic dysfunction in takotsubo hearts is initially recognized as a myocardial metabolic inflexibility, we suggest that the widespread alterations of systemic metabolism with complex interplay between the heart and peripheral tissues rather than just cardiometabolic disorders per se account for long-term maladaptive metabolic, functional and structural impairment under this condition. Therapeutic strategies with the recent evidence from small clinical and animal researches, especially for targeting substrate utilization and/or oxidative stress, might be promising tools to improve the outcome of patients with TTS beyond that achieved with traditional sympathetic inhibition and symptomatic therapies.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Ting Xiong
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China,*Correspondence: Daxin Wang, ,
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98
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Hu G, Wu J, Gu H, Deng X, Xu W, Feng S, Wang S, Song Y, Pang Z, Deng X, Vendrov AE, Madamanchi NR, Runge MS, Wang X, Zhang Y, Xiao H, Dong E. Galectin-3-centered paracrine network mediates cardiac inflammation and fibrosis upon β-adrenergic insult. SCIENCE CHINA LIFE SCIENCES 2022; 66:1067-1078. [PMID: 36449214 DOI: 10.1007/s11427-022-2189-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/26/2022] [Indexed: 12/05/2022]
Abstract
Rapid over-activation of β-adrenergic receptors (β-AR) following acute stress initiates cardiac inflammation and injury by activating interleukin-18 (IL-18), however, the process of inflammation cascades has not been fully illustrated. The present study aimed to determine the mechanisms of cardiac inflammatory amplification following acute sympathetic activation. With bioinformatics analysis, galectin-3 was identified as a potential key downstream effector of β-AR and IL-18 activation. The serum level of galectin-3 was positively correlated with norepinephrine or IL-18 in patients with chest pain. In the heart of mice treated with β-AR agonist isoproterenol (ISO, 5 mg kg-1), galectin-3 expression was upregulated markedly later than IL-18 activation, and Nlrp3-/- and Il18-/- mice did not show ISO-induced galectin-3 upregulation. It was further revealed that cardiomyocyte-derived IL-18 induced galectin-3 expression in macrophages following ISO treatment. Moreover, galectin-3 deficiency suppressed ISO-induced cardiac inflammation and fibrosis without blocking ISO-induced IL-18 increase. Treatment with a galectin-3 inhibitor, but not a β-blocker, one day after ISO treatment effectively attenuated cardiac inflammation and injury. In conclusion, galectin-3 is upregulated to exaggerate cardiac inflammation and injury following acute β-AR activation, a galectin-3 inhibitor effectively blocks cardiac injury one day after β-AR insult.
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Affiliation(s)
- Guomin Hu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Jimin Wu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Huijun Gu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100087, China
| | - Xiangning Deng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Wenli Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Shan Feng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Shuaixing Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Yao Song
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Zhengda Pang
- Department of Physiology and Pathophysiology, Cardiovascular Research Center, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, China
| | - Xiuling Deng
- Department of Physiology and Pathophysiology, Cardiovascular Research Center, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, China
| | - Aleksandr E Vendrov
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Nageswara R Madamanchi
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Marschall S Runge
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Xinyu Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Youyi Zhang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Han Xiao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China.
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China.
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China.
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China.
| | - Erdan Dong
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
- Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
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99
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Airò G, Maffezzoli M, Lazzarin A, Bianconcini M, Greco A, Buti S, Leonetti A. Takotsubo syndrome in a patient with metastatic renal cell carcinoma treated with pembrolizumab plus axitinib. Immunotherapy 2022; 14:1297-1305. [DOI: 10.2217/imt-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of a patient with metastatic renal cell carcinoma who developed Takotsubo syndrome (TTS) 6 days after starting pembrolizumab plus axitinib as first-line treatment. Coronary angiogram was negative for obstructive coronary artery disease and echocardiogram revealed a depressed left ventricular ejection fraction with apical akinesis. Axitinib was discontinued and myocardial contractile function fully recovered 23 days after the initial presentation. The treatment was safely resumed and granted a partial response of disease. A literature review regarding TTS in patients receiving VEGFR tyrosine kinase inhibitors and/or immune checkpoint inhibitors was performed. TTS is reported as a rare adverse event and the possible causal relationship between TTS and antineoplastic therapy is still unclear. Further research is warranted to better understand cardiotoxicity mechanisms and their management.
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Affiliation(s)
- Giulia Airò
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
| | - Michele Maffezzoli
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
| | | | | | - Alessandro Greco
- Cardiology Unit, University Hospital of Parma, Parma, 43126, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
- Department of Medicine & Surgery, University of Parma, Parma, 43126, Italy
| | - Alessandro Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
- Department of Medicine & Surgery, University of Parma, Parma, 43126, Italy
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100
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Yildiz M, Ashokprabhu N, Shewale A, Pico M, Henry TD, Quesada O. Myocardial infarction with non-obstructive coronary arteries (MINOCA). Front Cardiovasc Med 2022; 9:1032436. [PMID: 36457805 PMCID: PMC9705379 DOI: 10.3389/fcvm.2022.1032436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is evident in up to 15% of all acute myocardial infarctions (AMI) and disproportionally affects females. Despite younger age, female predominance, and fewer cardiovascular risk factors, MINOCA patients have a worse prognosis than patients without cardiovascular disease and a similar prognosis compared to patients with MI and obstructive coronary artery disease (CAD). MINOCA is a syndrome with a broad differential diagnosis that includes both ischemic [coronary artery plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection (SCAD), and coronary embolism/thrombosis] and non-ischemic mechanisms (Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy)-the latter called MINOCA mimickers. Therefore, a standardized approach that includes multimodality imaging, such as coronary intravascular imaging, cardiac magnetic resonance, and in selected cases, coronary reactivity testing, including provocation testing for coronary vasospasm, is necessary to determine underlying etiology and direct treatment. Herein, we review the prevalence, characteristics, prognosis, diagnosis, and treatment of MINOCA -a syndrome often overlooked.
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Affiliation(s)
- Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Namrita Ashokprabhu
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Aarushi Shewale
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Madison Pico
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Odayme Quesada
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, United States
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