351
|
Shojaei F, Habibi Z, Goudarzi S, Firouzabadi FD, Montazerin SM, Najafi H, Kahe F, Momenzadeh K, Mir M, Khan F, Jamil U, Jamil A, Lee JJ, Chi G. COVID-19: A double threat to takotsubo cardiomyopathy and spontaneous coronary artery dissection? Med Hypotheses 2020; 146:110410. [PMID: 33267999 PMCID: PMC7680528 DOI: 10.1016/j.mehy.2020.110410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that has affected millions of individuals worldwide. Prior studies suggest that COVID-19 may be associated with an increased risk for various cardiovascular disorders, such as myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. Early reports of non-COVID-19 patients have described the concurrence of takotsubo cardiomyopathy (TTC) and spontaneous coronary artery dissection (SCAD). However, the interplay between COVID-19, TTC and SCAD has not been well established. We herein propose two sets of two-hit hypotheses for the development of SCAD and TTC in the context of COVID-19. The first two-hit hypothesis explains the development of SCAD, in which TTC-associated formation of vulnerable coronary substrate serves as the first hit (predisposing factor), and COVID-19-associated inflammation and vascular disruption serves as the second hit (precipitating factor). The second two-hit hypothesis is proposed to explain the development of TTC, in which SCAD-associated formation of vulnerable myocardial substrate serves as the first hit, and COVID-19-associated sympathetic overactivity serves as the second hit. Under this conceptual framework, COVID-19 poses a double threat for the development of SCAD (among patients with underlying TTC) as well as TTC (among patients with underlying SCAD), thereby forming a reciprocal causation. This hypothesis provides a rationale for the joint assessment of TTC and SCAD in COVID-19 patients with pertinent cardiovascular manifestations.
Collapse
Affiliation(s)
- Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zahra Habibi
- Global Studies Institute, Université de Genève, Geneva, Switzerland
| | - Sogand Goudarzi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Memar Montazerin
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Homa Najafi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Farima Kahe
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kaveh Momenzadeh
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Mahshid Mir
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Faris Khan
- Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Umer Jamil
- Department of Medicine, OSF Healthcare, St. Francis Medical Center, Peoria, IL, USA
| | - Adeel Jamil
- Department of Medicine, OSF Healthcare, St. Francis Medical Center, Peoria, IL, USA
| | - Jane J Lee
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
352
|
Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
Collapse
Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| |
Collapse
|
353
|
Al-Tkrit A, Mekaiel A, Aneeb M, Alawawdeh F, Mangla A. Left Ventricular Free Wall Rupture in Broken-Heart Syndrome: A Fatal Complication. Cureus 2020; 12:e11316. [PMID: 33282591 PMCID: PMC7714725 DOI: 10.7759/cureus.11316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy is usually a transient condition and is treated conservatively. It is rarely associated with ventricular free wall rupture, a fatal complication of the disease described in this report. Cardiothoracic surgery performed emergent ventricular wall repair; however, treatment was unsuccessful, and the patient expired.
Collapse
Affiliation(s)
- Amna Al-Tkrit
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Andrew Mekaiel
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Mohammad Aneeb
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Firas Alawawdeh
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Aditya Mangla
- Cardiology, Jamaica Hospital Medical Center, Queens, USA
| |
Collapse
|
354
|
Chrysohoou C, Aggeli C, Avgeropoulou C, Aroni M, Bonou M, Boutsikou M, Brili S, Chamodraka E, Dagre A, Flevari P, Fountoulaki A, Frogoudaki A, Gkouziouta A, Grapsa J, Hatzinikolaou-Kotsakou E, Kalantzi K, Kitsiou A, Kostakou P, Kourea R, Koutrolou-Sotiropoulou P, Marketou M, Mavrogeni S, Naka KK, Nikolaou M, Papazachou O, Papavasileiou LP, Simeonidou E, Theopistou A, Triantafyllidi H, Trikka C, Tsekoura D, Tzifa A, Vaina S, Vrettou AR, Zaglavara T, Kolovou G. Cardiovascular disease in women: Executive summary of the expert panel statement of women in cardiology of the hellenic cardiological society. Hellenic J Cardiol 2020; 61:362-377. [PMID: 33045394 PMCID: PMC7546688 DOI: 10.1016/j.hjc.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
The perception that women represent a low-risk population for cardiovascular (CV) disease (CVD) needs to be reconsidered. Starting from risk factors, women are more likely to be susceptible to unhealthy behaviors and risk factors that have different impact on CV morbidity and mortality as compared to men. Despite the large body of evidence as regards the effect of lifestyle factors on the CVD onset, the gender-specific effect of traditional and non-traditional risk factors on the prognosis of patients with already established CVD has not been well investigated and understood. Furthermore, CVD in women is often misdiagnosed, underestimated, and undertreated. Women also experience hormonal changes from adolescence till elder life that affect CV physiology. Unfortunately, in most of the clinical trials women are underrepresented, leading to the limited knowledge of CV and systemic impact effects of several treatment modalities on women's health. Thus, in this consensus, a group of female cardiologists from the Hellenic Society of Cardiology presents the special features of CVD in women: the different needs in primary and secondary prevention, as well as therapeutic strategies that may be implemented in daily clinical practice to eliminate underestimation and undertreatment of CVD in the female population.
Collapse
Affiliation(s)
- Christina Chrysohoou
- 1st Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
| | - Constantina Aggeli
- 1st Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | | | | | | | | | - Stella Brili
- 1st Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Anna Dagre
- Thriaseio Geniko Nosokomeio Elefsinas, Greece
| | | | | | | | | | - Julia Grapsa
- Guy's and Saint Thomas' Hospitals NHS Trust:, UK
| | | | | | | | | | - Roy Kourea
- Panepistemiako Geniko Nosokomeio Attikon, Greece
| | | | - Maria Marketou
- Panepistemiako Geniko Nosokomeio Erakleiou Crete, Greece
| | | | | | | | - Ourania Papazachou
- Helena Venizelou general and Maternity District Hospital: Geniko Nosokomeio Elena Benizelou, Greece
| | | | | | | | | | | | - Dorothea Tsekoura
- 1st Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Sophia Vaina
- 1st Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | | | | | | |
Collapse
|
355
|
|
356
|
Fundão NHF, Ribeiro HB, Campos CDM, Seleme VB, Soeiro ADM, Vieira MLC, Mathias W, Hajjar LA, Ribeiro EE, Kalil R. The Clinical Course of Takotsubo Syndrome Diagnosed According to the InterTAK Criteria. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
357
|
Zalewska-Adamiec M, Chlabicz M, Kuźma Ł, Bachorzewska-Gajewska H, Dobrzycki S. Effectiveness of Levosimendan in an 84-Year-Old Patient with Takotsubo Syndrome Complicated by Acute Heart Failure. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927081. [PMID: 33077703 PMCID: PMC7585457 DOI: 10.12659/ajcr.927081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although takotsubo syndrome (TTS) is usually mild, severe complications such as acute heart failure may occur in the acute phase. Because of the etiology of TTS, typical catecholamines are not recommended; the use of inotropic drugs with a different mechanism of action is recommended, mainly levosimendan. CASE REPORT An 84-year-old patient with cardiovascular risk factors, hospitalized in a city hospital because of exacerbation of chronic obstructive pulmonary disease (COPD), was transferred to the clinic with suspected myocardial infarction. At the time of admission, the patient was hemodynamically stable. The coronarography indicated insignificant atherosclerotic lesions in the coronary arteries. The echocardiography revealed apical akinesis and hypokinesis of the apical and middle left ventricular segments (LV). The ejection fraction (EF) was 40%. TTS was diagnosed. After 12 h of hospitalization, the patient developed symptoms of acute heart failure, with deterioration of the LV systolic function (EF 30%). Levosimendan was included in the treatment, which led to an increased blood pressure and clinical improvement after several hours. Over the next few days, the patient's condition improved and he was transferred to the referral center, from which he was discharged to home. CONCLUSIONS In patients with COPD, exacerbation of the disease may be a trigger for TTS. In acute heart failure complicating TTS, administration of levosimendan improves the clinical condition of patients.
Collapse
Affiliation(s)
| | - Małgorzata Chlabicz
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland.,Department of Population Medicine and Civilization Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland.,Department of Clinical Medicine, Medical University of Białystok, Białystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland
| |
Collapse
|
358
|
Fong HK, Gandhi ZJ, Malik FA, Panchal A, Savani S, Doshi R, Desai R. Alarmingly Rising Trends in Venous Thromboembolic Events and Respiratory Failure in Takotsubo Syndrome-Related Hospitalizations in the United States. Cureus 2020; 12:e10985. [PMID: 33209541 PMCID: PMC7667718 DOI: 10.7759/cureus.10985] [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] [Accepted: 10/16/2020] [Indexed: 11/05/2022] Open
Abstract
Background There is very scarce data about the shifting landscape of complications like venous thromboembolic events (VTE) and respiratory failure in Takotsubo syndrome (TTS). We have assessed the rates and trends of these complications in (TTS)-related hospitalizations. Methods The National Inpatient Sample (2007-2014) was queried to identify adult hospitalizations for TTS and subsequent VTE and respiratory failure using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes. Trends were assessed using discharge weights and the linear-by-linear association test for the overall cohort and subgroups based on age, sex, and race. Results Of 156,506 admissions for TTS from 2007-2014, 3.5% (N=5,550) of admissions revealed VTE whereas 17.4% (N=27,252) of admissions revealed respiratory failure. There were significantly rising trends in VTE (from 2.2% to 4.2%) and respiratory failure (10% to 20.7%) with TTS (p<0.05) from 2007-2014. On subgroup analysis, all subgroups showed rising trends in VTE and respiratory failure. However, young (18-44 years), male patients admitted with TTS demonstrated a greater surge in VTE as compared to other groups. In contrast, the frequency of respiratory failure rose more significantly in young, male, non-white TTS patients compared to older, female and white TTS patients. Conclusion There were alarming trends in the VTE and respiratory failure despite the improved understanding of TTS etiopathogenesis and advanced diagnostic modalities among TTS-related admissions, mostly comprising of young, male, and non-white patients. Introduction.
Collapse
Affiliation(s)
- Hee Kong Fong
- Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, USA
| | - Zainab J Gandhi
- Internal Medicine, C.U. Shah Medical College, Surendranagar, IND
| | - Faizan A Malik
- Internal Medicine, Texas Tech University Health Sciences Center at Permian Basin, Odessa, USA
| | - Ankur Panchal
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Sejal Savani
- Public Health, New York University, New York City, USA
| | - Rajkumar Doshi
- Internal Medicine, University of Nevada, Reno School of Medicine, Reno, USA
| | - Rupak Desai
- Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, USA
| |
Collapse
|
359
|
Abstract
Takotsubo cardiomyopathy or takotsubo syndrome (TTS) has become a well-known disease not only in Japan but also in the rest of the world. Early reports suggested that TTS is a self-limiting disease with better prognosis than acute coronary syndrome. However, recent data showed that TTS is not a benign disease as compared with acute coronary syndrome. In addition to the apical ballooning, several other types of wall motion abnormalities have been classified as variants of TTS. In particular, right ventricular involvement, or biventricular TTS, is not uncommon and is associated with poor in-hospital as well as long-term outcomes. With respect to the pathophysiology, modulation (desensitization) of the beta-adrenergic receptor is suspected as a possible mechanism for transiently depressed myocardial contraction. Although specific treatments to improve prognosis of TTS are still uncertain, observational data suggest favorable impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Finally, in the era of COVID-19, we should pay attention to a variety of cardiovascular conditions related to COVID-19. TTS is one of these conditions that can be triggered by both emotional and physical impact of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| |
Collapse
|
360
|
Gili S, Cammann VL, Schlossbauer SA, Kato K, D'Ascenzo F, Di Vece D, Jurisic S, Micek J, Obeid S, Bacchi B, Szawan KA, Famos F, Sarcon A, Levinson R, Ding KJ, Seifert B, Lenoir O, Bossone E, Citro R, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Gaita F, Di Mario C, Wischnewsky MB, Bax JJ, Prasad A, Böhm M, Ruschitzka F, Lüscher TF, Ghadri JR, Templin C. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J 2020; 40:2142-2151. [PMID: 31098611 PMCID: PMC6612368 DOI: 10.1093/eurheartj/ehz170] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.
Collapse
Affiliation(s)
- Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Susanne A Schlossbauer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Flurina Famos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles CA, USA
| | - Rena Levinson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Biological Sciences, University of California San Diego, San Diego, CA, USA
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Olivia Lenoir
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Eduardo Bossone
- Division of Cardiology 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Discipline of Medicine, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| |
Collapse
|
361
|
Comparison of Complications and In-Hospital Mortality in Takotsubo (Apical Ballooning/Stress) Cardiomyopathy Versus Acute Myocardial Infarction. Am J Cardiol 2020; 132:29-35. [PMID: 32762963 DOI: 10.1016/j.amjcard.2020.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022]
Abstract
There are limited data on the incidence of complications and in-hospital outcomes, in patients with Takotsubo cardiomyopathy (TC), as compared with acute myocardial infarction (AMI). From 2007 to 2014, a retrospective cohort of TC was compared with AMI using the National Inpatient Sample database. Complications were classified as acute heart failure, ventricular arrhythmic, cardiac arrest, high-grade atrioventricular block, mechanical, vascular/access, pericardial, stroke, and acute kidney injury. Temporal trends, clinical characteristics, and in-hospital outcomes were compared. During the 8-year period, 3,329,876 admissions for AMI or TC were identified. TC diagnosis was present in 88,849 (2.7%). Compared with AMI admissions, those with TC were older, female, and of white race. Use of pulmonary artery catheter and mechanical ventilation was higher, but hemodialysis lower in TC. The overall frequency of complications was higher in TC (38.2% vs 32.6%). Complication rates increased in both groups over time, but the delta was greater for TC (23% [2007] vs 43% [2014]) compared with AMI (27% vs 36%). The TC cohort had a higher rate of heart failure (29% vs 16.6%) and strokes (0.5% vs 0.2%), but lower rates of other complications (all p <0.001). In-hospital mortality was lower for TC (2.6% vs 3.1%; p <0.001). TC was an independent predictor of lower in-hospital mortality in admissions with complications. In conclusion, compared with AMI, TC is associated with greater likelihood of heart failure, but lower rates of other complications and mortality. There has been a temporal increase in the rates of in-hospital complications and mortality due to TC.
Collapse
|
362
|
Scudiero F, Arcari L, Cacciotti L, De Vito E, Marcucci R, Passaseo I, Limite LR, Musumeci MB, Autore C, Citro R, Bossone E, Sanna GD, Bacchi B, Volpe M, Di Mario C, Parodi G. Prognostic relevance of GRACE risk score in Takotsubo syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:721-728. [DOI: 10.1177/2048872619882363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background:
Takotsubo syndrome is an increasingly recognised cardiac condition that clinically mimics an acute coronary syndrome, but data regarding its prognosis remain controversial. It is currently unknown whether acute coronary syndrome risk scores could effectively be applied to Takotsubo syndrome patients. This study aims to assess whether the Global Registry of Acute Coronary Events (GRACE) score can predict clinical outcome in Takotsubo syndrome and to compare the prognosis with matched acute coronary syndrome patients.
Methods:
A total of 561 Takotsubo syndrome patients was included in this prospective registry. According to the GRACE score, the population was divided into quartiles. The primary endpoint was all-cause mortality and the secondary endpoints were cardiocerebrovascular events (a composite of all-cause mortality, cardiovascular death, recurrence of Takotsubo syndrome and stroke).
Results:
The median GRACE risk score was 139±27. Takotsubo syndrome patients with a higher GRACE risk score mostly have a higher rate of physical triggers and lower left ventricular ejection fraction on admission. During long-term follow-up, all-cause mortality rates were 5%, 11%, 12% and 22%, respectively, in the first, second, third and fourth quartile (P<0.001). After multivariate analysis, the GRACE risk score was found to be a strong predictor of all-cause mortality (odds ratio (OR) 1.68, 95% confidence interval (CI) 1.28–2.20; P=0.001) and cardiocerebrovascular events (OR 1.63, 95% CI 1.26–2.11; P=0.001). Moreover, all-cause mortality in Takotsubo syndrome patients was comparable with the matched acute coronary syndrome cohort.
Conclusion:
In Takotsubo syndrome, the GRACE risk score allows us to predict all-cause mortality and cardiocerebrovascular events at long-term follow-up.
Collapse
Affiliation(s)
- Fernando Scudiero
- Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Luca Arcari
- Clinical and Molecular Medicine Department, Sapienza University of Rome, Italy
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Italy
| | - Elena De Vito
- Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Rossella Marcucci
- Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Ilaria Passaseo
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Italy
| | - Luca Rosario Limite
- Clinical and Molecular Medicine Department, Sapienza University of Rome, Italy
| | | | - Camillo Autore
- Clinical and Molecular Medicine Department, Sapienza University of Rome, Italy
| | - Rodolfo Citro
- University Hospital ‘San Giovanni di Dio e Ruggi d’Aragona’, Italy
| | - Eduardo Bossone
- University Hospital ‘San Giovanni di Dio e Ruggi d’Aragona’, Italy
| | - Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Italy
| | - Beatrice Bacchi
- Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine Department, Sapienza University of Rome, Italy
- IRCCS Neuromed, Italy
| | - Carlo Di Mario
- Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Italy
| |
Collapse
|
363
|
Macaya F, Vedia Ó, Salazar CH, Mejía-Rentería H, Ruiz-Pizarro V, Salinas P, Gonzalo N, Pérez-Vizcayno MJ, Vilacosta I, Fernández-Ortiz A, Macaya C, Escaned J, Núñez-Gil IJ. Clinical outcomes of patients presenting with spontaneous coronary artery dissection versus takotsubo syndrome: a propensity score analysis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:694-702. [DOI: 10.1177/2048872619886311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background:
Spontaneous coronary artery dissection and takotsubo syndrome are non-atherosclerotic causes of acute coronary syndromes. They share clinical features including female predominance and frequent triggers. We compared the outcomes of patients with spontaneous coronary artery dissection and patients with takotsubo syndrome with similar clinical characteristics.
Methods:
Patients with spontaneous coronary artery dissection (n=81) or takotsubo syndrome (n=341) were 1:1 propensity matched according to age, sex, cardiovascular risk factors and clinical presentation. We compared baseline characteristics, effects on left ventricular function, and recurrence of major adverse cardiovascular events; defined as a composite of new hospitalisation for cardiac cause, clinical recurrence (spontaneous coronary artery dissection/takotsubo syndrome), myocardial infarction and death.
Results:
Propensity score yielded 78 pairs: 85% were women, whose average age was 55.3±12.6 years, 28% had two or more cardiovascular risk factors, 37% presented with ST-segment elevation and 5% presented with cardiogenic shock. In the spontaneous coronary artery dissection group, 50% (39/78) of cases involved the left anterior descending artery and 18% (14/78) underwent revascularisation. After a median follow-up of 5 years (interquartile range 2.4–5), major adverse cardiovascular events were significantly higher in the spontaneous coronary artery dissection group (18% (14/78) vs. 8% (6/78); hazard ratio 3.40, 95% confidence interval 1.2–9.4). This was mainly driven by early readmissions for cardiac causes (17% vs. 5%, P=0.007). Spontaneous coronary artery dissection was associated with higher peak values of creatinine kinase during admission (creatinine kinase/upper limit of normality 2.49 vs. 1.21, P<0.001). Binary left ventricular systolic dysfunction was more prevalent in the takotsubo syndrome group (22% vs. 53%, P<0.001), but no significant differences were noted at follow-up (6% vs. 1%, P=0.181).
Conclusions:
In this cohort of middle-aged predominantly female patients presenting with acute coronary syndromes, the diagnosis of spontaneous coronary artery dissection compared to takotsubo syndrome conferred a worse long-term clinical outcome, mainly driven by an increased risk of rehospitalisation for cardiac causes.
Collapse
|
364
|
Affiliation(s)
- Philippe Meyer
- Cardiology Service, Geneva University Hospitals, Geneva, Switzerland
| | - Jelena-Rima Ghadri
- Departement of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Christian Templin
- Departement of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
365
|
Frederiksen KP, Søholm H, Havndrup O, Procida K. Case report: spontaneous coronary artery dissection and suspicion of takotsubo cardiomyopathy in a patient presenting with T-wave inversions, severe QTc prolongation, elevated cardiac biomarkers, and apical akinesia. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33204956 PMCID: PMC7649457 DOI: 10.1093/ehjcr/ytaa172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/04/2019] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Abstract
Background In patients suspected of acute coronary syndrome, but where the coronary angiography (CAG) has shown unobstructed coronary arteries differential diagnoses include spontaneous coronary artery dissection and takotsubo cardiomyopathy. This case report presents a patient with spontaneous coronary artery dissection but diagnostic signs suspicious of takotsubo cardiomyopathy. Which leads to a consideration of the co-existence of the diseases. Case summary A 57-year-old woman was acutely admitted to the emergency ward with sudden development of chest discomfort, palpitations, and dyspnoea. At hospitalization, the electrocardiography showed T-wave inversions in I, aVL, and V2, and Troponin I was elevated. Initial echocardiography revealed apical akinesia consistent with takotsubo cardiomyopathy. Initially, a diagnosis of acute coronary syndrome or takotsubo cardiomyopathy was suspected. The patient was further diagnostically assessed with CAG including optical coherence tomography which showed spontaneous coronary artery dissection in the left anterior descending artery. At follow-up 3 months later, CAG showed a fully healed coronary artery, and repeated echocardiography showed normalization of the left ventricular function. Discussion In this case report, initially, acute coronary syndrome was suspected due to electrocardiography with T-wave inversions and elevated cardiac biomarkers. Takotsubo cardiomyopathy was suspected when echocardiography showed apical ballooning, but CAG with optical coherence tomography revealed a spontaneous coronary artery dissection. Interestingly no severe obstructions of coronary arteries were seen, and follow-up echocardiography showed fully regained myocardial function. This leads to the debate as to whether this might be a case of co-existing spontaneous coronary artery dissection and takotsubo cardiomyopathy.
Collapse
Affiliation(s)
- Kåre Peter Frederiksen
- Roskilde Department of Cardiology, Zealand University Hospital, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet - Copenhagen University Hospital, Denmark
| | - Helle Søholm
- Roskilde Department of Cardiology, Zealand University Hospital, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Ole Havndrup
- Roskilde Department of Cardiology, Zealand University Hospital, Denmark
| | - Kristina Procida
- Roskilde Department of Cardiology, Zealand University Hospital, Denmark
| |
Collapse
|
366
|
Saboe A, Sari MT, Febrianora M. A rare manifestation of Takotsubo Cardiomyopathy associated with non-tuberculous mycobacterium. J Clin Tuberc Other Mycobact Dis 2020; 21:100191. [PMID: 32995573 PMCID: PMC7516290 DOI: 10.1016/j.jctube.2020.100191] [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] [Indexed: 10/26/2022] Open
Abstract
Background Takotsubo Cardiomyopathy or broken heart syndrome is a rare cause of non-ischemic cardiomyopathy that produce left ventricular dysfunction with characteristic left ventricular apical ballooning. It rarely caused by infection. We present an atypical manifestation of non-tuberculous mycobacterial (NTM) infection with myocardial involvement and its diagnostic challenge. Case illustration A 57-year-old female presented with prolonged fever, fatigue and weight loss for one and half months. General examination was unremarkable with elevated C-Reactive Protein and normal troponin. Electrocardiogram (ECG) showed diffuse T wave inversion with prolonged QTc. Echocardiography showed hypokinetic apical with normal ejection fraction. Angiography showed patent coronary arteries. Ventriculography showed apical ballooning. Workup with ethambutol scan revealed active mycobacterial infection in both lung and mesentery. Sputum polymerase chain reaction (PCR) was positive for non-tuberculous mycobacterium. Follow up ECG and echocardiography showed improvement in QTc interval and left ventricular wall motion abnormalities. Results Takotsubo Cardiomyopathy may manifest as asymptomatic ventricular dysfunction following non-tuberculous mycobacterial infection. A thorough investigation will help identify the systemic disease with cardiac involvement which potentially could be fatal. Conclusion Takotsubo cardiomyopathy may be triggered by infection. Identification of causal is crucial as a management strategy to restore cardiac function.
Collapse
Affiliation(s)
- Aninka Saboe
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Minsy Titi Sari
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Mega Febrianora
- Department of Cardiology and Vascular Medicine, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, Indonesia
| |
Collapse
|
367
|
Koutroumpakis E, Taylor T, Damaraju S, Badruddin Mawji S. "Covidsubo": Stress-Induced Cardiomyopathy by Novel Coronavirus Disease 2019. Cardiology 2020; 145:779-783. [PMID: 32987390 PMCID: PMC7573897 DOI: 10.1159/000511450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/04/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION COVID-19 is a rapidly growing infectious disease that represents an immediate threat for the health of millions of people around the world, both in direct and indirect ways. CASE PRESENTATION In the present report we describe the development of stress cardiomyopathy in a patient who was overwhelmingly stressed by watching the news coverage of the COVID-19 pandemic. CONCLUSION Physicians and scientists around the globe should be aware of the psychological consequences of COVID-19 and their potential to cause physical illness.
Collapse
Affiliation(s)
- Efstratios Koutroumpakis
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA,
| | - Travis Taylor
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Division of Cardiology, Coastal Cardiology, CHRISTUS Spohn Health System, Corpus Christi, Texas, USA
| | - Srikanth Damaraju
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Division of Cardiology, Coastal Cardiology, CHRISTUS Spohn Health System, Corpus Christi, Texas, USA
| | - Shamim Badruddin Mawji
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Division of Cardiology, Coastal Cardiology, CHRISTUS Spohn Health System, Corpus Christi, Texas, USA
| |
Collapse
|
368
|
Mouedder F, El Ouazzani J, Elouafi N, Bazid Z. Association of Acute Pancreatitis and Myocardial Infarction: Is the Heart Victim or Culprit? - A Case Report and Review of the Literature. Cureus 2020; 12:e10697. [PMID: 33133862 PMCID: PMC7593207 DOI: 10.7759/cureus.10697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Acute pancreatitis can be associated with electrical changes mimicking acute coronary syndrome with normal coronary arteries. The association of acute pancreatitis with ST-segment elevation and elevated cardiac enzymes has been reported in few observations. The pathophysiological mechanisms of this association remain poorly understood. We report the case of a 63-year-old woman presenting with chest pain, changes in the electrocardiogram and elevated cardiac enzymes with normal coronary arteries associated with acute pancreatitis. Stress cardiomyopathy or Takotsubo syndrome associated with acute pancreatitis was the most likely diagnosis in our case. Stress cardiomyopathy should be considered a possibility in case of patients with acute pancreatitis who present with clinical signs suggestive of acute coronary syndrome.
Collapse
Affiliation(s)
- Fadoua Mouedder
- Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Jamal El Ouazzani
- Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Noha Elouafi
- Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| | - Zakaria Bazid
- Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
| |
Collapse
|
369
|
Speer T, Fiege M, Fastner C. [Delayed Takotsubo syndrome - A critical perioperative incident]. Dtsch Med Wochenschr 2020; 145:1400-1404. [PMID: 32971555 DOI: 10.1055/a-1185-7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The term Takotsubo syndrome (TTS) describes a transient ventricular dysfunction. Symptoms and complication rate are similar to those of a myocardial infarction. MEDICAL HISTORY An 81-year-old female patient was admitted for thrombendarterectomy of the left femoral artery. Prior to a recent biological aortic valve replacement, coronary heart disease had been ruled out. ANESTHETIC INDUCTION AND CLINICAL FINDINGS After induction of anesthesia, relevant arterial hypotension and sinus bradycardia occurred. After catecholamine administration, transient ST segment elevations were observed, which postoperatively developed a myocardial infarction-like dynamic. Echocardiography and values of cardiac enzymes initially revealed no abnormalities. THERAPY, COURSE AND DIAGNOSIS After a symptom-free interval the patient developed severe cardiac decompensation on the third postoperative day. At this point, the clinical picture of TTS was visible. Stabilisation of the clinical condition was achieved with levosimendan therapy. CONCLUSION Dynamic ECG changes in the perioperative situation always require differentiated diagnosis and possibly longer monitoring. TTS is a relevant differential diagnosis because it is subject to severe complications.
Collapse
Affiliation(s)
- Tillmann Speer
- Klinik für Anästhesiologie, Klinikum Itzehoe, Itzehoe, Deutschland
| | - Marko Fiege
- Klinik für Anästhesiologie, Klinikum Itzehoe, Itzehoe, Deutschland
| | - Christian Fastner
- I. Medizinische Klinik - Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim der Universität Heidelberg und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Heidelberg/Mannheim, Mannheim, Deutschland
| |
Collapse
|
370
|
Yakupoglu HY, Saeed S, Senior R, Baksi AJ, Lyon AR, Khattar RS. Reversible exercise-induced left ventricular dysfunction in symptomatic patients with previous Takotsubo syndrome: insights from stress echocardiography. Eur Heart J Cardiovasc Imaging 2020:jeaa237. [PMID: 32944732 DOI: 10.1093/ehjci/jeaa237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/04/2020] [Indexed: 02/24/2024] Open
Abstract
AIMS Takotsubo syndrome (TTS) is usually associated with rapid and spontaneous recovery of left ventricular (LV) function. However, a proportion of patients may have persistent symptoms. This study aimed to determine the haemodynamic and LV contractile responses to exercise in these patients. METHODS AND RESULTS Thirty symptomatic TTS patients referred for exercise echocardiography, a median of 15 months following the index TTS episode, were matched with 30 controls with normal exercise echocardiography. Beta-blockers were withheld prior to the test. LV volumes, ejection fraction (EF) and wall motion score index (WMSI), were measured at rest and stress. The TTS cohort were Caucasian women with mean age of 64.6 ± 7.4 years and similar coronary risk factor profile and EF to controls. Resting systolic blood pressure (SBP), LV end-diastolic volume, wall stress, and right ventricular fractional area change were higher in TTS patients compared with controls. Stress echo data showed similar exercise time, peak heart rate, and peak SBP in TTS patients vs. controls, but TTS patients had higher LV volumes, lower exercise LVEF (70 ± 10% vs. 78 ± 7%; P = 0.001), ΔLVEF (4 ± 8% vs. 12 ± 5%; P < 0.001), and WMSI (1.4 ± 0.4 vs. 1 ± 0; P < 0.001) compared with controls. Twenty TTS patients had clear exercise-induced wall motion abnormalities, mainly involving the apex or more globally, with a mean ΔLVEF of 1% compared with 12% in controls. Among the other 10 TTS patients, the ΔLVEF was 10%. CONCLUSION Symptomatic patients with previous TTS have a blunted contractile response to exercise. The therapeutic and prognostic implications of these findings need further investigation.
Collapse
Affiliation(s)
- H Yakup Yakupoglu
- Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK
| | - Sahrai Saeed
- Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK
| | - Roxy Senior
- Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK
- Cardiovascular Division, National Heart and Lung Institute, Imperial College, London, UK
| | - A John Baksi
- Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK
- Cardiovascular Division, National Heart and Lung Institute, Imperial College, London, UK
| | - Alexander R Lyon
- Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK
- Cardiovascular Division, National Heart and Lung Institute, Imperial College, London, UK
| | - Rajdeep S Khattar
- Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK
- Cardiovascular Division, National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
371
|
Tsuji M, Amiya E, Bujo C, Maki H, Ishida J, Hatano M, Ono M, Komuro I. Takotsubo syndrome in the same heart before and after heart transplantation. ESC Heart Fail 2020; 7:4311-4314. [PMID: 32964639 PMCID: PMC7754914 DOI: 10.1002/ehf2.12970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/04/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023] Open
Abstract
Heart transplantation is an effective therapy for patients with end‐stage heart failure. In some cases, Takotsubo syndrome (TTS) was seen in the donor heart. We report a case of TTS in a 40‐year‐old woman with a history of epileptic seizures who underwent heart transplantation from a donor with TTS. The donor was brain‐dead due to severe hypoxic encephalopathy during cardiac arrest with TTS. Fifteen months after heart transplantation, she was readmitted for epileptic seizures. Electrocardiogram showed T‐wave inversion, and transthoracic echocardiography showed apical ballooning. Coronary angiography was normal, and endomyocardial biopsy was negative for rejection. Iodine‐123 metaiodobenzylguanidine imaging demonstrated a low heart‐to‐mediastinum ratio and high washout rate. Eighteen days after admission, recovery of left ventricular dysfunction was confirmed, and she was diagnosed with TTS triggered by epileptic seizures. It is important to recognize the risk of recurrent TTS in heart transplantation patients from a donor with TTS.
Collapse
Affiliation(s)
- Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
372
|
Frankel E, Prior P, Mehta H, Rajagopalan P, Wiener DH, Rose A, Marhefka GD. One Patient, Three Variants, Four Episodes of Takotsubo Cardiomyopathy. ACTA ACUST UNITED AC 2020; 4:204-207. [PMID: 32875182 PMCID: PMC7451881 DOI: 10.1016/j.case.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
TCM is an increasingly recognized clinical entity. Variants include apical, midventricular, basal, and focal. The authors present a unique case in which one patient developed three variants.
Collapse
Affiliation(s)
- Eitan Frankel
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Patrick Prior
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Hetal Mehta
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Priya Rajagopalan
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David H Wiener
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Andrew Rose
- Pennsylvania Heart and Vascular Group, Philadelphia, Pennsylvania
| | - Gregary D Marhefka
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
373
|
Pyrethroid insecticide-induced takotsubo syndrome. Anatol J Cardiol 2020; 24:201-203. [PMID: 32870165 PMCID: PMC7585976 DOI: 10.14744/anatoljcardiol.2020.25668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
374
|
Minhas AS, Hays AG. Reply: Takotsubo Syndrome Associated With COVID 19: And the InterTAK Diagnosis Score? JACC Case Rep 2020; 2:1835-1836. [PMID: 32838335 PMCID: PMC7413057 DOI: 10.1016/j.jaccas.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Anum S. Minhas
- Johns Hopkins Hospital, Division of Cardiology, 600 North Wolfe Street, Halsted 500, Baltimore, Maryland 21287
| | | |
Collapse
|
375
|
Yakupoglu HY, Wechalekar K, Baksi AJ, Lyon AR, Khattar RS. Exercise-Induced Reversible Apical Ballooning in a Patient With Previous Takotsubo Syndrome and Ongoing Symptoms. Circ Cardiovasc Imaging 2020; 13:e010237. [DOI: 10.1161/circimaging.119.010237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- H. Yakup Yakupoglu
- Royal Brompton and Harefield NHS Trust, Sydney Street, London, United Kingdom (H.Y.Y., K.W., A.J.B., A.R.L., R.S.K.)
| | - Kshama Wechalekar
- Royal Brompton and Harefield NHS Trust, Sydney Street, London, United Kingdom (H.Y.Y., K.W., A.J.B., A.R.L., R.S.K.)
| | - A. John Baksi
- Royal Brompton and Harefield NHS Trust, Sydney Street, London, United Kingdom (H.Y.Y., K.W., A.J.B., A.R.L., R.S.K.)
- National Heart and Lung Institute, Imperial College, London, United Kingdom (A.J.B., A.R.L., R.S.K.)
| | - Alexander R. Lyon
- Royal Brompton and Harefield NHS Trust, Sydney Street, London, United Kingdom (H.Y.Y., K.W., A.J.B., A.R.L., R.S.K.)
- National Heart and Lung Institute, Imperial College, London, United Kingdom (A.J.B., A.R.L., R.S.K.)
| | - Rajdeep S. Khattar
- Royal Brompton and Harefield NHS Trust, Sydney Street, London, United Kingdom (H.Y.Y., K.W., A.J.B., A.R.L., R.S.K.)
- National Heart and Lung Institute, Imperial College, London, United Kingdom (A.J.B., A.R.L., R.S.K.)
| |
Collapse
|
376
|
Special Article - Emotional versus physical Takotsubo syndrome: Two faces of the same medal or two different syndromes? Prog Cardiovasc Dis 2020; 63:699-701. [DOI: 10.1016/j.pcad.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
377
|
Templin C, Hänggi J, Klein C, Topka MS, Hiestand T, Levinson RA, Jurisic S, Lüscher TF, Ghadri JR, Jäncke L. Altered limbic and autonomic processing supports brain-heart axis in Takotsubo syndrome. Eur Heart J 2020; 40:1183-1187. [PMID: 30831580 PMCID: PMC6462306 DOI: 10.1093/eurheartj/ehz068] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/30/2018] [Accepted: 02/25/2019] [Indexed: 12/16/2022] Open
Abstract
Aims Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction often triggered by emotional or physical stress. Severe activation of the sympathetic nervous system with catecholamine release caused by a dysfunctional limbic system has been proposed as a potential mechanism. We hypothesize that brain regions responsible for autonomic integration and/or limbic processing might be involved in the development of TTS. Here, we investigated alterations in resting state functional connectivity in TTS patients compared with healthy controls. Methods and results Using brain functional magnetic resonance imaging (fMRI), resting state functional connectivity has been assessed in 15 subjects with TTS and 39 healthy controls. Network-based statistical analyses were conducted to identify subnetworks with altered resting state functional connectivity. Sympathetic and parasympathetic networks have been constructed in addition to the default mode network and whole-brain network. We found parasympathetic- and sympathetic-associated subnetworks both showing reduced resting state functional connectivity in TTS patients compared with controls. Important brain regions constituting parasympathetic- and sympathetic-associated subnetworks included the amygdala, hippocampus, and insula as well as cingulate, parietal, temporal, and cerebellar regions. Additionally, the default mode network as well as limbic regions in the whole-brain analysis demonstrated reduced resting state functional connectivity in TTS, including the hippocampus, parahippocampal, and medial prefrontal regions. Conclusion For the first time, we demonstrate hypoconnectivity of central brain regions associated with autonomic functions and regulation of the limbic system in patients with TTS. These findings suggest that autonomic-limbic integration might play an important role in the pathophysiology and contribute to the understanding of TTS.
Collapse
Affiliation(s)
- Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, Zurich, Switzerland
| | - Carina Klein
- Division Neuropsychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, Zurich, Switzerland
| | - Marlene S Topka
- Division Neuropsychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, Zurich, Switzerland
| | - Thierry Hiestand
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Stjepan Jurisic
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, Cardiology, Sydney Street, London, UK
| | - Jelena-Rima Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, Zurich, Switzerland.,University Research Priority Program (URPP), Dynamic of Healthy Aging, University of Zurich, Andreasstrasse 15, Zurich, Switzerland
| |
Collapse
|
378
|
Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA, Bertrand P, Donal E, Dweck M, Galderisi M, Haugaa KH, Sade LE, Stankovic I, Cosyns B, Edvardsen T. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). Eur Heart J Cardiovasc Imaging 2020; 21:1184-1207. [DOI: 10.1093/ehjci/jeaa149] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
Collapse
Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila,” Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
379
|
Takotsubo Cardiomyopathy in Dextrocardia with Situs Inversus. Case Rep Cardiol 2020; 2020:8844691. [PMID: 32884846 PMCID: PMC7455845 DOI: 10.1155/2020/8844691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 02/04/2023] Open
Abstract
Takotsubo cardiomyopathy (TTC) is an acute reversible form of left ventricular (LV) systolic dysfunction extending beyond a coronary artery vascular territory usually due to physical or psychological stressors. Dextrocardia with situs inversus is a rare embryologic anomaly whereby the heart and aorta are mirrored on the contralateral side. We describe a case of a 93-year-old female with dextrocardia who presented with chest pain, atrial fibrillation with rapid ventricular response, and transient inferior ST elevation. Coronary angiography demonstrated an eccentric mid right coronary artery (RCA) lesion and apical ballooning consistent with concurrent takotsubo cardiomyopathy (TTC). To our knowledge, this is the first reported case of this dual pathology in a patient with dextrocardia, highlighting the procedural and diagnostic complexity in the setting of a rare anatomicvariant.
Collapse
|
380
|
Doi YL, Kubo T, Kitaoka H. A Novel Disease Entity in Search of Its Own Identity ― Takotsubo Syndrome. Is It Really “Cardiomyopathy”? ―. Circ Rep 2020; 2:446-448. [PMID: 33693267 PMCID: PMC7819659 DOI: 10.1253/circrep.cr-20-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:
The term “takotsubo cardiomyopathy” is commonly used in clinical practice. However, there is conceptual problem with the term “cardiomyopathy” in this context because “cardiomyopathy” implies a primary and chronic myocardial disease of unknown etiology. In this study we reviewed the literature related to takotsubo cardiomyopathy to investigate whether it is appropriate to use the term “cardiomyopathy” for this condition. Methods and Results:
A literature review revealed that this condition was originally described in 1990 in Japan as postischemic myocardial stunning with unique left ventricular apical ballooning and that it gradually gained global attention thereafter. Subsequently, the term “takotsubo cardiomyopathy” was introduced to describe this heart failure phenotype. However, this term has been called into question because several recent studies investigating the mechanism underlying this condition have provided evidence of myocardial ischemia possibly due to microvascular dysfunction. The term “takotsubo syndrome” was suggested to describe this microvascular acute coronary syndrome, which is in agreement with the original description of the condition as myocardial stunning following acute myocardial ischemia. Conclusions:
Based on the accumulating evidence of acute myocardial ischemia due to microvascular dysfunction as the mechanism underlying this condition, in addition to the fact that the term “cardiomyopathy” literally implies a primary and chronic myocardial disease, it is advisable that the term “takotsubo syndrome” is used until the etiology and underlying mechanism of this condition are fully clarified.
Collapse
Affiliation(s)
- Yoshinori L. Doi
- Cardiomyopathy Institute, Chikamori Hospital
- Department of Cardiology and Aging Science, Kochi Medical School
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medical School
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medical School
| |
Collapse
|
381
|
Alashi A, Isaza N, Faulx J, Popovic ZB, Menon V, Ellis SG, Faulx M, Kapadia SR, Griffin BP, Desai MY. Characteristics and Outcomes of Patients With Takotsubo Syndrome: Incremental Prognostic Value of Baseline Left Ventricular Systolic Function. J Am Heart Assoc 2020; 9:e016537. [PMID: 32755253 PMCID: PMC7660826 DOI: 10.1161/jaha.120.016537] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background We sought to determine (1) long‐term outcomes in patients presenting with documented Takotsubo syndrome (TS), (2) whether left ventricular global longitudinal strain (LV‐GLS) provides incremental prognostic value, and (3) prognostic cutoffs of LV ejection fraction (LVEF) and LV‐GLS during an acute TS episode. Methods and Results We studied 650 patients with TS (aged 66±14 years, 88% women) who were diagnosed clinically and angiographically between 2006 and 2018. Baseline LVEF and LV‐GLS (using velocity vector imaging) were recorded. The primary end point was all‐cause mortality. TS triggers were unknown (34%), emotional (16%), physical (41%), and neurologic (10%). Mean LVEF and LV‐GLS were 36±10% and −11.6±0.4%; in addition, 94% patients had LVEF <52%, and 80% had apical ballooning. No patient had obstructive coronary artery disease. At a median of 2.2 years (interquartile range, 0.7–4.4), 175 (27%) had died (9% in‐hospital deaths). Multivariate Cox survival analysis revealed that higher age (hazard ratio [HR], 1.35), male sex (HR, 1.75), lower baseline LVEF (HR, 1.02), worse LV‐GLS (HR, 1.04), neurologic trigger (HR, 2.66), and physical trigger (HR, 2.64) were associated with mortality, whereas aspirin (HR, 0.70) and β‐blockers (HR, 0.73) improved survival (all P<0.049). The addition of LVEF and LV‐GLS to clinical markers (age, sex, cardiogenic shock at presentation, and peak troponin I) significantly increased log‐likelihood ratios: clinical (−521.48), clinical plus LVEF (−511.32, P<0.001), and clinical plus LVEF and LV‐GLS (−500.68, P<0.001). On penalized spline analysis, LVEF of 38% and LV‐GLS of −10% were cutoffs below which survival was significantly worse. Conclusions Patients with TS with a neurologic or physical trigger had significantly worse survival than those without such a trigger, with baseline LVEF and LV‐GLS providing incremental prognostic value.
Collapse
Affiliation(s)
- Alaa Alashi
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Nicolas Isaza
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Jackson Faulx
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Zoran B Popovic
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Venu Menon
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Michael Faulx
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| |
Collapse
|
382
|
Manzur-Sandoval D, Carmona-Levario P, García-Cruz E. Giant inverted T waves in a patient with COVID-19 infection. Ann Emerg Med 2020; 77:264-267. [PMID: 33010955 PMCID: PMC7402110 DOI: 10.1016/j.annemergmed.2020.07.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Daniel Manzur-Sandoval
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Edgar García-Cruz
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| |
Collapse
|
383
|
Agdamag AC, Patel H, Chandra S, Rao A, Suboc TM, Marinescu K, Ledsky C, Volgman AS. Sex Differences in Takotsubo Syndrome: A Narrative Review. J Womens Health (Larchmt) 2020; 29:1122-1130. [DOI: 10.1089/jwh.2019.7741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Arianne Clare Agdamag
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Hena Patel
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sonal Chandra
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Anupama Rao
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Tisha Marie Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Karolina Marinescu
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Clara Ledsky
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | | |
Collapse
|
384
|
Sakatani A, Kume K, Nishio M, Hirooka K, Hayashi T. Takotsubo syndrome triggered by coronary artery embolism in a patient with chronic atrial fibrillation. J Cardiol Cases 2020; 22:45-47. [PMID: 32774517 PMCID: PMC7403553 DOI: 10.1016/j.jccase.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 11/30/2022] Open
Abstract
Although takotsubo syndrome is defined as a reversible heart failure syndrome with the absence of obstructive coronary artery disease, some cases of concomitant takotsubo syndrome and acute myocardial infarction have been reported. We herein describe the case of a patient with chronic nonvalvular atrial fibrillation who was not receiving anticoagulant therapy, who developed takotsubo syndrome triggered by acute myocardial infarction probably due to coronary artery thromboembolism. <Learning objective: Takotsubo syndrome triggered by acute myocardial infarction rarely occurs. Patients with a broad infarct-area require careful management because of the development of adverse events such as cardiogenic shock.>
Collapse
Affiliation(s)
| | - Kiyoshi Kume
- Corresponding author at: Cardiovascular Division, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan.
| | | | | | | |
Collapse
|
385
|
Y-Hassan S, Falhammar H. Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas. J Clin Med 2020; 9:jcm9082435. [PMID: 32751501 PMCID: PMC7465968 DOI: 10.3390/jcm9082435] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Pheochromocytomas and paragangliomas (PPGLs) are rare neuro-endocrine tumors. The catecholamine surge causes paroxysmal or chronic secondary hypertension. PPGLs may present as hypertensive- or PPGL-crisis with severe life-threatening cardiac and cerebrovascular complications. PPGLs-induced cardiac manifestations have been reported with diagnoses as PPGLs-induced electrocardiogram (ECG) changes “mimicking acute myocardial infarction”, arrhythmias, myocarditis, acute coronary syndrome, dilated cardiomyopathy, and lately as takotsubo syndrome. Critical analysis of these reports reveals that most of these cardiac manifestations have certain features in common. They have a dramatic clinical presentation and are reversible if the disease is treated with appropriate medical therapy and surgical resection of the PPGL tumor. They may have the same repolarization ECG changes irrespective of the clinical cardiac diagnosis, usually associated with mild to moderate elevations of myocardial biomarkers as troponins and normal coronary arteries. The histopathological findings are usually focal or multifocal in the form hypercontracted sarcomeres and contraction band necrosis (myofibrillar degeneration) with subsequent secondary mononuclear cell infiltration. Evidences argue the PPGL caused surge of catecholamines triggers hyperactivation of the sympathetic nervous system with cardiac sympathetic nerve terminal disruption with norepinephrine spillover causing the cardiac complications. A comprehensive review of various reported cardiovascular manifestations and complications of PPGLs are presented.
Collapse
Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, 141 86 Stockholm, Sweden;
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Correspondence:
| |
Collapse
|
386
|
Iannaccone G, Montone RA, Del Buono MG, Meucci MC, Rinaldi R, Gurgoglione FL, Russo M, Camilli M, Niccoli G, Crea F. Recurrent asymptomatic Takotsubo syndrome after 20 years: are we looking at the tip of the iceberg only? Future Cardiol 2020; 17:309-314. [PMID: 32648481 DOI: 10.2217/fca-2020-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Takotsubo syndrome (TS) is an acute and reversible form of myocardial stunning preceded by emotional or physical stress, not explained by an obstruction of an epicardial coronary artery as in acute coronary syndrome. Over the last decades, TS is receiving growing attention, leading to an increase in awareness and diagnostic rate. Chest pain and dyspnea are the most common presenting symptoms; however, nonspecific presentations make the diagnosis challenging for clinicians. Here, we present the case of a 76-year-old female who experienced two completely asymptomatic episodes of TS 20 years apart.
Collapse
Affiliation(s)
- Giulia Iannaccone
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Marco Giuseppe Del Buono
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Chiara Meucci
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Rinaldi
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Luca Gurgoglione
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Russo
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Camilli
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Department of Cardiovascular & Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| |
Collapse
|
387
|
Lüscher TF. The secret of success of heart failure therapy: A lesson for ACHD? INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
388
|
Desai R, Parekh T, Kumar G, Sachdeva R. First episodes versus first recurrent episodes of Takotsubo syndrome: Pathophysiologic findings remain significantly different with comparable clinical outcomes. Int J Cardiol 2020; 310:23-24. [DOI: 10.1016/j.ijcard.2020.04.018] [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: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 11/26/2022]
|
389
|
Rostagno C, Polidori G, Ceccofiglio A, Cartei A, Boccaccini A, Peris A, Rubbieri G, Civinini R, Innocenti M. Takotsubo Syndrome: Is this a Common Occurrence in Elderly Females after Hip Fracture? J Crit Care Med (Targu Mures) 2020; 6:146-151. [PMID: 32864459 PMCID: PMC7430354 DOI: 10.2478/jccm-2020-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/31/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The prevalence of Takotsubo syndrome in hip fracture is not known. METHODS Hip fracture patients were evaluated in a multidisciplinary unit. Patients with ECG abnormalities and increased troponin I values at the time of hospital admission were included in the study Follow-up was clinical at 30 days and by telephonic interview at one year. RESULTS Between October 1st 2011 to September 30th 2016, 51 of 1506 patients had preoperative evidence of myocardial damage. Eight, all females, fulfilled the Mayo criteria for Takotsubo syndrome, six had no coronary lesions. Hip surgery was uneventful, and all eight were alive at thirty days, and seven of these were still alive after one year. Forty-three patients had myocardial infarction: mortality at thirty days and one year were 11% and 44% (p<0.0001, Student's t-test; log-rank test). CONCLUSION At least 15% of patients with hip fracture and preoperative myocardial damage had Takotsubo syndrome. They were all elderly females. Contrary to myocardial infarction, Takotsubo syndrome has a favourable long term prognosis.
Collapse
Affiliation(s)
| | | | | | | | | | - Adriano Peris
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Gaia Rubbieri
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | |
Collapse
|
390
|
Vágó H, Szabó L, Dohy Z, Czimbalmos C, Tóth A, Suhai FI, Bárczi G, Gyarmathy VA, Becker D, Merkely B. Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries. Heart 2020; 106:992-1000. [PMID: 32447308 PMCID: PMC7306881 DOI: 10.1136/heartjnl-2019-316295] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries. METHODS In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out. RESULTS CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality. CONCLUSIONS CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.
Collapse
Affiliation(s)
- Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - György Bárczi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - V Anna Gyarmathy
- EpiConsult LLC, Dover, Delaware, USA
- Johns Hopkins, Baltimore, Maryland, USA
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
391
|
Ives CW, Smith PA, Atchley TJ, Pogwizd SM. A novel case of reverse Takotsubo cardiomyopathy following brain biopsy. Echocardiography 2020; 37:1080-1083. [PMID: 32594548 DOI: 10.1111/echo.14700] [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: 12/30/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022] Open
Abstract
Reverse Takotsubo cardiomyopathy (rTTC) is a variant of Takotsubo cardiomyopathy (TTC) or stress-induced cardiomyopathy. TTC is a transient cardiomyopathy resulting in a heart failure syndrome, triggered by emotional and/or physical stressors, that is usually self-limited. rTTC is characterized by basal wall hypokinesis and apical wall hyperkinesis, the opposite of TTC. rTTC is more commonly associated with neurologic conditions, most notably intracranial hemorrhage. We present the first case in the literature of rTTC specifically following brain biopsy.
Collapse
Affiliation(s)
- Christopher W Ives
- Department of Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phillip A Smith
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Travis J Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven M Pogwizd
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
392
|
Y-Hassan S. Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction. World J Cardiol 2020; 12:231-247. [PMID: 32774776 PMCID: PMC7383352 DOI: 10.4330/wjc.v12.i6.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial “cramp” (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided.
Collapse
Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm S-141 86, Sweden
| |
Collapse
|
393
|
Chen M, Zhao T, Chen G, Hu S. A rare long-term undetected pheochromocytoma leading to Takotsubo syndrome in an older male patient: a case report. BMC Endocr Disord 2020; 20:93. [PMID: 32576166 PMCID: PMC7313138 DOI: 10.1186/s12902-020-00578-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/16/2020] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Takotsubo syndrome is an uncommon, acute, and reversible cardiomyopathy that occurs primarily in postmenopausal females. The clinical presentation of the syndrome resembles acute coronary syndrome, but coronary angiography reveals no obstructive coronary artery disease. Rarely, a catecholamine surge due to pheochromocytoma may induce Takotsubo syndrome. The clinical features of pheochromocytoma include paroxysmal hypertension, headache, palpitations, and profuse sweating. However, owing to the episodic, rather than continued, symptoms and signs of pheochromocytoma, its timely diagnosis poses a challenge for clinicians. Here, we report a rare case of long-term undetected pheochromocytoma leading to Takotsubo syndrome in an older male patient. CASE PRESENTATION A 70-year-old man presented with paroxysmal chest distress and chest pain. Examinations revealed acute coronary syndrome with normal coronary arteries, heart failure, reversible left ventricular regional wall motion abnormalities, labile blood pressure, a giant left adrenal mass, and extremely high levels of metanephrine and normetanephrine. Clinical manifestations, laboratory reports, and imaging findings suggested a diagnosis of Takotsubo syndrome caused by pheochromocytoma. Supportive therapy, administration of alpha- adrenergic receptor blockers, and left adrenal mass resection resolved the patient's symptoms. A histological examination confirmed the presence of pheochromocytoma. We reviewed his history of midbrain hemorrhage 6 years prior and found a mass in the left adrenal region by reviewing the computed tomography images of the lung that were also taken 6 years prior, on which the pheochromocytoma was evident. CONCLUSIONS Our case illustrates the importance of understanding the link between pheochromocytoma and Takotsubo syndrome. A diagnosis of pheochromocytoma-induced Takotsubo syndrome should be considered during the differential diagnosis of acute coronary syndrome, especially in patients with labile blood pressure and normal coronary angiography findings; meanwhile, assessments of catecholamines and its metabolites and abdominal computed tomography scan should be performed at the right time. Clinicians should also be alert to potential pheochromocytoma in patients with unexplained cerebral hemorrhage, even in the absence of symptoms of catecholamine excess.
Collapse
Affiliation(s)
- Min Chen
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, #79, Qingchun Road, Zhejiang, 310003, Hangzhou, China.
| | - Tong Zhao
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, #79, Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Guoping Chen
- Department of Endocrinology, the First Affiliated Hospital, College of Medicine, Zhejiang University, #79, Qingchun Road, Zhejiang, 310003, Hangzhou, China
| | - Shenjiang Hu
- Department of Cardiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, #79, Qingchun Road, Zhejiang, 310003, Hangzhou, China
| |
Collapse
|
394
|
|
395
|
Mauro C, Vriz O, Romano L, Citro R, Russo V, Ranieri B, Alamro B, Aladmawi M, Granata R, Galzerano D, Bellino M, Cocchia R, Mehta RM, Dellegrottaglie S, Alsergani H, Mehta RH, Bossone E. Imaging Cardiovascular Emergencies: Real World Clinical Cases. Heart Fail Clin 2020; 16:331-346. [PMID: 32503756 DOI: 10.1016/j.hfc.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.
Collapse
Affiliation(s)
- Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Olga Vriz
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Luigia Romano
- Department of General and Emergency Radiology, A Cardarelli Hospital, Via Cardarelli 9, Naples I-80131, Italy
| | - Rodolfo Citro
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Valentina Russo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | | | - Bandar Alamro
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Mohammed Aladmawi
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Riccardo Granata
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, Naples I-80131, Italy
| | - Domenico Galzerano
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Michele Bellino
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Rosangela Cocchia
- Division of Cardiac Rehabilitation - Echo Lab, A Cardarelli Hospital, Naples, Italy
| | - Rahul M Mehta
- ProMedica Monroe Regional Hospital, 718 North Macomb Street, Monroe, MI 48162, USA
| | - Santo Dellegrottaglie
- Division of Cardiology, Clinica Villa dei Fiori, C.so Italia 157, 80011, Acerra, Naples, Italy
| | - Hani Alsergani
- Cardiology Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, MBC-16, PO Box 3354, Riyadh 11211, Saudi Arabia
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Durham, 300 West Morgan Street, Durham, NC 27701, USA
| | - Eduardo Bossone
- Division of Cardiac Rehabilitation - Echo Lab, A Cardarelli Hospital, Naples, Italy.
| |
Collapse
|
396
|
Affiliation(s)
- Jelena-Rima Ghadri
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Shams Y-Hassan
- Department of Cardiology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Felix Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Department of Cardiology, Royal Brompton & Harefield Hospital and Imperial College, London, UK
| | - Christian Templin
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
397
|
Left Ventricular Sphericity Index is a reproducible bedside echocardiographic measure of geometric change between acute phase Takotsubo's syndrome and acute anterior myocardial infarction. IJC HEART & VASCULATURE 2020; 29:100547. [PMID: 32514426 PMCID: PMC7267721 DOI: 10.1016/j.ijcha.2020.100547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
TS and AMI are separate cardiac conditions with similar clinical presentations. TS have a higher LVSI than AMI, indicating a more spherical left ventricle. LVSI may be utilised acutely to assist differentiation of acute phase TS and AMI.
Background Left ventricular sphericity index (LVSI) is a simple, quick and reproducible measure to evaluate LV geometric changes. The aim of our study was to evaluate the utility of LVSI as a rapid discrimination tool in two disease processes; Takotsubo’s Syndrome (TS) and Anterior Myocardial Infarction (AMI), in the absence of significant left ventricular systolic dysfunction. Methods Consecutive patients with acute phase TS admitted to our institution (Jan 2013 - Dec 2018) were evaluated (n=66). Patients with a comprehensive two-dimensional transthoracic echocardiogram were included in primary analysis (n=50) and age-matched with a cohort of patients with acute anterior AMI (n=50). Appraisal of demographic, clinical and echocardiographic parameters of patients was undertaken. Biplane LVSI was calculated as an average of the short- and long-axis length in the 4- and 2-chamber apical views. Results A total of 50 TS patients (64.3±13.7 years, 18% men) were matched with 50 AMI (62.10±12.84 years, 74% men) patients. There was no significant difference in baseline cardiovascular risk factors other than diabetes mellitus (AMI 34% vs TS 17%, p = 0.034). There was also no difference in LV mass (p=0.10) or LVEF (p=0.52) between the two groups. Interestingly, there was a significant difference in mean LVSI between TS (0.60±0.06) vs AMI (0.52±0.07) (p<0.01) reflecting a more spherical shaped left ventricle in the acute TS group. Conclusions LVSI is reflective of geometric changes in the left ventricle and may be helpful as a rapid and reproducible diagnostic tool in differentiating between TS and AMI in the acute phase.
Collapse
|
398
|
Assessment of coronary microvascular dysfunction: An integral part of risk-stratification in Takotsubo cardiomyopathy - A response. Rev Port Cardiol 2020; 39:359-360. [DOI: 10.1016/j.repc.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
399
|
Assessment of coronary microvascular dysfunction: An integral part of risk-stratification in Takotsubo cardiomyopathy - A response. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
400
|
Vassiliki’ Coutsoumbas G, Gallo P, Zagnoni S, Di Pasquale G. Long-term injury after Takotsubo syndrome (stress cardiomyopathy). Eur Heart J Suppl 2020; 22:E73-E78. [PMID: 32523444 PMCID: PMC7270968 DOI: 10.1093/eurheartj/suaa065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Takotsubo syndrome is a clinical condition characterized by transient impairment of left ventricular contractility, in association with symptoms, increase in indices of myocardial necrosis, as well as electrocardiographic changes, but without a coronary culprit lesion, and often after a significant psychological or physical stress. Albeit very similar to acute coronary syndrome (ACS) as far as presentation and clinical course, Takotsubo syndrome was considered, up until recently, a condition with very favourable long-term prognosis, in view of the frequent complete functional recovery. More recently, several retrospective observational studies as well as registers, unexpectedly called attention to a significant incidence of major adverse cardiovascular events, not limited to the recovery period but also during the long-term follow-up, in a way very similar to the outcome of patients after ACS. Several negative prognostic factors have been isolated, such as physical stress as trigger of the condition, the presence of severe left ventricular dysfunction, and the consequent cardiogenic shock during the acute phase. These factors are able to classify better the patient's prognosis, both in the short- and long-term, and identify patients requiring a more stringent clinical follow-up, considering the higher likelihood of adverse cardiovascular events.
Collapse
Affiliation(s)
| | - Pamela Gallo
- Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy
| | - Silvia Zagnoni
- Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy
| | | |
Collapse
|