351
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Affiliation(s)
| | | | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Via Olgettina, 58, Milan, Italy
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352
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Spoladore R, Boccellino A, Fragasso G, Slavich M, Cappelletti A, Margonato A. An unusual trigger of Tako-Tsubo cardiomyopathy. J Cardiovasc Med (Hagerstown) 2019; 20:619-620. [PMID: 30889079 DOI: 10.2459/jcm.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Massimo Slavich
- Clinical Cardiology Unit, IRCCS San Raffaele University Hospital
| | | | - Alberto Margonato
- Clinical Cardiology Unit, IRCCS San Raffaele University Hospital.,Vita-Salute University, Milan, Italy
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353
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Oindi FM, Sequeira E, Sequeira HR, Mutiso SK. Takotsubo cardiomyopathy in pregnancy: a case report and literature review. BMC Pregnancy Childbirth 2019; 19:89. [PMID: 30866848 PMCID: PMC6416971 DOI: 10.1186/s12884-019-2233-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is rare in pregnancy and is characterized by left ventricular dysfunction with apical ballooning. This transient cardiac dysfunction may affect women of childbearing age in the antepartum, intrapartum or postpartum period. Most patients respond well to medical management with resolution of cardiac dysfunction within weeks. CASE PRESENTATION A 35-year-old female in her second pregnancy presented with severe preeclampsia at 31 weeks of gestation. She subsequently developed severe substernal chest pain and workup showed a stress induced cardiomyopathy prior to her delivery via caesarean section. She had full recovery of her cardiac function by 12 weeks postpartum after medical management. CONCLUSIONS Stress induced cardiomyopathy, though rare, should be considered after acute myocardial infarction has been ruled out in gravid females presenting with acute chest pain. Management should involve a multidisciplinary team. Cardiac function recovery is common within 4 weeks although some patients may require long term heart failure management.
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Affiliation(s)
- Felix Mwembi Oindi
- Department of Obstetrics and Gynecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Evan Sequeira
- Department of Obstetrics and Gynecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
| | - Herman Ryan Sequeira
- Department of Pulmonary and Critical Care Medicine, Norwalk Hospital/Yale University, Norwalk, CT, USA
| | - Steve Kyende Mutiso
- Department of Obstetrics and Gynecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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354
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Joyner MJ. Depression Depresses Vasodilation. Circ Res 2019; 124:465-466. [DOI: 10.1161/circresaha.119.314595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael J. Joyner
- From the Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN 55905
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355
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Desai R, Abbas SA, Goyal H, Durairaj A, Fong HK, Hung O, Sachdeva R, Barac A, Yusuf SW, Kumar G. Frequency of Takotsubo Cardiomyopathy in Adult Patients Receiving Chemotherapy (from a 5-Year Nationwide Inpatient Study). Am J Cardiol 2019; 123:667-673. [PMID: 30538037 DOI: 10.1016/j.amjcard.2018.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 01/30/2023]
Abstract
Takotsubo cardiomyopathy (TC) develops in patients who are under significant emotional, psychosocial, or sudden biochemical stress. However, the added burden of TC on the patients receiving chemotherapy has never been studied. We aimed to describe the additional clinical and economic burden, along with the potential predictors of TC and related in-hospital mortality in patients receiving chemotherapy using the largest inpatient cohort. We identified chemotherapy-related adult hospitalizations using the National Inpatient Sample databases (2010 to 2014). Primary end points were the incidence of TC and the odds of in-hospital mortality. Secondary end points were gender-based incidence differences, length of stay (LOS), hospital charges, and discharge disposition. We identified 1,067,977 chemotherapy-related hospitalizations, of which, 562 hospitalizations revealed TC incidence. Other co-morbidities were also significantly higher in the TC cohort. In unmatched analyses, the LOS (median 17 days vs 5 days) and total hospital charges (median $162,825 vs $46,335) were significantly higher in the TC group. A propensity-matched analysis confirmed the increased healthcare burden. Multivariate analysis revealed over 2-times higher odds (odds ratio [OR] 2.17) of in-hospital mortality in the TC group. Female gender (OR 2.48), and nonelective (OR 2.26), and nonfederal government hospital (OR 2.68) admissions had more than twice the odds of developing TC. An advanced age, Asian race, urban-teaching hospital, and complications such as septicemia, fluid-electrolyte disorders, cardiogenic shock, and respiratory failure independently raised mortality odds in the TC group. In conclusion, we observed an overall increasing nationwide trend in TC incidence in patients receiving chemotherapy, which adds to significantly increased in-hospital mortality, LOS, and healthcare charges.
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Affiliation(s)
- Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | | | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Ashwin Durairaj
- Department of Cardiology, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Hee Kong Fong
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, Missouri
| | - Olivia Hung
- Department of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona
| | - Rajesh Sachdeva
- Department of Cardiology, Morehouse School of Medicine, Atlanta, Georgia; Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ana Barac
- Department of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Syed Wamique Yusuf
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gautam Kumar
- Department of Cardiology, Atlanta VA Medical Center, Decatur, Georgia; Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
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356
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Citro R, Radano I, Parodi G, Di Vece D, Zito C, Novo G, Provenza G, Bellino M, Prota C, Silverio A, Antonini-Canterin F, Rigo F, Vriz O, Galasso G, Bossone E, Salerno-Uriarte J, Piscione F. Long-term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction. Eur J Heart Fail 2019; 21:781-789. [PMID: 30714660 DOI: 10.1002/ejhf.1373] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/18/2018] [Accepted: 11/02/2018] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the long-term outcome of patients with Takotsubo syndrome (TTS) and severely reduced left ventricular ejection fraction (LVEF ≤ 35%) at presentation. METHODS AND RESULTS The study population included 326 patients (mean age 69.5 ± 10.7 years, 28 male) with TTS enrolled in the Takotsubo Italian Network, divided into two groups according to LVEF (≤ 35%, n = 131; > 35%, n = 195), as assessed by transthoracic echocardiography at hospital admission. In-hospital events were recorded in both groups. At long-term follow-up (median 26.5 months, interquartile range 18-33), composite major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, heart failure, and TTS recurrence) and rehospitalization were investigated. Compared to patients with LVEF > 35%, patients with LVEF ≤ 35% were older (71.2 ± 10.8 vs. 68.4 ± 10.6 years; P = 0.026) and experienced more frequently cardiogenic shock (16% vs. 4.6%; P < 0.001), acute heart failure (28.2% vs. 12.8%; P = 0.001), and intra-aortic balloon pump support (11.5% vs. 2.6%; P = 0.001) in the acute phase. At long-term follow-up, higher rates of composite MACE (25.2% vs. 10.8%; P = 0.001) and rehospitalization for cardiac causes (26% vs. 13.3%; P = 0.004) were observed in these patients. LVEF ≤ 35% at admission [hazard ratio (HR) 2.184, 95% confidence interval (CI) 1.231-3.872; P = 0.008] and age (HR 1.041, 95% CI 1.011-1.073; P = 0.006) were independent predictors of MACE. Patients with LVEF ≤ 35% also had a significant lower freedom from composite MACE during long-term follow-up (χ2 = 11.551, P = 0.001). CONCLUSION Left ventricular ejection fraction ≤ 35% at presentation is a key parameter to identify TTS patients at higher risk not only in the acute phase but also at long-term follow-up.
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Affiliation(s)
- Rodolfo Citro
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Ilaria Radano
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Guido Parodi
- Division of Interventional Cardiology, University Hospital of Sassari, Sassari, Italy
| | - Davide Di Vece
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.,Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Concetta Zito
- Division of Cardiology, University of Messina, Messina, Italy
| | - Giuseppina Novo
- Division of Cardiology, University of Palermo, Palermo, Italy
| | - Gennaro Provenza
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Michele Bellino
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Costantina Prota
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Angelo Silverio
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | | | - Fausto Rigo
- Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy
| | - Olga Vriz
- Heart Centre, Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Gennaro Galasso
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | | | - Federico Piscione
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
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357
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Wang D, Li S, Jiang J, Yan J, Zhao C, Wang Y, Ma Y, Zeng H, Guo X, Wang H, Tang J, Zuo H, Lin L, Cui G. Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis. SCIENCE CHINA. LIFE SCIENCES 2019; 62:187-202. [PMID: 30519877 PMCID: PMC7102358 DOI: 10.1007/s11427-018-9385-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 01/02/2023]
Abstract
Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%-70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation, (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.
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Affiliation(s)
- Daowen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.
| | - Sheng Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Jiangang Jiang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Jiangtao Yan
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Yexin Ma
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Xiaomei Guo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Hong Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Jiarong Tang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Houjuan Zuo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Li Lin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Guanglin Cui
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China
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358
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Abstract
BACKGROUND Case series have reported reversible left ventricular dysfunction, also known as stress cardiomyopathy or Takotsubo cardiomyopathy (TCM), in the setting of acute neurological diseases such as subarachnoid hemorrhage. The relative associations between various neurological diseases and Takotsubo remain incompletely understood. METHODS We performed a cross-sectional study of all adults in the National Inpatient Sample, a nationally representative sample of US hospitalizations, from 2006 to 2014. Our exposures of interest were primary diagnoses of acute neurological disease, defined by ICD-9-CM diagnosis codes. Our outcome was a diagnosis of TCM. Binary logistic regression models were used to examine the associations between our pre-specified neurological diagnoses and TCM after adjustment for demographics. RESULTS Among acute neurological diagnoses, the strongest associations were seen with subarachnoid hemorrhage (odds ratio [OR] 11.7; 95% confidence interval [CI] 10.2-13.4), status epilepticus (OR 4.9; 95% CI 3.7-6.3), and seizures (OR 1.3; 95% CI 1.1-1.5). In a sensitivity analysis including secondary diagnoses of acute neurological diagnoses, associations were also seen with transient global amnesia (OR 2.3; 95% CI 1.5-3.6), meningoencephalitis (OR 2.1; 95% CI 1.7-2.5), migraine (OR 1.7; 95% CI 1.5-1.8), intracerebral hemorrhage (OR 1.3; 95% CI 1.1-1.5), and ischemic stroke (OR 1.2; 95% CI 1.1-1.3). In addition, female sex was strongly associated with Takotsubo (OR 5.1; 95% CI 4.9-5.4). CONCLUSION TCM appears to be associated with varying degrees with several acute neurological diseases besides subarachnoid hemorrhage.
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359
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Horie K, Takahashi H, Fujimoto Y, Kaneko D, Yada Y, Matsubara S. Takotsubo syndrome occurring concomitantly with pre-eclampsia: A case report. J Obstet Gynaecol Res 2019; 45:1071-1075. [PMID: 30689260 DOI: 10.1111/jog.13904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/08/2018] [Indexed: 11/28/2022]
Abstract
Takotsubo syndrome (TTS) patients show transient ventricular dysfunction without coronary artery stenosis. We report a pregnant woman with TTS occurring concomitantly with severe pre-eclampsia (PE). A primiparous woman complained of dyspnea at 35 weeks of gestation. She showed severe PE, and cardiac ultrasound identified akinesis of the anterior lower wall. On the same day, emergent cesarean section was performed due to a nonreassuring fetus status, yielding a male infant with an umbilical artery pH of 6.851. Unfortunately, the neonate died of multiple organ failure. Following the delivery, her cardiac function markedly improved, and coronary angiography showed no coronary artery stenosis. Considering the clinical findings, we diagnosed the patient with TTS. Regarding antenatally occurring TTS, only six patients have been reported including the present one. Of the six patients, three had severe PE. Although previous reports on pregnancy-associated TTS described good maternal outcomes, antenatally occurring TTS complicated by severe PE may become critical for fetuses.
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Affiliation(s)
- Kenji Horie
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Yoko Fujimoto
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Daisuke Kaneko
- Department of Cardiology, Jichi Medical University, Tochigi, Japan
| | - Yukari Yada
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
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360
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Cusmà-Piccione M, Longobardo L, Oteri A, Manganaro R, Di Bella G, Carerj S, Khandheria BK, Zito C. Takotsubo cardiomyopathy: queries of the current era. J Cardiovasc Med (Hagerstown) 2019; 19:624-632. [PMID: 30234685 DOI: 10.2459/jcm.0000000000000707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
: Takotsubo cardiomyopathy (TTS), also known as left ventricular apical ballooning syndrome, is an acute, usually reversible heart failure syndrome that most often affects postmenopausal women experiencing an emotionally stressful event. It is characterized by sudden left ventricular dysfunction and wall motion abnormalities involving the apical and mid segments. TTS has been increasingly recognized in recent years, and more and more information about the pathophysiology, diagnosis, and treatment of these patients has been reported. However, much is still unknown. TTS has a wide variety of clinical subtypes and has been described in several clinical contexts. Moreover, TTS simulates ST-segment elevation myocardial infarction and acute myocarditis, and it can be difficult to obtain a certain diagnosis. As a result, clinical decisions are challenging, and many patients currently receive an inappropriate management strategy. The aim of this review is to critically analyze the evidence about this disease reported in the literature, with particular focus on the pathophysiological processes, the diagnostic elements that can help the clinician differentiate it from other diseases, and the best management of these patients.
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Affiliation(s)
- Maurizio Cusmà-Piccione
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Luca Longobardo
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Alessandra Oteri
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Roberta Manganaro
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Gianluca Di Bella
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Scipione Carerj
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin, USA
| | - Concetta Zito
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
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361
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Sun CK, Hung KC. Should surgery proceed or be abandoned after intra-operative anaphylaxis? Anaesthesia 2019; 74:255. [PMID: 30656668 DOI: 10.1111/anae.14554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C-K Sun
- E-Da Hospital, Kaohsiung, Taiwan
| | - K-C Hung
- Chi Mei Medical Center, Tainan, Taiwan
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362
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Frequently Recurrent Takotsubo Syndrome in COPD. Case Rep Cardiol 2019; 2019:6706935. [PMID: 30729044 PMCID: PMC6343172 DOI: 10.1155/2019/6706935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease is common among patients with chronic obstructive pulmonary disease (COPD). Takotsubo syndrome (TTS) is a transient cardiac disorder that, in its typical form, involves left ventricular dysfunction with apical ballooning and mimics acute coronary syndrome (ACS). “Bronchogenic TTS” has been proposed as a specific form of TTS (during severe acute dyspnea in asthma or COPD) with atypical presentation. Recurrent TTS in COPD seems to be exceptionally rare since only a handful of clinical cases have previously been reported in the literature. Here, we present a unique case of a frequently recurrent TTS during COPD exacerbation in a 70-year-old woman, with at least 4 different episodes of TTS within 5 years. This case report exemplifies the difficulties of the diagnosis of TTS at the onset of acute COPD exacerbation. Potential pathophysiological mechanisms and therapeutic strategies are also briefly discussed.
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363
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Pelliccia F, Pasceri V, Patti G, Tanzilli G, Speciale G, Gaudio C, Camici PG. Long-Term Prognosis and Outcome Predictors in Takotsubo Syndrome: A Systematic Review and Meta-Regression Study. JACC-HEART FAILURE 2019; 7:143-154. [PMID: 30611720 DOI: 10.1016/j.jchf.2018.10.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study assessed the incidence of long-term adverse outcomes in patients with Takotsubo syndrome (TTS). BACKGROUND The long-term prognosis of TTS is controversial. It is also unclear whether presenting characteristics are associated with the subsequent long-term prognosis. METHODS We searched the PubMed, Embase, and Cochrane databases and reviewed cited references up to March 31, 2018, to identify studies with >6 months of follow-up data. RESULTS Overall, we selected 54 studies that included a total of 4,679 patients (4,077 women and 602 men). Death during admission occurred in 112 patients (2.4%), yielding a frequency of 1.8% (95% confidence interval [CI]: 1.2% to 2.5%), with significant heterogeneity (I2 = 78%; p < 0.001). During a median follow-up of 28 months (interquartile range: 23 to 34 months), 464 of 4,567 patients who the survived index admission died (103 because of cardiac causes and 351 because of noncardiac issues). The annual rate of total mortality was 3.5% (95% CI: 2.6% to 4.5%), with significant heterogeneity (I2 = 74%; p < 0.001). Overall, 104 cases of recurrence of TTS were detected during follow-up, yielding a 1.0% annual rate of recurrence (95% CI: 0.7% to 1.3%), without significant heterogeneity (I2 = 39%; p = 0.898). Meta-regression analysis showed that long-term total mortality in each study was significantly associated with older age (p = 0.05), physical stressor (p = 0.0001), and the atypical ballooning form of TTS (p = 0.009). CONCLUSIONS Our update analysis of patients discharged alive after TTS showed that long-term rates of overall mortality and recurrence were not trivial, and that some presenting features (older age, physical stressor, and atypical ballooning) were significantly associated with an unfavorable long-term prognosis.
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Affiliation(s)
| | - Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Giuseppe Patti
- Department of Cardiology, University of L'Aquila, L'Aquila, Italy
| | - Gaetano Tanzilli
- Department of Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Giulio Speciale
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Gaudio
- Department of Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Paolo G Camici
- Department of Cardiology, Vita e Salute University and San Raffaele Hospital, Milan, Italy
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364
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Griebe M, Ebert A, Nees F, Katic K, Gerber B, Szabo K. Enhanced cortisol secretion in acute transient global amnesia. Psychoneuroendocrinology 2019; 99:72-79. [PMID: 30193207 DOI: 10.1016/j.psyneuen.2018.08.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Stress-related transient inhibition of memory formation in the hippocampus has been hypothesized as one of the underlying pathomechanisms of transient global amnesia (TGA). TGA episodes, during which patients cannot encode and recall new information (anterograde amnesia affecting episodic long-term memory), are frequently preceded by a psychologically or physically stressful event. METHODS We measured salivary cortisol during acute TGA in 14 patients, as well as cortisol day-profiles and the effect of experimental exposure to stress (using the socially evaluated cold pressor test) on cortisol levels during the subacute phase. We assessed psychiatric comorbidity as well as depression, trait anxiety and chronic stress. These findings were compared with data of 20 healthy controls. FINDINGS Nine patients reported a precipitating stressor and all 14 developed typical hippocampal lesions on follow-up MRI. During TGA, salivary cortisol levels were more than 3-fold higher compared to time-matched day levels. While there was no difference in mean cortisol levels of the diurnal rhythm, we found a significant interaction between groups during experimental stress exposure (p = 0.049) with the TGA group revealing a higher cortisol increase. The TGA group reported higher levels of depressive symptomatology (CES-D) and higher scores of chronic stress (TICS) compared with the control group and there was a significant correlation between cortisol increase during TGA and the results of self-rating according to the CES-D (r = 0.615; p = 0.004), as well as to the STAI (r = 0.702; p = 0.001). CONCLUSION Our findings of enhanced secretion of cortisol in acute TGA patients correlating with symptoms of depression and anxiety and a persisting hyperreactivity to experimental stress in the subacute phase support the hypothesis that stress might be significant for the pathogenesis of TGA.
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Affiliation(s)
- Martin Griebe
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Ebert
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Katic
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Benjamin Gerber
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Kristina Szabo
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University, Mannheim, Germany.
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365
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Rodríguez M, Rzechorzek W, Herzog E, Lüscher TF. Misconceptions and Facts About Takotsubo Syndrome. Am J Med 2019; 132:25-31. [PMID: 30077501 DOI: 10.1016/j.amjmed.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 12/13/2022]
Abstract
Takotsubo syndrome, initially described in the 1990s by Sato, has been increasingly recognized around the world. Pathophysiology is directed towards central role of catecholamine surge , but other aspects like microvascular endothelial dysfunction and vasospasm have also been described. Dyspnea and chest pain are most common manifestations, but syncope can also be seen. Right ventricular involvement is not uncommon, and left ventricular outflow tract obstruction is a frequent complication. EKG can differentiate between Takotsubo syndrome and myocardial infarction, but coronary angiography should always be performed. Although treatment has been angiotensin converting enzyme inhibitors and betablockers, recent evidence from nonrandomized studies shows no benefit on betablockers regarding outcomes.
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Affiliation(s)
| | | | - Eyal Herzog
- Division of Cardiology, Department of Medicine, Cardiovascular Intensive Care Unit and Echocardiography Laboratory, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart at Mount Sinai St. Luke's-Mount Sinai West Hospital, New York, NY
| | - Thomas F Lüscher
- Director of Education, Research and Development, Royal Brompton & Harefield Hospital Trust and Imperial College London, UK
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367
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Mid-Left Ventricular Ballooning Variant Takotsubo Syndrome Induced by Treadmill Exercise Stress Testing. Case Rep Cardiol 2018; 2018:5282747. [PMID: 30581631 PMCID: PMC6276522 DOI: 10.1155/2018/5282747] [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: 07/10/2018] [Accepted: 10/30/2018] [Indexed: 11/18/2022] Open
Abstract
Stress-induced cardiomyopathy, also known as takotsubo cardiomyopathy, presents similar to a myocardial infarction after a physical or emotional stressor but without any evidence of obstructive coronary artery disease. Different patterns of myocardial involvement and several triggering events have been reported, but classically this condition is characterized by a stress-induced transient left ventricular apical systolic dysfunction. We describe a case of treadmill exercise stress testing-triggered variant of takotsubo cardiomyopathy with mid-left ventricular hypokinesis.
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368
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Lamata P, Uhlig J, Kowallick JT, Raaz U, Villa A, Lotz J, Hasenfuß G, Thiele H, Eitel I, Schuster A. Temporal changes within mechanical dyssynchrony and rotational mechanics in Takotsubo syndrome: A cardiovascular magnetic resonance imaging study. Int J Cardiol 2018; 273:256-262. [PMID: 30195843 PMCID: PMC6236127 DOI: 10.1016/j.ijcard.2018.04.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The pathophysiological significance of dyssynchrony and rotation in Takotsubo syndrome (TTS) is unknown. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS. METHODS This multicenter study included 152 TTS patients undergoing CMR (mean 3 days after symptom onset). Apical, midventricular and basal short axis views were analysed in a core-laboratory. Systolic torsion, diastolic recoil and dyssynchrony expressed as circumferential and radial uniformity ratio estimates (CURE and RURE: 0 to 1; 1 = perfect synchrony) were compared to a matched control group (n = 21). Follow-up CMR (n = 20 patients; mean 62 days, SD 7.2) and general follow-up (n = 136; mean 3.3 years, SD 2.4) were performed. RESULTS CURE was initially reduced compared to controls (p = 0.001) and recovered at follow-up (p < 0.001) as opposed to RURE (p = 0.116 and p = 0.179). CURE and RURE discriminated between ballooning patterns (p = 0.001 and p = 0.045). Recoil was generally impaired during the acute phase (p = 0.015), torsion only in highly dyssynchronous patients (p = 0.024). Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality. The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p < 0.01), greater reduction of left ventricular function (p < 0.001) and a strong trend towards increased mortality (p = 0.074). CONCLUSION Transient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Johannes Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Uwe Raaz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Joachim Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany; Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia.
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Shimizu M, Fujii H, Suzuki M, Yamawake N, Nishizaki M. PR deviation as a risk marker for cardiac events in patients with Takotsubo syndrome. Pacing Clin Electrophysiol 2018; 41:1652-1659. [DOI: 10.1111/pace.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Masato Shimizu
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
| | - Hiroyuki Fujii
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
| | - Makoto Suzuki
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
| | - Noriyoshi Yamawake
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
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Scheitz JF, Nolte CH, Doehner W, Hachinski V, Endres M. Stroke–heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol 2018; 17:1109-1120. [DOI: 10.1016/s1474-4422(18)30336-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/14/2018] [Accepted: 09/05/2018] [Indexed: 01/01/2023]
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371
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Taqueti VR, Di Carli MF. Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:2625-2641. [PMID: 30466521 PMCID: PMC6296779 DOI: 10.1016/j.jacc.2018.09.042] [Citation(s) in RCA: 376] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/06/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022]
Abstract
Coronary microvascular disease (CMD) refers to the subset of disorders affecting the structure and function of the coronary microcirculation, is prevalent in patients across a broad spectrum of cardiovascular risk factors, and is associated with an increased risk of adverse events. Contemporary evidence supports that most patients with CMD also have macrovessel atherosclerosis, which has important implications for their prognosis and management. In this state-of-the-art review, the authors summarize the pathophysiology of CMD, provide an update of diagnostic testing strategies, and classify CMD into phenotypes according to severity and coexistence with atherosclerosis. They examine emerging data highlighting the significance of CMD in specific populations, including obesity and insulin resistance, myocardial injury and heart failure with preserved ejection fraction, and nonobstructive and obstructive coronary artery disease. Finally, they discuss the role of CMD as a potential target for novel interventions beyond conventional approaches, representing a new frontier in cardiovascular disease reduction.
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Affiliation(s)
- Viviany R Taqueti
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/VTaqMD
| | - Marcelo F Di Carli
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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372
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Dias A, Núñez Gil IJ, Santoro F, Madias JE, Pelliccia F, Brunetti ND, Salmoirago-Blotcher E, Sharkey SW, Eitel I, Akashi YJ, El-Battrawy I, Franco E, Akin I, Jaguszewski M, Dawson D, Figueredo VM, Napp LC, Christensen TE, Hebert K, Ben-Dor I, Ozaki Y, García-Garcia HM, Kajita AH, Akasaka T, Kurisu S, Lerman A, Waksman R. Takotsubo syndrome: State-of-the-art review by an expert panel - Part 1. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:70-79. [PMID: 30528096 DOI: 10.1016/j.carrev.2018.11.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/30/2022]
Abstract
Takotsubo syndrome (TTS) is an acute cardiac condition independent of epicardial coronary obstruction that mimics acute coronary syndrome and is characterized by acute heart failure with reversible ventricular motion abnormalities. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Experts in the field provide a thorough and detailed review of this syndrome. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. In part 1 of this two-part manuscript, we discuss how TTS came to be known, several patterns and forms it can take in patients, epidemiology and pathophysiology of the syndrome, and clinical presentation.
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Affiliation(s)
- Andre Dias
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America
| | - Ivan J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Francesco Santoro
- Department of Medical & Surgery Sciences, University of Foggia, Foggia, Italy
| | - John E Madias
- Icahn School of Medicine at Mount Sinai/Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America
| | | | | | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Scott W Sharkey
- Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | - Ingo Eitel
- Cardiology, Angiology, Intensive Care Medicine, University Lübeck, Schleswig-Holstein, Germany
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ibrahim El-Battrawy
- Department of Internal Medicine, University Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Germany
| | - Emiliana Franco
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America
| | - Ibrahim Akin
- Department of Internal Medicine, University Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Germany
| | | | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Vincent M Figueredo
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Kathy Hebert
- GE Healthcare, Miami, FL, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Yuichi Ozaki
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Héctor M García-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Alexandre H Kajita
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Montone RA, Niccoli G, Lanza GA, Crea F. Reconsidering aetiologies of type 2 myocardial infarction: when a classification is a simplistic approach for a complex reality. Eur Heart J 2018; 39:3826. [PMID: 30203043 DOI: 10.1093/eurheartj/ehy537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
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374
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Talebi S, Azhir A, Argulian E. Stress cardiomyopathy: Provoked chaotic T-wave lability. Ann Noninvasive Electrocardiol 2018; 23:e12544. [DOI: 10.1111/anec.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/12/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Soheila Talebi
- Cardiology Department; Mount-Sinai St. Luke's Hospital; New York NY USA
| | - Alaleh Azhir
- Department of Biomedical Engineering; Johns Hopkins University; Baltimore MD USA
| | - Edgar Argulian
- Cardiology Department; Mount-Sinai St. Luke's Hospital; New York NY USA
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375
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Binaghi G, Congia D, Cossa S, Ganga R, Giardina G, Matta G, Merella W, Melis M, Pasqualucci D, Serra E, Porcu M. Seizures and recurrence of Takotsubo syndrome: One clinical presentation and trigger, but two different anatomical variants in the same patient. A case to meditate on. Seizure 2018; 63:37-39. [PMID: 30396042 DOI: 10.1016/j.seizure.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- G Binaghi
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
| | - D Congia
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - S Cossa
- Department of Radiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - R Ganga
- Department of Interne Medicine, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - G Giardina
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - G Matta
- Department of Radiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - W Merella
- Department of Neurology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - M Melis
- Department of Neurology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - D Pasqualucci
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - E Serra
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - M Porcu
- Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
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376
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Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, Moeller FG, Berrocal D, Abbate A. Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:1955-1971. [PMID: 30309474 PMCID: PMC7058348 DOI: 10.1016/j.jacc.2018.07.072] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
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Affiliation(s)
- Horacio Medina de Chazal
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lori Keyser-Marcus
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Liangsuo Ma
- Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - F Gerard Moeller
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia; Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Berrocal
- Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.
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377
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Rellini G, Piazza R, Loiudice E, Cassin M, Bernardi G, Pavan D, Cervesato E, Nicolosi GL. Heterogeneity of clinical presentation in Tako-Tsubo syndromes: the prevalence of normal segmental wall motion and normal ECG pattern. J Cardiovasc Med (Hagerstown) 2018; 19:717-724. [PMID: 30320724 DOI: 10.2459/jcm.0000000000000729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to report the heterogeneity of clinical presentation in Tako-Tsubo syndrome (TTS), including a significant prevalence of normal ECG and echocardiographic patterns in a series of consecutive patients from a single center. METHODS AND RESULTS From our database we selected a total of 168 cases of TTS. A total of 140 of these (Group A); 14 men (10%), mean age 60.3 years, range 39-87; 126 women (90%), mean age 66.1 years, range 43-93; matched the following reported criteria: typical stenocardic pain immediately following an emotional acute stress, or acute medical or surgical event within the preceding 12 h; acute rise and fall of troponin release; absence of significant coronary disease at coronary angiography. ECG findings at presentation ranged from T wave abnormalities (41 cases, 29.3%) to ST elevation (52 cases, 37.1%) and ST depression (11 cases, 7.9%), whereas in 36 cases (25.7%) the ECG was normal. Echocardiography at presentation showed akinesia of the total apical or medium-apical segments in 74 patients (53%), whereas it showed akinesia of left ventricular wall segments in other locations in 30 patients (21%) and even normal regional wall motion and thickening in 36 patients (26%). We described also a series of 13 female patients (mean age 70.2 years; age range 45-85 years) (Group B) who did not complain of chest pain at presentation, but showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography. Finally we selected 15 female patients (mean age 69.3 years; age range 49-89 years) (Group C) who formally did not report acute stress immediately preceding their presentation to the hospital for chest pain. They showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography and only one case of normal ECG pattern at presentation. CONCLUSION In this series of acute TTS, a wide variability of ECG and echocardiographic patterns are observed, ranging from ST elevation with coexisting segmental wall motion abnormalities of the typical TTS to a clinical presentation characterized by normal ECG and normal segmental wall motion pattern.
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Affiliation(s)
| | | | | | | | | | | | | | - Gian L Nicolosi
- Cardiology Department, ARC, Ospedale Civile.,Cardiology Clinic, Policlinico San Giorgio, Pordenone, Italy
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378
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Chow LTC, Chow MBCY. Coronary artery myointimal dysplasia in patients with pheochromocytoma-possible causal relationship: pathophysiology and clinical implication with reference to Takotsubo cardiomyopathy and spontaneous coronary dissection. Cardiovasc Pathol 2018; 37:45-53. [PMID: 30342321 DOI: 10.1016/j.carpath.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/25/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
Myocardial damage in catecholamine cardiomyopathy, characterized by patchy myocyte necrosis commonly with contraction band appearances, interstitial fibrosis, and varying degrees of inflammatory infiltrates, has been well documented. However, coronary vascular pathology has not been recognized. Autopsy of a 43-year-old housewife who died of acute apical anteroseptal myocardial infarction revealed the incidental finding of a left adrenal pheochromocytoma. The epicardial and intramyocardial median- and small-sized coronary arteries exhibited myointimal dysplasia in the form of fibroblastic proliferation in the intima and media, resulting in thickened dysplastic vessels with marked luminal narrowing, occasionally leading to near-total occlusion. The distal left anterior descending artery showed features of recanalization after prior embolic occlusion. The density and severity of vascular involvement revealed a decreasing gradient from apical to basal region, mainly affecting the left ventricle, but the proximal coronary arteries were minimally affected. Myointimal dysplasia was not seen in control cases of hypertensive heart, and despite its presence in hearts with hypertrophic cardiomyopathy, it lacked the distinctive pattern of distribution and the epicardial vessels are uninvolved. Myointimal dysplasia probably results from reactive fibroplasia in response to the vasoconstrictive effect of circulating or local neurosecretory catecholamine and appears crucial in the pathogenesis of various types of catecholamine cardiomyopathy, including Takotsubo or stress cardiomyopathy. Together with the direct catecholamine cardiotoxicity, they result in diffuse microscopic ischemic necrosis and fibrosis. Depending on the type of catecholamine overproduction and action, together with the characteristic anatomic distribution and density of the various types of adrenergic receptors in the ventricles, different regions of the heart are variously affected so that different patterns of ventricular dysfunction are produced, with the subsequent angiographic appearances ranging from apical through midventricular to basal ballooning. Additional complications from the myointimal dysplasia include spontaneous coronary dissection, acute myocardial infarction, and superimposed thrombus formation in the dysplastic vessels and dyskinetic ventricle, with the risk of further damage from embolic events.
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379
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El-Battrawy I, Gietzen T, Ansari U, Behnes M, Lang S, Zhou X, Borggrefe M, Akin I. Short-term and long-term incidence of stroke in Takotsubo syndrome. ESC Heart Fail 2018; 5:1191-1194. [PMID: 30299590 PMCID: PMC6301155 DOI: 10.1002/ehf2.12357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/10/2018] [Accepted: 08/30/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- 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, Germany
| | - Thorsten Gietzen
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- 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, Germany
| | - Xiaobo Zhou
- 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, 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, 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, Germany
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380
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Takotsubo Cardiomyopathy Associated with Polycythemia Vera. Case Rep Cardiol 2018; 2018:4542925. [PMID: 30327735 PMCID: PMC6171202 DOI: 10.1155/2018/4542925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/26/2018] [Indexed: 11/18/2022] Open
Abstract
Takotsubo cardiomyopathy is characterized by transient apical ballooning with preserved basal ventricular function triggered by physical or emotional stressors. We present a case of a 75-year-old man referred to our facility for the management of acute myocardial infarction later diagnosed as takotsubo cardiomyopathy. We believe platelet-mediated adrenaline release from massive thrombocytosis might have been the precipitating factor for the pathogenesis of takotsubo cardiomyopathy.
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381
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Mansencal N, Dubourg O. [What is the risk of Takotsubo in women?]. Presse Med 2018; 47:817-822. [PMID: 30213471 DOI: 10.1016/j.lpm.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy preferentially affects postmenopausal women (# 90%). Takotsubo cardiomyopathy mimics an acute coronary syndrome and is defined as a transient left ventricular systolic dysfunction. Diagnosis is based on the criteria of the Mayo Clinic. Stress is found in around 80% of cases: physical stress, emotional stress, medical stress. Physical stress is less found in women. Incidence of Takotsubo cardiomyopathy is 54.9/1,000,000 inhabitants in women versus only 3.6/1,000,000 inhabitants in men. Diagnosis is based on electrocardiogram, biomarkers, echocardiography, coronary angiography and left ventricular angiography, and cardiac magnetic imaging. The complete recovery of left ventricular systolic function must be assessed, allowing to confirm the diagnosis of Takotsubo cardiomyopathy.
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Affiliation(s)
- Nicolas Mansencal
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Ambroise-Paré, université de Versailles-Saint Quentin (UVSQ), centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, pôle V, 92100 Boulogne, France; Inserm U-1018, centre de recherche en épidémiologie et santé des populations, équipe 5 (EpReC, épidémiologie rénale et cardiovasculaire), 94800 Villejuif, France.
| | - Olivier Dubourg
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Ambroise-Paré, université de Versailles-Saint Quentin (UVSQ), centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, pôle V, 92100 Boulogne, France; Inserm U-1018, centre de recherche en épidémiologie et santé des populations, équipe 5 (EpReC, épidémiologie rénale et cardiovasculaire), 94800 Villejuif, France
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382
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Mamaladze T. Takotsubo Syndrome - Case Review. J Insur Med 2018; 47:176-183. [PMID: 30192722 DOI: 10.17849/insm-47-03-176-183.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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383
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Coronary artery disease in post-menopausal women: are there appropriate means of assessment? Clin Sci (Lond) 2018; 132:1937-1952. [DOI: 10.1042/cs20180067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023]
Abstract
The recognition of sex differences in cardiovascular disease, particularly the manifestations of coronary artery disease (CAD) in post-menopausal women, has introduced new challenges in not only understanding disease mechanisms but also identifying appropriate clinical means of assessing the efficacy of management strategies. For example, the majority of treatment algorithms for CAD are derived from the study of males, focus on epicardial stenoses, and inadequately account for the small intramyocardial vessel disease in women. However, newer investigational modalities, including stress perfusion cardiac magnetic resonance imaging and positron emission tomography are providing enhanced diagnostic accuracy and prognostication for women with microvascular disease. Moreover, these investigations may soon be complemented by simpler screening tools such as retinal vasculature imaging, as well as novel biomarkers (e.g. heat shock protein 27). Hence, it is vital that robust, sex-specific cardiovascular imaging modalities and biomarkers continue to be developed and are incorporated into practice guidelines that are used to manage women with CAD, as well as gauge the efficacy of any new treatment modalities. This review provides an overview of some of the sex differences in CAD and highlights emerging advances in the investigation of CAD in post-menopausal women.
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384
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Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries. Am J Med 2018; 131:1118-1124. [PMID: 29859805 DOI: 10.1016/j.amjmed.2018.04.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries. METHODS We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event. RESULTS Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P = .006) and similar to that of patients with coronary heart disease (30%; P = .954). Using the HADS anxiety subscale, we found that the prevalence of anxiety in patients with myocardial infarction with non-obstructive coronary arteries (27%) was higher than in healthy controls (9%; P = .002) and similar to that of patients with coronary heart disease (21%; P = .409). Using the HADS depression subscale, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (17%) was higher than in healthy controls (4%; P = .003) and similar to that of patients with coronary heart disease (13%; P = .466). Patients with myocardial infarction with non-obstructive coronary arteries and takotsubo syndrome scored higher on the HADS anxiety subscale than those without (P = .028). CONCLUSIONS This is the first study on the mental health of patients with myocardial infarction with non-obstructive coronary arteries to show that prevalence rates of anxiety and depression are similar to those in patients with coronary heart disease.
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385
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Moderato L, Lazzeroni D, Coruzzi P. Letter by Moderato et al Regarding Article, "Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy". Circulation 2018; 138:960-961. [PMID: 30354452 DOI: 10.1161/circulationaha.117.033253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luca Moderato
- Department of Medicine and Surgery, University of Parma, Italy (L.M.)
| | | | - Paolo Coruzzi
- Department of Medicine and Surgery, University of Parma, Italy (P.C.)
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386
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Madias JE. Brain-heart pathway to injury in takotsubo syndrome. Clin Cardiol 2018; 41:883. [DOI: 10.1002/clc.22970] [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: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- John E. Madias
- Icahn School of Medicine at Mount Sinai; New York New York
- Division of Cardiology; Elmhurst Hospital Center; Elmhurst New York
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387
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Pelliccia F, Sinagra G, Elliott P, Parodi G, Basso C, Camici PG. Takotsubo: One, no one and one hundred thousand diseases. Int J Cardiol 2018; 261:35. [DOI: 10.1016/j.ijcard.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 11/30/2022]
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388
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Liu VY, Agha AM, Lopez-Mattei J, Palaskas N, Kim P, Thompson K, Mouhayar E, Marmagkiolis K, Hassan SA, Karimzad K, Iliescu CA. Interventional Cardio-Oncology: Adding a New Dimension to the Cardio-Oncology Field. Front Cardiovasc Med 2018; 5:48. [PMID: 29868614 PMCID: PMC5967297 DOI: 10.3389/fcvm.2018.00048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/01/2018] [Indexed: 01/10/2023] Open
Abstract
The management of cardiovascular disease in patients with active cancer presents a unique challenge in interventional cardiology. Cancer patients often suffer from significant comorbidities such as thrombocytopenia and coagulopathic and/or hypercoagulable states, which complicates invasive evaluation and can specifically be associated with an increased risk for vascular access complications. Furthermore, anticancer therapies cause injury to the vascular endothelium as well as the myocardium. Meanwhile, improvements in diagnosis and treatment of various cancers have contributed to an increase in overall survival rates in cancer patients. Proper management of this patient population is unclear, as cancer patients are largely excluded from randomized clinical trials on percutaneous coronary intervention (PCI) and national PCI registries. In this review, we will discuss the role of different safety measures that can be applied prior to and during these invasive cardiovascular procedures as well as the role of intravascular imaging techniques in managing these high risk patients.
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Affiliation(s)
- Victor Y Liu
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ali M Agha
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kara Thompson
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elie Mouhayar
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Saamir A Hassan
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kaveh Karimzad
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar A Iliescu
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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389
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Kawano H, Yamasa T, Arakawa S, Matsumoto Y, Sato O, Maemura K. We need more useful surrogate markers for the efficacy of beta-blockers for the treatment of Takotsubo cardiomyopathy. Geriatr Gerontol Int 2018; 18:817-818. [DOI: 10.1111/ggi.13319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroaki Kawano
- Department of Cardiovascular Medicine; Nagasaki University Hospital; Nagasaki Japan
- Department of Cardiology; Nagasaki Rosai Hospital; Sasebo Japan
| | | | - Shuji Arakawa
- Department of Cardiovascular Medicine; Nagasaki University Hospital; Nagasaki Japan
- Department of Cardiology; Nagasaki Rosai Hospital; Sasebo Japan
| | - Yuji Matsumoto
- Department of Cardiology; Nagasaki Rosai Hospital; Sasebo Japan
- Department of Cardiology; Sasebo Municipal General Hospital; Sasebo Japan
| | - Osami Sato
- Department of Cardiology; Nagasaki Rosai Hospital; Sasebo Japan
- Department of Cardiology; Saint Nova Hospital; Saikai Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine; Nagasaki University Hospital; Nagasaki Japan
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390
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Yalta K, Yilmaztepe M, Zorkun C. Left Ventricular Dysfunction in the Setting of Takotsubo Cardiomyopathy: A Review of Clinical Patterns and Practical Implications. Card Fail Rev 2018; 4:14-20. [PMID: 29892470 PMCID: PMC5971666 DOI: 10.15420/cfr.2018:24:2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is primarily regarded as a form of acute and transient myocardial disease with a variety of characteristic wall-motion abnormalities. Importantly, a significant portion of TTC cases generally present with variable degrees of acute left ventricular (LV) dysfunction with or without clinical HF. On the other hand, LV dysfunction in the setting of TTC has been universally and exclusively considered as a synonym for systolic dysfunction, potentially overlooking other forms of myocardial pathologies, including transient diastolic dysfunction, in this setting. More interestingly, recent observations suggest that TTC, despite its macroscopic recovery, may not always manifest as a fully reversible phenomenon, suggesting persistence of microscopic changes at the cellular level to some degree. In clinical practice, these residual changes might largely account for the evolution of certain pathologies, including persistent diastolic dysfunction and subclinical LV dysfunction with variable symptomatology (particularly those arising during high levels of myocardial workload, including exercise, etc.) among TTC survivors. Within this context, the present review aims to highlight various clinical patterns and implications of LV dysfunction in the setting of TTC, and to provide basic information regarding morphological and mechanistic characteristics of wall-motion abnormalities in this setting.
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Affiliation(s)
- Kenan Yalta
- Trakya University, Cardiology Department Edirne, Turkey
| | | | - Cafer Zorkun
- Trakya University, Cardiology Department Edirne, Turkey
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391
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MR imaging of catecholamine-mediated myocarditis complicated by left ventricular thrombus. Diagn Interv Imaging 2018; 99:337-338. [DOI: 10.1016/j.diii.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 12/23/2022]
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392
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Vilela E, Silva M, Guerreiro C, Caeiro D, Fonseca M, Primo J, Braga P, Gama V. Takotsubo syndrome and coronary vasospasm: Two faces of the same coin? Indian Heart J 2018; 70:455-458. [PMID: 29961469 PMCID: PMC6034106 DOI: 10.1016/j.ihj.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- Eduardo Vilela
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | - Marisa Silva
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Marlene Fonseca
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - João Primo
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
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393
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Fernández-Ferreira R, Morales-Victorino N, Herrera-Gomar M, Alcántara-Meléndez MA, García-Graullera M, González-Chon O, García-López SM. Stress induced cardiomyopathy due to a Mexican earthquake. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:219-224. [PMID: 29606490 DOI: 10.1016/j.acmx.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022] Open
Abstract
Takotsubo Cardiomyopathy mainly occurs in postmenopausal women, with or without cardiovascular disease, and is commonly associated with emotional or physical stress. After nearly 27 years of extensive efforts towards a better understanding of this disorder, current knowledge remains limited. Many people suffer post-traumatic stress, and this situation can be associated to stress cardiomyopathy. The case is presented of a female who suffers stress associated with the earthquake of 19 September 2017 in Mexico City, and arrived in the Emergency Department in cardiogenic shock.
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Affiliation(s)
| | | | - Magali Herrera-Gomar
- Coronary Care Unit Department, Médica Sur Clinic & Foundation, México City, Mexico
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394
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Wellens HJ. Giant T-wave changes after termination of atrial fibrillation. Heart Rhythm 2018; 15:629-630. [PMID: 29605016 DOI: 10.1016/j.hrthm.2017.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute, Maastricht, The Netherlands.
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395
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Marafioti V, Turri G, Carbone V, Monaco S. Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil. Clin Cardiol 2018; 41:551-555. [PMID: 29663451 PMCID: PMC6490097 DOI: 10.1002/clc.22910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/16/2022] Open
Abstract
The Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis.
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Affiliation(s)
- Vincenzo Marafioti
- Cardiovascular and Thoracic DepartmentUniversity Hospital of VeronaVeronaItaly
| | - Giulia Turri
- Department of Neurological and Movement SciencesUniversity Hospital of VeronaVeronaItaly
| | - Vincenzo Carbone
- Department of Medicine and PharmacologyUniversity Hospital of MessinaMessinaItaly
| | - Salvatore Monaco
- Department of Neurological and Movement SciencesUniversity Hospital of VeronaVeronaItaly
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396
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Ranieri M, Finsterer J, Bedini G, Parati EA, Bersano A. Takotsubo Syndrome: Clinical Features, Pathogenesis, Treatment, and Relationship with Cerebrovascular Diseases. Curr Neurol Neurosci Rep 2018; 18:20. [PMID: 29569186 DOI: 10.1007/s11910-018-0833-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review paper aims to provide a complete and updated overview on the clinical and pathophysiological aspects of Takotsubo syndrome (TTS), including prognosis, therapy, and the association with cerebrovascular conditions. RECENT FINDINGS TTS is an increasingly recognized non-ischemic cardiomyopathy characterized by sudden, temporary weakening of the myocardium, of which the pathogenesis is unknown. Although pathogenesis of TTS remains unclear, a complex interaction between catecholamine-mediated stimulation, myocardial stunning, and subsequent stress-related myocardial dysfunction seems to be the main pathophysiological mechanism. Stroke is linked to TTS by a dual relationship since it may induce TTS by catecholamine release even if TTS itself also may be complicated by left ventricular thrombi leading to stroke. Given its possible complications, including the association with neurological diseases, both cardiologist and neurologists should be aware about TTS in order to diagnose it promptly and to initiate appropriate therapeutic measures.
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Affiliation(s)
- M Ranieri
- Cerebrovascular Disease Unit, IRCCS Foundation "C. Besta", Neurological Institute, Milan, Italy
| | - J Finsterer
- Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - G Bedini
- Laboratory of Cellular Neurobiology, IRCCS Foundation "C. Besta", Neurological Institute, Milan, Italy
| | - E A Parati
- Cerebrovascular Disease Unit, IRCCS Foundation "C. Besta", Neurological Institute, Milan, Italy
| | - A Bersano
- Cerebrovascular Disease Unit, IRCCS Foundation "C. Besta", Neurological Institute, Milan, Italy. .,Fondazione IRCCS Istituto Neurologico "Carlo Besta", Via Celoria 11, 20133, Milan, Italy.
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397
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Madias JE. Diabetes mellitus prevalence in patients with takotsubo syndrome: the case of the brain-heart disconnect. Heart Lung 2018; 47:222-225. [PMID: 29573816 DOI: 10.1016/j.hrtlng.2018.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyperactive autonomic nervous system (ANS) is among the postulated pathophysiologic mechanisms of takotsubo syndrome (TTS). Diabetes mellitus (DM) with its associated ANS peripheral neuropathy could exert a "protective" influence for the emergence of TTS. METHODS A patient-based meta-analysis of the data obtained from all patients presented individually was carried out, focusing on age, gender, and history of hypertension (HTN) and DM. RESULTS The prevalences of HTN and DM for all 2,342 patients, aged 61.1 ± 17.3, 85.1% female, were 37.4% and 9.5%, for patients ≥ 60 years old were 45.8% and 11.7%, and for patients ≥65 years old were 48.2% and 12.3%, correspondingly. The prevalence of DM in patients with TTS is less than half of the world's and USA's elderly populations. CONCLUSIONS Prevalence of DM in patients with TTS is lower than in the general population, suggesting that DM, may have a "protective" effect for the emergence of TTS.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY.
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Pelliccia F, Gaudio C. The elusive link between sex hormone levels and Takotsubo syndrome. Int J Cardiol 2018; 250:58-59. [PMID: 29169761 DOI: 10.1016/j.ijcard.2017.10.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Carlo Gaudio
- Department of Cardiovascular Sciences, Sapienza University, Rome, Italy
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399
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de Bliek EC. ST elevation: Differential diagnosis and caveats. A comprehensive review to help distinguish ST elevation myocardial infarction from nonischemic etiologies of ST elevation. Turk J Emerg Med 2018; 18:1-10. [PMID: 29942875 PMCID: PMC6009807 DOI: 10.1016/j.tjem.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 12/22/2022] Open
Abstract
Prompt diagnosis of acute ST segment elevation myocardial infarction (STEMI) by the initial ECG is important in order to perform an urgent coronary angiography as soon as possible and achieve successful revascularization, therewith improving mortality and morbidity. Several diseases and conditions can mimic an acute myocardial infarction (AMI) but may not benefit from a (percutaneous) revascularization strategy. This narrative clinical review will discuss the ECG features of some of the causes of non-ischemic ST segment elevation to facilitate early recognition, prevent wrongful diagnosis and improve treatment outcomes.
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400
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Indolfi C, Spaccarotella C, Yasuda M, De Rosa S. The outlook of prognostic indicators for the Takotsubo syndrome. Int J Cardiol 2018; 255:158-159. [DOI: 10.1016/j.ijcard.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
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