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Krouma M, Aboudou Soilihi A, Pech-Gourg G, Arnaud S, Fadoua EL, Caruselli M, Scavarda D. Takotsubo syndrome linked to paroxysmal sympathetic hyperactivity as a postoperative complication after brain tumor removal: a case report and literature review. Childs Nerv Syst 2024; 40:2573-2579. [PMID: 38383868 DOI: 10.1007/s00381-024-06316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
Paroxysmal sympathetic hyperactivity (PSH) is a relatively common syndrome typically observed following traumatic brain injury (TBI). It manifests through a combination of non-specific symptoms that collectively define its presentation. Linked to sympathetic hyperactivity, takotsubo syndrome is a cardiomyopathy marked by left ventricular dysfunction and may coincide with PSH. While various factors can lead to the simultaneous occurrence of these syndromes, a notably rare scenario involves their manifestation after brain tumor removal. The nonspecific nature of PSH symptoms and of the cardiac dysfunction in takotsubo syndrome pose challenges in accurately diagnosing these conditions in an intensive care unit (ICU) setting. They often overlap with more prevalent diagnoses like sepsis, pulmonary embolism, and acute heart failure. Thus, it is crucial for clinicians dealing with these patients to be aware that symptoms indicating sympathetic activity surge and left heart failure might prompt consideration of takotsubo syndrome and PSH. This study presents the case of an 8-year-old girl who developed takotsubo syndrome associated with sympathetic hyperactivity following the surgical removal of a bulbar tumor. To the best of our knowledge, this is the tenth case of PSH following brain tumor removal in a pediatric patient and the first reported case of occurrence of takotsubo linked to PSH after brain tumor removal. We offer a detailed account of the patient's clinical journey in the ICU, accompanied by a comprehensive review of relevant literature to identify similar cases. The significance of this case study lies in emphasizing the potential occurrence of takotsubo syndrome due to PSH and underscores the importance of early diagnosis and management due to their association with unfavorable clinical outcomes.
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Affiliation(s)
- Manel Krouma
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - A Aboudou Soilihi
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Gregoire Pech-Gourg
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Sophie Arnaud
- Department of Pediatric Anesthesiology and Intensive Care, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - El Louali Fadoua
- Department of Pediatric and Congenital Cardiology, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Marco Caruselli
- Department of Pediatric Anesthesiology and Intensive Care, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Didier Scavarda
- Department of Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France.
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2
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Gregory J, Uzuner C. Reverse takotsubo induced cardiogenic shock in the peripartum period: A case report and literature review. Int J Gynaecol Obstet 2024. [PMID: 39049622 DOI: 10.1002/ijgo.15819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2-3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care.
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Affiliation(s)
- James Gregory
- Department of Obstetrics and Gynecology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Cansu Uzuner
- Department of Obstetrics and Gynecology, Nepean Hospital, Sydney, New South Wales, Australia
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3
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Gudmundsson T, Redfors B, Råmunddal T, Angerås O, Petursson P, Rawshani A, Hagström H, Alfredsson J, Ekenbäck C, Henareh L, Skoglund K, Ljungman C, Mohammad M, Jernberg T, Fröbert O, Erlinge D, Omerovic E. Importance of hospital and clinical factors for early mortality in Takotsubo syndrome: Insights from the Swedish Coronary Angiography and Angioplasty Registry. BMC Cardiovasc Disord 2024; 24:359. [PMID: 39004698 PMCID: PMC11247782 DOI: 10.1186/s12872-024-04023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute heart failure syndrome with symptoms similar to acute myocardial infarction. TTS is often triggered by acute emotional or physical stress and is a significant cause of morbidity and mortality. Predictors of mortality in patients with TS are not well understood, and there is a need to identify high-risk patients and tailor treatment accordingly. This study aimed to assess the importance of various clinical factors in predicting 30-day mortality in TTS patients using a machine learning algorithm. METHODS We analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients with TTS in Sweden between 2015 and 2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality in TTS patients. RESULTS Of 3,180 patients hospitalized with TTS, 76.0% were women. The median age was 71.0 years (interquartile range 62-77). The crude all-cause mortality rate was 3.2% at 30 days. Machine learning algorithms by gradient boosting identified treating hospitals as the most important predictor of 30-day mortality. This factor was followed in significance by the clinical indication for angiography, creatinine level, Killip class, and age. Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia and smoking status. CONCLUSIONS Using machine learning with gradient boosting, we analyzed all Swedish patients diagnosed with TTS over seven years and found that the treating hospital was the most significant predictor of 30-day mortality.
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Affiliation(s)
- Thorsteinn Gudmundsson
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Björn Redfors
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Oskar Angerås
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Petur Petursson
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Araz Rawshani
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Henrik Hagström
- Department of Cardiology, Umeå University Hospital, Umeå, Sweden
| | | | - Christina Ekenbäck
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Skoglund
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Charlotta Ljungman
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Moman Mohammad
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Tomas Jernberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden.
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Daralammouri Y, Hamayel H, Abugaber D, Nabulsi S. Takotsubo Cardiomyopathy: Patients Characteristics, Mortality, and Clinical Significance of Left Ventricular Outflow Tract Gradient, Retrospective Study. Cardiol Res Pract 2024; 2024:5549795. [PMID: 39015408 PMCID: PMC11251787 DOI: 10.1155/2024/5549795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
Background Takotsubo cardiomyopathy (TC) is a reversible left ventricular systolic dysfunction with apical ballooning. Left ventricular outflow tract (LVOT) obstruction may develop in these cases due to hyperdynamic state of the left ventricle. Limited data are available on the prevalence of LVOT gradient in TC and its association with patient outcomes and mortality. Methods Data were collected retrospectively for patients diagnosed with TC in a single tertiary center, demographic information, blood analysis results, and imaging finding including ejection fraction, and LVOT gradient was obtained from medical records. Additionally, medical treatment and outcome during hospitalization were extracted. Follow-up was conducted through cardiology clinic or phone contact. Result A total of 59 patients diagnosed with TC were reviewed during hospitalization, and 40 patients were followed up after discharge by phone contact and cardiology clinic. Most patients were female (91.5%), and nonsignificant coronary artery disease was present in 16.9% of patients. Approximately two-third of the patients had a reduced ejection fraction on admission, and only two patients (5.4%) continued to have reduced ejection fraction on echocardiography follow-up within a period of 2-14 days. LVOT gradient was present in 17 patients (28.5%); patients with preserved ejection fraction had a higher probability of having an LVOT gradient. However, there was no association between LVOT gradient and shock or mortality. Four patients (6.7%) experienced 30-day mortality, while all-cause mortality was reported in eight patients (13.5%) over the follow-up period (mean (±SD) 20.8 months ± 16.2). Conclusion LVOT obstruction may occur in TC patients; it has no correlation with shock or mortality. However, determining whether there is a gradient is important for deciding on specific treatment approach.
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Affiliation(s)
- Yunis Daralammouri
- Department of CardiologyAn-Najah National University Hospital, Nablus, State of Palestine
- Department of MedicineFaculty of Medicine and Health SciencesAn-Najah National University, Nablus, State of Palestine
| | - Hamza Hamayel
- Department of CardiologyAn-Najah National University Hospital, Nablus, State of Palestine
| | - Dina Abugaber
- Department of MedicineFaculty of Medicine and Health SciencesAn-Najah National University, Nablus, State of Palestine
- Department of Critical CareAn-Najah National University Hospital, Nablus, State of Palestine
| | - Sari Nabulsi
- Department of MedicineAn-Najah National University Hospital, Nablus, State of Palestine
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Lu X, Teng C, Cai P, Liang J, Wang Y, Abu H, Wang YJ, Madias JE, Liu K, Liu Q, Li P. Takotsubo Syndrome in Patients With COVID-19: A Systematic Review. CJC Open 2024; 6:818-825. [PMID: 39022174 PMCID: PMC11251070 DOI: 10.1016/j.cjco.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/07/2024] [Indexed: 07/20/2024] Open
Abstract
Background Respiratory conditions are major physical triggers of takotsubo syndrome (TTS) and portend worse outcomes. However, data on TTS in patients with coronavirus disease-2019 infection (COVID-19) are limited. Methods We searched PubMed, Embase, and Cochrane Library databases for case reports for the period 2019-2022 describing TTS in patients with COVID-19 pneumonia (TTS-COVID). We summarized the clinical data and outcomes and compared them to those in patients with TTS with an acute respiratory disease other than COVID-19 as a trigger (TTS-acute respiratory disease) and those with TTS with no respiratory disease (TTS-no respiratory disease). Results The mortality rate was higher in those with TTS-COVID (26.0%) than those with TTS-acute respiratory disease (5.7%) or TTS-no respiratory disease (4.2%; P < 0.001 for both). The proportion of men was higher in TTS-COVID (33.3%) than it was in TTS-no respiratory disease (9.1%; P < 0.001). The manifestations of TTS in COVID patients were atypical (dyspnea [70.3%] and cough [40.6%]); few had chest pain (23.4%). Cardiovascular risk factors were common in the TTS-COVID cohort, but fewer patients were on cardioprotective medications in this group than in the other 2 groups. Level of catecholamine use was higher in the TTS-COVID group (37.7%) than it was in the TTS-no respiratory disease (10.9%; P < 0.001) group. Apical ballooning (72.6%) was the most common TTS subtype, and basal segment type was seen in 11.0% of TTS-COVID patients. Conclusions COVID-19 patients who developed TTS had high mortality rates and unique features, compared with those in the TTS-acute respiratory disease group or the TTS-no respiratory disease group. Understanding the pathophysiology of TTS in COVID-19 may help prevent TTS and direct therapy in this setting.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Catherine Teng
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Jing Liang
- Xinxiang Medical University, Xinxiang, China
| | | | - Hawa Abu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Yuan Jia Wang
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, USA
| | - John E. Madias
- Cardiology Division, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Queens, New York, USA
| | - Kan Liu
- Division of Cardiology and Heart and Vascular Center, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Qi Liu
- Wafic Said Molecular Cardiology Research Laboratory, The Texas Heart Institute, Houston, Texas, USA
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Zulfaj E, Nejat A, Haamid A, Elmahdy A, Espinosa A, Redfors B, Omerovic E. Animal models of Takotsubo syndrome: bridging the gap to the human condition. Front Cardiovasc Med 2024; 11:1351587. [PMID: 38841261 PMCID: PMC11152046 DOI: 10.3389/fcvm.2024.1351587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/18/2024] [Indexed: 06/07/2024] Open
Abstract
Modelling human diseases serves as a crucial tool to unveil underlying mechanisms and pathophysiology. Takotsubo syndrome (TS), an acute form of heart failure resembling myocardial infarction, manifests with reversible regional wall motion abnormalities (RWMA) of the ventricles. Despite its mortality and clinical similarity to myocardial infarction, TS aetiology remains elusive, with stress and catecholamines playing central roles. This review delves into current animal models of TS, aiming to assess their ability to replicate key clinical traits and identifying limitations. An in-depth evaluation of published animal models reveals a variation in the definition of TS among studies. We notice a substantial prevalence of catecholamine-induced models, particularly in rodents. While these models shed light on TS, there remains potential for refinement. Translational success in TS research hinges on models that align with human TS features and exhibit the key features, including transient RWMA. Animal models should be comprehensively evaluated regarding the various systemic changes of the applied trigger(s) for a proper interpretation. This review acts as a guide for researchers, advocating for stringent TS model standards and enhancing translational validity.
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Affiliation(s)
- Ermir Zulfaj
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - AmirAli Nejat
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Abdulhussain Haamid
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ahmed Elmahdy
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Aaron Espinosa
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Björn Redfors
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Core Facilities - Experimental Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Core Facilities - Experimental Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden
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Pambianchi G, Marchitelli L, Cundari G, Ruoli L, Conia L, Catalano C, Galea N. Takotsubo syndrome: left atrial and ventricular myocardial strain impairment in the subacute and convalescent phases assessed by CMR. Eur Radiol Exp 2024; 8:34. [PMID: 38413432 PMCID: PMC10899127 DOI: 10.1186/s41747-024-00423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique. METHODS We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30 days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7 days) and 31 during the convalescence (cTTS, 8-30 days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls. RESULTS All patients were women (mean age 63 years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670). CONCLUSIONS LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery. RELEVANCE STATEMENT Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies. KEY POINTS • In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS.
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Affiliation(s)
- Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Letizia Ruoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy.
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Isogai T, Okada A, Morita K, Michihata N, Makito K, Matsui H, Fushimi K, Yasunaga H. Body Mass Index and Outcomes in Patients with Takotsubo Syndrome: A Nationwide Retrospective Cohort Study. Cardiology 2024; 149:314-324. [PMID: 38387447 PMCID: PMC11309069 DOI: 10.1159/000537971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is a cardiac disorder that mimics acute coronary syndrome at presentation. While previous studies have demonstrated a relationship between body mass index (BMI) and outcomes in acute coronary syndrome, few have examined its relationship with TTS. METHODS Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified 14,551 patients admitted for TTS between 2010 and 2021. By applying multivariable regressions with restricted cubic splines, we examined the association between BMI and in-hospital mortality after adjusting for potential confounders. RESULTS Mean BMI was 21.1 kg/m2, classifying patients into severe underweight (<16.0 kg/m2, 7.1%), mild/moderate underweight (16.0-18.4 kg/m2, 18.3%), normal weight (18.5-22.9 kg/m2, 46.8%), overweight (23.0-27.4 kg/m2, 22.2%), and obese (≥27.5 kg/m2, 5.6%) groups. Patients with severe or mild/moderate underweight were older and had a higher prevalence of impaired physical activity, malignancy, chronic pulmonary disease, and pneumonia. In-hospital mortality was the highest (9.4%) in the severe underweight group, followed by the mild/moderate underweight group (5.4%), with the lowest being in the obese group (2.1%). Severe underweight (adjusted odds ratio = 2.05; 95% confidence interval [CI] = 1.54-2.73) and mild/moderate underweight (1.26; 95% CI = 1.01-1.57) were significantly associated with higher mortality compared with normal weight, while no significant association was noted with obesity. A nonlinear association between continuous BMI and mortality was observed, with mortality increasing when BMI decreased <20.0 kg/m2 but nearly plateauing in BMI >20.0 kg/m2. CONCLUSIONS The present nationwide analysis demonstrated a nonlinear association between BMI and in-hospital mortality of TTS. BMI is an easily available and clinically relevant marker for the risk stratification of TTS.
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Affiliation(s)
- Toshiaki Isogai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Kanako Makito
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Tini G, Arcari L, Mistrulli R, Follesa F, Cianca A, Sclafani M, Tocci G, Spallarossa P, Battistoni A, Cacciotti L, Musumeci B, Barbato E. A contemporary update on cancer and takotsubo syndrome. Front Cardiovasc Med 2024; 10:1301383. [PMID: 38259302 PMCID: PMC10800806 DOI: 10.3389/fcvm.2023.1301383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Takotsubo syndrome (TTS) is characterized by a transient left ventricular systolic dysfunction, burdened by significant acute and long-term mortality and morbidity. The prognosis of TTS, especially in the long-term, is influenced by both non-cardiovascular (non-CV) and CV comorbidities, among which cancer is one of the most common. The presence of a malignancy is proven to be associated with higher mortality in TTS. Moreover, a number of anticancer treatments has been reported to possibly cause TTS as a form of cardiotoxicity, even though clearcut associations are lacking. The aim of this narrative review is to sum up contemporary knowledge on the association of cancer and TTS, addressing unmet needs and practical implications. The importance of a close collaboration between cardiologists and oncologists is herein highlighted, both to allow an adequate management of the acute TTS phase, and to actively and safely return to the oncologic management once the acute setting is resolved.
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Affiliation(s)
- Giacomo Tini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Raffaella Mistrulli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Federico Follesa
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cianca
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Sclafani
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiology Network, Genova, Italy
| | - Allegra Battistoni
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Cacciotti
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Witczyńska A, Alaburda A, Grześk G, Nowaczyk J, Nowaczyk A. Unveiling the Multifaceted Problems Associated with Dysrhythmia. Int J Mol Sci 2023; 25:263. [PMID: 38203440 PMCID: PMC10778936 DOI: 10.3390/ijms25010263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Dysrhythmia is a term referring to the occurrence of spontaneous and repetitive changes in potentials with parameters deviating from those considered normal. The term refers to heart anomalies but has a broader meaning. Dysrhythmias may concern the heart, neurological system, digestive system, and sensory organs. Ion currents conducted through ion channels are a universal phenomenon. The occurrence of channel abnormalities will therefore result in disorders with clinical manifestations depending on the affected tissue, but phenomena from other tissues and organs may also manifest themselves. A similar problem concerns the implementation of pharmacotherapy, the mechanism of which is related to the impact on various ion currents. Treatment in this case may cause unfavorable effects on other tissues and organs. Drugs acting through the modulation of ion currents are characterized by relatively low tissue specificity. To assess a therapy's efficacy and safety, the risk of occurrences in other tissues with similar mechanisms of action must be considered. In the present review, the focus is shifted prominently onto a comparison of abnormal electrical activity within different tissues and organs. This review includes an overview of the types of dysrhythmias and the basic techniques of clinical examination of electrophysiological disorders. It also presents a concise overview of the available pharmacotherapy in particular diseases. In addition, the authors review the relevant ion channels and their research technique based on patch clumping.
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Affiliation(s)
- Adrianna Witczyńska
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland;
| | - Aidas Alaburda
- Department of Neurobiology and Biophysics, Institute of Bioscience, Vilnius University Saulėtekio Ave. 7, LT-10257 Vilnius, Lithuania;
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland;
| | - Jacek Nowaczyk
- Department of Physical Chemistry and Physicochemistry of Polymers, Faculty of Chemistry, Nicolaus Copernicus University, 7 Gagarina St., 87-100 Toruń, Poland;
| | - Alicja Nowaczyk
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland;
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D'Amario D, Borovac JA, Patti G. A machine-learning-based prediction model in patients with takotsubo syndrome: 'You can't stop change any more than you can stop the suns from setting!'. Eur J Heart Fail 2023; 25:2312-2315. [PMID: 37975147 DOI: 10.1002/ejhf.3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Josip Angelo Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
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12
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Muhammad H, Bag A, Iyer A. Takotsubo Syndrome: Is It Just a "Broken Heart"? J Community Hosp Intern Med Perspect 2023; 13:132-133. [PMID: 38596562 PMCID: PMC11000835 DOI: 10.55729/2000-9666.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Affiliation(s)
- Haris Muhammad
- Department of Internal Medicine, Englewood Health/Hackensack University, Englewood, NJ,
USA
| | - Angila Bag
- Department of Internal Medicine, Englewood Health/Hackensack University, Englewood, NJ,
USA
| | - Aparna Iyer
- Department of Internal Medicine, Englewood Health/Hackensack University, Englewood, NJ,
USA
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13
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Watanabe Y, Yoshikawa T, Isogai T, Sakata K, Yamaguchi T, Arao K, Takaoka Y, Inohara T, Imori Y, Mochizuki H, Yamamoto T, Asai K, Nagao K, Takayama M. Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network. J Cardiol 2023; 82:356-362. [PMID: 37343932 DOI: 10.1016/j.jjcc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Hypoalbuminemia is common in critically ill patients and is associated with poor outcomes. However, the relationship between serum albumin levels and clinical outcomes in patients with takotsubo syndrome remains unclear. We examined the impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome. METHODS Using the multicenter registry of the Tokyo Cardiovascular Care Unit Network between January 2017 and December 2020, we identified 631 eligible patients with takotsubo syndrome (median age, 78 years; male proportion, 22 %) and documented serum albumin levels at admission, which were used to allocate patients to hypoalbuminemia (serum albumin <3.5 g/dL) or normal albumin (serum albumin ≥3.5 g/dL) groups. Patient characteristics and in-hospital mortality were compared between the groups. RESULTS Hypoalbuminemia was detected in 200 (32 %) patients at admission. The hypoalbuminemia group was older and had a higher proportion of men and preceding physical triggers than the normal albumin group. In-hospital all-cause mortality was greater in the hypoalbuminemia group than in the normal albumin group (9.5 % vs. 1.9 %, p < 0.001). Both cardiac (3.0 % vs. 0.5 %, p = 0.015) and non-cardiac (6.5 % vs. 1.4 %, p = 0.002) mortality was greater in the hypoalbuminemia group. In multivariable logistic regression analysis, hypoalbuminemia was independently associated with increased in-hospital mortality, even after adjusting for confounders, including age, sex, and triggering events (odds ratio, 3.23; 95 % confidence interval, 1.31-7.95; p = 0.011). CONCLUSIONS In patients with takotsubo syndrome, hypoalbuminemia is a common comorbidity and is associated with a substantial risk of in-hospital death. Close monitoring and comprehensive critical care are required in these patients.
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Affiliation(s)
- Yukihiro Watanabe
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Taku Inohara
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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14
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Takuma S, Asaka T, Kitagawa Y, Fujisawa T. Reply to the letter to the editor by Finsterer et al. titled "Before blaming the tooth extraction, consider alternative triggers of Takotsubo". SPECIAL CARE IN DENTISTRY 2023; 43:738-739. [PMID: 36309476 DOI: 10.1111/scd.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Shigeru Takuma
- Faculty of Dental Medicine, and Graduate School of Dental Medicine, Department of Dental Anesthesiology, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Faculty of Dental Medicine and Graduate School of Dental Medicine, Department of Oral Diagnosis and Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Faculty of Dental Medicine and Graduate School of Dental Medicine, Department of Oral Diagnosis and Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Faculty of Dental Medicine, and Graduate School of Dental Medicine, Department of Dental Anesthesiology, Hokkaido University, Sapporo, Japan
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15
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Arao K, Yoshikawa T, Isogai T, Imori Y, Mochizuki H, Sakata K, Takaoka Y, Yamaguchi T, Nagao K, Yamamoto T, Takayama M. A study of takotsubo syndrome over 9 years at the Tokyo Cardiovascular Care Unit Network Registry. J Cardiol 2023; 82:93-99. [PMID: 36640906 DOI: 10.1016/j.jjcc.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/04/2022] [Accepted: 12/17/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute cardiovascular disease with clinical manifestations similar to those of acute myocardial infarction (AMI), and TTS sometimes occurs just after catastrophes. Large-scale studies of TTS in Japan are scarce, so we examined data over 9 years from Tokyo metropolitan acute cardiovascular care hospital network registry. METHODS A total of 1626 patients were diagnosed with TTS between 2010 and 2018 at Tokyo Cardiovascular Care Unit Network facilities, and data from all these patients were analyzed. We investigated annual and monthly captured incidence of TTS, temporal trend of the captured incidence proportion of TTS versus AMI, the occurrence of TTS on the day of the great earthquake, and we elucidated the prognostic factors for in-hospital death. RESULTS The annual incidence proportion of TTS versus AMI increased from 2.3 % to 4.5 % (p < 0.001) over 9 years. The mean TTS patient age was 74.4 years: the peak incidence of TTS was at 80 to 84 years of age for both male and female; females accounted for 78.5 % of patients. The monthly variation of the incidence of TTS was found (p = 0.009). In 2011, a total of 137 cases of TTS occurred, with as many as 6 occurring on March 11, the day of the Great East Japan Earthquake. There was a definable trigger for TTS in 64 % (physical: 36 %; emotional: 27 %; others: 2 %). All-cause in-hospital mortality was 5.3 % and was higher in males than in females (10.3 % vs 3.9 %; p < 0.001). Non-cardiac causes accounted for 62 % of in-hospital mortality. Factors at presentation that were associated with in-hospital all-cause mortality were male sex, low body mass index, and a high C-reactive protein level. CONCLUSIONS This study elucidated the clinical features, in-hospital outcomes, and their attributed factors in patients with TTS in real-world clinical practice in Japan.
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Affiliation(s)
- Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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16
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Takuma S, Asaka T, Kitagawa Y, Fujisawa T. Takotsubo syndrome after a minimally invasive tooth extraction in a patient without dental phobia: A case report. SPECIAL CARE IN DENTISTRY 2023; 43:281-285. [PMID: 35934843 DOI: 10.1111/scd.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Takotsubo syndrome (TTS) is a rare, stress-induced acute cardiac disorder. Its precipitating factors include emotionally or physically stressful events and exogenous and endogenous adrenaline. In this report, we describe a case of atypical TTS in a 73-year-old woman who reported no dental fear and required acute cardiac care in an outpatient setting. She underwent routine extraction of an upper left premolar under local anesthesia. She reported heart palpitations after the injection, and the procedure was completed in 15 min. After presenting symptoms of sweating, pale skin, vomiting, low blood pressure, and ST-segment elevation, cardiologists ordered echocardiography, coronary angiography, and ventriculography. Upon receiving a TTS diagnosis, the patient was hospitalized and administered an intra-aortic balloon pump and beta-blocker. Her symptoms resolved, and she was discharged with no sequelae. We found no precipitating factors in the progression of TTS in this case, which suggests that TTS can develop in the absence of precipitating factors. All general dentists and oral surgeons should recognize the possible risk of TTS, even during minimally invasive dental procedures, such as routine extractions in patients without dental phobia.
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Affiliation(s)
- Shigeru Takuma
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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17
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Abstract
Takotsubo syndrome (TTS), triggered by intense emotional or physical stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4-5%) owing to cardiogenic shock, myocardial rupture, or life-threatening arrhythmias. Thus, its prognosis is not as benign as previously thought, as it may cause mechanical complications (cardiac rupture) and potentially lethal arrhythmias and sudden cardiac death (SCD). Similar to MI, some patients may perish before reaching the hospital due to out-of-hospital cardiac arrest; this may lead to underestimation of the actual SCD risk. Furthermore, after discharge, some patients may develop late SCD and/or TTS recurrence that may result in SCD. There are risk factors for SCD in TTS patients, such as severe/persistent QT-interval prolongation inciting torsade-de-pointes, other ECG abnormalities (diffuse giant negative T-waves, widened QRS-complex), bradyarrhythmias, comorbidities, concurrent obstructive coronary artery disease or vasospasm, male gender, older age, severe left ventricular dysfunction, and use of sympathomimetic drugs. All these issues are herein reviewed, case reports/series and data from large cohort studies and meta-analyses are analyzed, risk factors are tabulated, and proarrhythmic effects and management strategies are discussed and pictorially illustrated.
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Affiliation(s)
| | | | - Helen Melita
- 69106Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
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18
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Chen J, Wang Y, Shou X, Liu Q, Mei Z. Development and validation of a prognostic nomogram for Takotsubo syndrome patients in the intensive care units: a retrospective cohort study. Sci Rep 2023; 13:477. [PMID: 36627324 PMCID: PMC9832151 DOI: 10.1038/s41598-022-27224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Patients with Takotsubo syndrome (TTS) admitted to the intensive care unit (ICU) always confront a higher risk of in-hospital death than those hospitalized in the cardiology unit. The prognosis of the latter was analyzed by a large number of studies. However, there was no utility model to predict the risk of in-hospital death for patients with TTS in the ICU. This study aimed to establish a model predicting in-hospital death in patients with TTS admitted to ICU. We retrospectively included ICU patients with TTS from the MIMIC-IV database. The outcome of the nomogram was in-hospital death. Least Absolute Shrinkage Selection Operator (LASSO) analysis selected predictors preliminarily. The model was developed by multivariable logistic regression analysis. Calibration, decision curve analysis (DCA), and receiver operating characteristic (ROC) measured the performance of the nomogram on the accuracy, clinical utility, and discrimination, respectively. Eventually, 368 ICU patients with TTS were enrolled in this research. The in-hospital mortality was 13.04%. LASSO regression and multivariate logistic regression analysis verified risk factors significantly associated with in-hospital mortality. They were potassium, prothrombin time (PT), age, myocardial infarction, white cell count (WBC), hematocrit, anion gap, and sequential organ failure assessment (SOFA) score. This nomogram excellently discriminated against patients with a risk of in-hospital death. The area under curve (AUC) was 0.779 (95%CI: 0.732-0.826) in training set and 0.775 (95%CI: 0.711-0.839) in test set. The calibration plot and DCA showed good clinical benefits for this nomogram. We developed a nomogram that predicts the probability of in-hospital death for ICU patients with TTS. This nomogram was able to discriminate patients with a high risk of in-hospital death and performed clinical utility.
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Affiliation(s)
- Jun Chen
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Yimin Wang
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Xinyang Shou
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Qiang Liu
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Ziwei Mei
- Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China.
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Del Buono MG, Damonte JI, Moroni F, Ravindra K, Westman P, Chiabrando JG, Bressi E, Li P, Kapoor K, Mao Y, Oakes T, Rodriguez-Miguelez P, Gal TS, Koneru J, Ellenbogen KA, Kron J, Abbate A. QT Prolongation and In-Hospital Ventricular Arrhythmic Complications in Patients With Apical Ballooning Takotsubo Syndrome. JACC Clin Electrophysiol 2022; 8:1500-1510. [PMID: 36543499 DOI: 10.1016/j.jacep.2022.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Takotsubo syndrome is associated with life threatening arrhythmias, and the apical ballooning pattern is characterized by a peculiar QT prolongation and particularly high-risk of arrhythmias. OBJECTIVES The aim of the study was to determine the association of QT interval on electrocardiogram for ventricular arrhythmic complications in patients with apical ballooning Takotsubo syndrome in a diverse population at a large urban hospital in the U.S. METHODS We reviewed 105 cases of apical ballooning Takotsubo syndrome in patients admitted between 2011 and 2017. Two cardiologists reviewed the electrocardiograms to measure QT interval, adjusted for rate using the Fridericia formula (QTCF), and ventricular arrhythmic complications during the hospitalization. Data are reported as median and interquartile range or number and percentage. RESULTS Of the 105 patients, 86 (82%) were female, and 34 (32%) were self-reported Black or African American. The mean age was 65 years (range: 58-72 years). Left ventricular ejection fraction was 25% (range: 25%-35%). Heart rate was 101 beats/min (range: 83-121 beats/min). Ten (11%) patients experienced a ventricular arrhythmic complication and had significantly longer QTCF (470 [range: 422-543] milliseconds) than did those without complications (417 [range: 383-456] milliseconds, P = 0.031). The area under the curve for QTCF was 0.708 (95% CI: 0.536-0.880; P = 0.031). Twenty-eight (27%) patients had a QTCF ≥460 milliseconds and significantly more arrhythmic complications (21% vs 5%, odds ratio 4.997 [95% CI: 1.288-19.237], P = 0.021). QTCF was an independent predictor of ventricular arrhythmias: odds ratio 1.090 for each 10-millisecond increase in QTCF (95% CI: 1.004-1.183; P = 0.040, corrected for sex). CONCLUSIONS In a diverse population of patients with apical ballooning Takotsubo syndrome admitted to a large urban hospital in the United States, QTCF at admission ≥460 milliseconds identifies patients at high risk for in-hospital arrhythmic complications. Further studies are needed to determine strategies aimed at shortening QT interval to potentially prevent life-threatening arrhythmic events.
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Affiliation(s)
- Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Juan Ignacio Damonte
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Francesco Moroni
- Robert M. Berne Cardiovascular Research Center, and Department of Medicine, Division of Cardiovascular Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, Virginia, USA
| | - Krishna Ravindra
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Peter Westman
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Juan G Chiabrando
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edoardo Bressi
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pengyang Li
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kunal Kapoor
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yuxuan Mao
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Travis Oakes
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Tamas S Gal
- Department of Biostatistics, Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jayanthi Koneru
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kenneth A Ellenbogen
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordana Kron
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Robert M. Berne Cardiovascular Research Center, and Department of Medicine, Division of Cardiovascular Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, Virginia, USA.
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20
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Reverse Takotsubo cardiomyopathy after orthotopic liver transplantation. A case report. J Crit Care Med (Targu Mures) 2022; 8:117-122. [PMID: 35950160 PMCID: PMC9097646 DOI: 10.2478/jccm-2022-0002] [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: 12/20/2021] [Accepted: 03/19/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Takotsubo cardiomyopathy is a rare reversible type of heart failure, often precipitated by emotional stress; other risk factors include intracranial bleeding, ischemic stroke, sepsis, major surgery, pheochromocytoma. The clinical, electrical and blood sample analysis features resemble those of a myocardial infarction- however, they occur in the absence of angiographic coronary filling defects. Case presentation A 61-year-old male patient, 71 kg, 175 cm, underwent liver transplantation for Child-Pugh B cirrhosis secondary to mixed viral hepatitis (B and D). His medical records revealed mild mitral, aortic, and tricuspid insufficiencies and heart failure with preserved ejection fraction. An initially uneventful perioperative stage was succeeded by cardiogenic shock (cardiac index – 1.2 l/min/ sqm), which the patient developed 24 hours after the intervention. Elevated cardiac markers and ECG abnormalities showing ST-T changes in the V2-V5 leads were additionally noted. Transesophageal echocardiography (TEE) revealed an acute onset reduction in the left ventricular systolic function secondary to basal hypokinesia. No coronary obstruction was detected by percutaneous angiography. The above findings lead to the diagnosis of reverseTakotsubo cardiomyopathy. Further, the patient developed acute kidney injury and liver graft failure, succumbing within 48 hours after the surgical procedure. Conclusions We report a rare case of reverse Takotsubo cardiomyopathy in a male patient after orthotopic liver transplant.
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