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Demirel O, Paar V, Tolnai P, Topf A, Hoppe UC, Lichtenauer M, Mirna M. Heat Shock Protein 70 Constitutes a Promising Novel Biomarker in Differential Diagnosis between Takotsubo Syndrome and Non-ST-Segment Elevation Myocardial Infarction. J Clin Med 2024; 13:4152. [PMID: 39064192 PMCID: PMC11277720 DOI: 10.3390/jcm13144152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Due to similar clinical presentation and a lack of specific biomarkers, initial differentiation between Takotsubo syndrome (TTS) and non-ST-segment elevation myocardial infarction (NSTEMI) remains challenging in daily practice. Heat Shock Protein 70 (HSP70) is a novel biomarker that is recognized for its potential in the diagnosis and differentiation of cardiovascular conditions. (2) Methods: Data from a total of 156 patients were analyzed (32.1% NSTEMI, 32.7% TTS, and 35.3% controls). Serum concentrations of HSP70 were determined using ELISA and compared between patients and controls. ROC curve analysis, logistic regression analysis and propensity-score-weighted logistic regression were conducted. (3) Results: Concentrations of HSP70 were highest in patients with TTS (median 1727 pg/mL vs. ACS: median 1545 pg/mL vs. controls: median 583 pg/mL, p < 0.0001). HSP70 was predictive for TTS in binary logistic regression analysis (B(SE) = 0.634(0.22), p = 0.004), which even remained significant after correction for possible confounders in propensity-score-weighted analysis. ROC curve analysis also revealed a significant association of HSP70 with TTS (AUC: 0.633, p = 0.008). (4) Conclusions: Based on our findings, HSP70 constitutes a promising biomarker for discrimination between TTS and NSTEMI, especially in combination with established cardiovascular biomarkers like pBNP or high-sensitivity cardiac troponin.
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Affiliation(s)
- Ozan Demirel
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Philipp Tolnai
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Albert Topf
- Hospital Villach, Department of Internal Medicine, 9500 Villach, Austria
| | - Uta C. Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
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2
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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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3
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Standifird C, Kaisler S, Gottula AL, Lauria MJ, Dean JT. Takotsubo Cardiomyopathy Syndrome in Critical Care Transport: A Case and Critical Review. Air Med J 2023; 42:372-376. [PMID: 37716811 DOI: 10.1016/j.amj.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 09/18/2023]
Abstract
Takotsubo cardiomyopathy syndrome, or simply takotsubo syndrome (TTS), is a form of stress cardiomyopathy thought to be caused by excess catecholamines in association with physical or emotional stress. Providers should maintain a high index of suspicion for TTS in patients with symptoms of acute coronary syndrome, acute decompensated heart failure, substernal chest pain, or dyspnea. However, TTS is a diagnosis of exclusion, and patients should initially be evaluated and treated for other causes, such as acute myocardial infarction. Critical care transport crews may encounter patients with TTS during their primary presentation, before diagnosis, or after the formal diagnosis is made in the catheterization laboratory. Therefore, crews should be familiar with unique aspects of the pathophysiology, diagnosis, and management of TTS. This article presents a case and provides a critical review of TTS for critical care transport clinicians.
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Affiliation(s)
- Colin Standifird
- Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV; OptimuMedicine, Las Vegas, NV.
| | - Sean Kaisler
- University of New Mexico School of Medicine, Albuquerque, NM; 306th Rescue Squadron, United States Air Force, Davis-Monthan AFB, Tucson, AZ
| | - Adam L Gottula
- Department of Emergency Medicine and Anesthesiology, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Michael J Lauria
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Lifeguard Air Emergency Services, Albuquerque, NM
| | - James T Dean
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
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4
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Akhtar MM, Cammann VL, Templin C, Ghadri JR, Lüscher TF. Takotsubo syndrome: getting closer to its causes. Cardiovasc Res 2023:7161872. [PMID: 37183265 DOI: 10.1093/cvr/cvad053] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 05/16/2023] Open
Abstract
Takotsubo syndrome (TTS) accounts for between 1 and 4% of cases presenting clinically as an acute coronary syndrome. It typically presents as a transient cardiac phenotype of left ventricular dysfunction with spontaneous recovery. More dramatic presentations may include cardiogenic shock or cardiac arrest. Despite progress in the understanding of the condition since its first description in 1990, considerable questions remain into understanding underlying pathomechanisms. In this review article, we describe the current published data on potential underlying mechanisms associated with the onset of TTS including sympathetic nervous system over-stimulation, structural and functional alterations in the central nervous system, catecholamine secretion, alterations in the balance and distribution of adrenergic receptors, the additive impact of hormones including oestrogen, epicardial coronary or microvascular spasm, endothelial dysfunction, and genetics as potentially contributing to the cascade of events leading to the onset. These pathomechanisms provide suggestions for novel potential therapeutic strategies in patients with TTS including the role of cognitive behavioural therapy, beta-blockers, and endothelin-A antagonists. The underlying mechanism of TTS remains elusive. In reality, physical or emotional stressors likely trigger through the amygdala and hippocampus a central neurohumoral activation with the local and systemic secretion of excess catecholamine and other neurohormones, which exert its effect on the myocardium through a metabolic switch, altered cellular signalling, and endothelial dysfunction. These complex pathways exert a regional activation in the myocardium through the altered distribution of adrenoceptors and density of autonomic innervation as a protective mechanism from myocardial apoptosis. More research is needed to understand how these different complex mechanisms interact with each other to bring on the TTS phenotype.
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Affiliation(s)
- Mohammed Majid Akhtar
- Royal Brompton and Harefield Hospitals, Imperial College and King's College, London SW3 6NP, UK
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zürich, Zürich 8091, Switzerland
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals, Imperial College and King's College, London SW3 6NP, UK
- Center for Molecular Cardiology, University of Zürich, Zürich 8952, Switzerland
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5
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Rehan R, Yong A, Ng M, Weaver J, Puranik R. Coronary microvascular dysfunction: A review of recent progress and clinical implications. Front Cardiovasc Med 2023; 10:1111721. [PMID: 36776251 PMCID: PMC9908997 DOI: 10.3389/fcvm.2023.1111721] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
The coronary microcirculation plays a cardinal role in regulating coronary blood flow to meet the changing metabolic demands of the myocardium. Coronary microvascular dysfunction (CMD) refers to structural and functional remodeling of the coronary microcirculation. CMD plays a role in the pathogenesis of obstructive and non-obstructive coronary syndromes as well as myocardial diseases, including heart failure with preserved ejection fraction (HFpEF). Despite recent diagnostic advancements, CMD is often under-appreciated in clinical practice, and may allow for the development of novel therapeutic targets. This review explores the diagnosis and pathogenic role of CMD across a range of cardiovascular diseases, its prognostic significance, and the current therapeutic landscape.
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Affiliation(s)
- Rajan Rehan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Department of Cardiology, Concord Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Andy Yong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Martin Ng
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - James Weaver
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Sydney Medical School, University of Sydney, Darlington, NSW, Australia,*Correspondence: Rajesh Puranik,
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6
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Miyajima K, Tawarahara K, Saito N. Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy. J Nucl Cardiol 2022; 29:2599-2611. [PMID: 34427859 PMCID: PMC9553766 DOI: 10.1007/s12350-021-02755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) shows reversible hypokinesis in the left ventricular (LV) apical-half segment and hyperkinesis in the LV basal-half segment. However, the precise pathophysiological mechanism of TTC is unclear. Therefore, this study sought to clarify the nuclear characteristics, degree of myocardial damage, and serial change of TTC and rTTC using myocardial perfusion imaging. METHODS We performed myocardial perfusion scintigraphy in 28 patients (TTC: 20, rTTC: 8) using Tc-99m sestamibi and assessed minimum percentage uptake (min-%-uptake), extent score (ES) and summed rest score (SRS) at acute and chronic phases. RESULTS Min-%-uptake improved from the acute to the chronic phase (TTC: 54 [48-59]% vs 87 [81-90]%, P < 0.01; rTTC: 60 [55-64]% vs 77 [71-79]%, P < 0.01), as did the ES (TTC: 32 [26-41]% vs 0.0 [0.0-6.0]%, P < 0.01; rTTC: 16 [12-34]% vs 0.0 [0.0-0.0]%, P = 0.02) and SRS (TTC: 4.5 [3.9-5.3] vs 0.0 [0.0-0.2], P < 0.01; rTTC: 3.6 [3.3-3.8] vs 0.0 [0.0-0.0], P = 0.01). CONCLUSION Tc-99m sestamibi uptake was reduced in hypokinetic regions in the acute phase and improved in the chronic phase. TTC and rTTC may involve a reversible disorder of the myocardial cell membrane, mitochondria, and microcirculation.
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Affiliation(s)
- Keisuke Miyajima
- Department of Cardiology, Hamamatu Red Cross Hospital, Hamamatsu, Shizuoka, Japan.
- Department of Cardiology, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ward, Hamamatsu, Shizuoka, Japan.
| | - Kei Tawarahara
- Department of Cardiology, Hamamatu Red Cross Hospital, Hamamatsu, Shizuoka, Japan
| | - Norihito Saito
- Department of Cardiology, Saito Clinic, Fujisawa, Kanagawa, Japan
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7
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Chen X, Zhou B, Shi L, Liu H, Pang Y, Wang R, Miller EJ, Sinusas AJ, Liu C. CT-free attenuation correction for dedicated cardiac SPECT using a 3D dual squeeze-and-excitation residual dense network. J Nucl Cardiol 2022; 29:2235-2250. [PMID: 34085168 DOI: 10.1007/s12350-021-02672-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attenuation correction (AC) using CT transmission scanning enables the accurate quantitative analysis of dedicated cardiac SPECT. However, AC is challenging for SPECT-only scanners. We developed a deep learning-based approach to generate synthetic AC images from SPECT images without AC. METHODS CT-free AC was implemented using our customized Dual Squeeze-and-Excitation Residual Dense Network (DuRDN). 172 anonymized clinical hybrid SPECT/CT stress/rest myocardial perfusion studies were used in training, validation, and testing. Additional body mass index (BMI), gender, and scatter-window information were encoded as channel-wise input to further improve the network performance. RESULTS Quantitative and qualitative analysis based on image voxels and 17-segment polar map showed the potential of our approach to generate consistent SPECT AC images. Our customized DuRDN showed superior performance to conventional network design such as U-Net. The averaged voxel-wise normalized mean square error (NMSE) between the predicted AC images by DuRDN and the ground-truth AC images was 2.01 ± 1.01%, as compared to 2.23 ± 1.20% by U-Net. CONCLUSIONS Our customized DuRDN facilitates dedicated cardiac SPECT AC without CT scanning. DuRDN can efficiently incorporate additional patient information and may achieve better performance compared to conventional U-Net.
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Affiliation(s)
- Xiongchao Chen
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Bo Zhou
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Luyao Shi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Yulei Pang
- Department of Mathematics, Southern Connecticut State University, New Haven, CT, USA
| | - Rui Wang
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA
- Department of Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Chi Liu
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Department of Radiology and Biomedical Imaging, Yale University, PO Box 208048, New Haven, CT, 06520-8048, USA.
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8
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The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management. J Pers Med 2022; 12:jpm12081244. [PMID: 36013193 PMCID: PMC9410002 DOI: 10.3390/jpm12081244] [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: 06/14/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.
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9
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Huhta TA, Ran L, Cooper CW, Davis MJ, Kornbluth J, Salem DN. An Association of Takotsubo Cardiomyopathy with Guillain-Barré Syndrome. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s336664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Madias JE. Blood norepinephrine/epinephrine/dopamine measurements in 108 patients with takotsubo syndrome from the world literature: pathophysiological implications. Acta Cardiol 2021; 76:1083-1091. [PMID: 33300464 DOI: 10.1080/00015385.2020.1826703] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Release of norepinephrine (NE) from neuronal cardiac nerve endings and/or blood-borne catecholamines (CATs), mainly epinephrine (EPI), may mediate TTS. The aim of this study was to document the levels of NE, EPI, and dopamine (DA) in patients with TTS. MATERIALS AND METHODS A qualitative/quantitative meta-analysis of CATs and their relationship to age, gender, and triggers, was carried out, employing the world literature on TTS, published in PubMed. RESULTS NE/EPI/DA in108 patients with TTS, 65.2 ± 16.4 years old, 89 (82.4%) women, revealed that: NE was measured more frequently than EPI, and EPI than DA; the timing of the measurements was variable; CATs were reported variably (qualitatively/quantitatively/with/without upper limits of normal); NE/EPI or NE/EPI/DA rose to the same degree; CATs were normal, or mildly/moderately elevated, with only 6 patients showing markedly elevated NE/EP/DA; NE, EPI, and DA were similar in patients with physical triggers and NE was similar in patients with physical, emotional, or no triggers (p = 0.47); EPI was higher than NE in patients with emotional triggers and EPI was higher in patients with emotional than physical triggers (p = 0.012); NE, EPI, and DA rose to the same proportion in men and women; types of TTS triggers were distributed proportionally in men and women. CONCLUSION NE, EPI, and DA rise proportionally in patients with TTS; CATs are mildly/moderately, and rarely markedly elevated; measurements of CATs should become more systematised; although CATs may not be essential for TTS diagnosis, they may contribute to prognosis and elucidation of the pathophysiology of TTS.
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Affiliation(s)
- John E. Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA
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11
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Lu X, Li P, Teng C, Cai P, Jin L, Li C, Liu Q, Pan S, Dixon RA, Wang B. Prognostic factors of Takotsubo cardiomyopathy: a systematic review. ESC Heart Fail 2021; 8:3663-3689. [PMID: 34374223 PMCID: PMC8497208 DOI: 10.1002/ehf2.13531] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by reversible ventricular dysfunction, has similar mortality to acute coronary syndrome. With the growing interest in the diagnosis of and interventions for TCM, many risk factors had been found to affect the prognosis of TCM patients, such as age, sex, and pre-existing diseases. Because of the incomplete understanding of the pathophysiologic mechanism in TCM, evidence-based medical therapy for this condition is lacking. Early intervention on risk factors may improve the outcomes of TCM. In this review, we sought to provide up-to-date evidence on risk factors and medical therapies that affect TCM outcome. We found that male sex, physical triggers, and certain comorbidities such as chronic kidney disease, malignant disease, higher body mass index, sepsis, chronic obstructive pulmonary disease, and anaemia were associated with poor TCM prognosis. In contrast, race, hyperlipidaemia, diabetes mellitus, and mood disorders were not clearly associated with TCM prognosis. We also reviewed the effect of medical therapies on TCM outcome, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, calcium channel blockers, and statins. The evidence that these medications confer a survival benefit on TCM patients is limited. Understanding these prognostic factors could help develop risk-stratification tools for TCM and establish effective prevention and interventions for this not-so-benign condition. Further multicentre clinical studies with large samples and meta-analyses of findings from previous studies are needed to address the inconsistent findings among the many potential risk factors for TCM.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Pengyang Li
- Division of CardiologyPauley Heart Center, Virginia Commonwealth UniversityRichmondVAUSA
| | - Catherine Teng
- Department of MedicineYale New Haven Health Greenwich HospitalGreenwichCTUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Ling Jin
- Department of MedicineMetrowest Medical CenterFraminghamMAUSA
| | - Chenlin Li
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Qi Liu
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Su Pan
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Richard A.F. Dixon
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
- Clinical Research Centerthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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12
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Micho Ulbeh T, Sara A, Uddin MM, Bell K, Elmograbi A, Cardozo S. Takotsubo cardiomyopathy caused by infusion reaction to paclitaxel. BMJ Case Rep 2021; 14:e243863. [PMID: 34376418 PMCID: PMC8356188 DOI: 10.1136/bcr-2021-243863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) secondary to an infusion reaction is extremely rare in the literature. Here, we present an unusual case of TCM in a patient with cervical squamous cell carcinoma who presented with acute hypoxic respiratory failure following the initiation of the first-cycle paclitaxel infusion therapy.
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Affiliation(s)
| | - Amir Sara
- Internal Medicine, Wayne State University, Detroit, Michigan, USA
| | - Mohammed M Uddin
- Internal Medicine, Wayne State University, Detroit, Michigan, USA
| | - Kendall Bell
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Adel Elmograbi
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Shaun Cardozo
- Department of Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
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13
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Matsushita K, Lachmet-Thébaud L, Marchandot B, Trimaille A, Sato C, Dagrenat C, Greciano S, De Poli F, Leddet P, Peillex M, Hess S, Carmona A, Jimenez C, Heger J, Reydel A, Ohlmann P, Jesel L, Morel O. Incomplete Recovery From Takotsubo Syndrome Is a Major Determinant of Cardiovascular Mortality. Circ J 2021; 85:1823-1831. [PMID: 33828028 DOI: 10.1253/circj.cj-20-1116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction (LVEF) in patients with Takotsubo syndrome (TTS), recent studies have demonstrated a long-lasting functional impairment in those patients. The present study sought to evaluate the predictors of incomplete recovery following TTS and its impact on cardiovascular mortality.Methods and Results:Patients with TTS between 2008 and 2018 were retrospectively enrolled at 3 different institutions. After exclusion of in-hospital deaths, 407 patients were split into 2 subgroups according to whether their LVEF was >50% (recovery group; n=341), or ≤50% (incomplete recovery group; n=66) at the chronic phase. Multivariate logistic regression analysis found that LVEF (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.91-0.98; P<0.001) and C-reactive protein levels (OR: 1.11; 95% CI: 1.02-1.22; P=0.02) at discharge were independent predictors of incomplete recovery. At a median follow up of 52 days, a higher cardiovascular mortality was evident in the incomplete recovery group (16% vs. 0.6%; P<0.001). CONCLUSIONS This study demonstrated that incomplete recovery after TTS is characterized by residual systemic inflammation and an increased cardiac mortality at follow up. Altogether, the present study findings determined that patients with persistent inflammation are a high-risk subgroup, and should be targeted in future clinical trials with specific therapies to attenuate inflammation.
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Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire.,UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg
| | - Lucie Lachmet-Thébaud
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Chisato Sato
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire.,Department of Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | | | | | | | | | - Marilou Peillex
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Sébastien Hess
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Adrien Carmona
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Charline Jimenez
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Joe Heger
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Antje Reydel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire
| | - Laurence Jesel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire.,UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire.,UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg
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14
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Díaz-Navarro R. Takotsubo syndrome: the broken-heart syndrome. THE BRITISH JOURNAL OF CARDIOLOGY 2021; 28:11. [PMID: 35747479 PMCID: PMC8822514 DOI: 10.5837/bjc.2021.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Takotsubo syndrome - also known as broken-heart syndrome, Takotsubo cardiomyopathy, and stress-induced cardiomyopathy - is a recently discovered acute cardiac disease first described in Japan in 1991. This review aims to update understanding on the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of Takotsubo syndrome, highlighting aspects of interest to cardiologists and general practitioners.
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Affiliation(s)
- Rienzi Díaz-Navarro
- Professor of Cardiology, Director of Internal Medicine Department, School of Medicine, and Researcher at the Center for Biomedical Research Faculty of Medicine, Universidad de Valparaíso, Angamos 655, Reñaca, Viña del Mar, 2540064, Chile
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15
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Lachmet-Thébaud L, Marchandot B, Matsushita K, Dagrenat C, Peillex M, Sato C, Trimaille A, Reydel A, Trinh A, Ohlmann P, Jesel L, Morel O. Systemic Inflammatory Response Syndrome Is a Major Determinant of Cardiovascular Outcome in Takotsubo Syndrome. Circ J 2020; 84:592-600. [DOI: 10.1253/circj.cj-19-1088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Benjamin Marchandot
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Kensuke Matsushita
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
- UMR 1260 INSERM Regenerative Nanomedicine, University of Strasbourg
| | - Charlotte Dagrenat
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Marilou Peillex
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Chisato Sato
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
- Department of Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Antonin Trimaille
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Antje Reydel
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Annie Trinh
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Patrick Ohlmann
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
| | - Laurence Jesel
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
- UMR 1260 INSERM Regenerative Nanomedicine, University of Strasbourg
| | - Olivier Morel
- Department of Cardiology, Nouvel Hopital Civil, University Hospital of Strasbourg
- UMR 1260 INSERM Regenerative Nanomedicine, University of Strasbourg
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16
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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17
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Stress-Induced Cardiomyopathy: As a Diagnosis That Is Time Sensitive and Anticipative in Certain Individuals. Case Rep Cardiol 2019; 2018:5243419. [PMID: 30627449 PMCID: PMC6305019 DOI: 10.1155/2018/5243419] [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: 09/05/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022] Open
Abstract
Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, presents as an acute coronary syndrome. However, the physiology and pathogenesis are different. It is imperative to treat stress-induced cardiomyopathy as an acute coronary syndrome, and once diagnosed, it is imperative to assess and treat heart failure and wait for the impaired myocardial energetics to resolve. At times, the myocardial recuperation is quick that we miss the diagnosis of Takotsubo cardiomyopathy.
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18
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Kim MS, Lee JH, Cho HJ, Cho JY, Choi JO, Hwang KK, Yoo BS, Kang SM, Choi DJ. KSHF Guidelines for the Management of Acute Heart Failure: Part III. Specific Management of Acute Heart Failure According to the Etiology and Co-morbidity. Korean Circ J 2019; 49:46-68. [PMID: 30637995 PMCID: PMC6331326 DOI: 10.4070/kcj.2018.0351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic heart failure (CHF) were introduced in March 2016. However, CHF and acute heart failure (AHF) represent distinct disease entities. Here, we introduce the Korean guidelines for the management of AHF with reduced or preserved ejection fraction. Part III of this guideline covers management strategies optimized according to the etiology of AHF and the presence of co-morbidities.
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Affiliation(s)
- Min Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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19
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Kobylecka M, Budnik M, Kochanowski J, Piatkowski R, Chojnowski M, Fronczewska-Wieniawska K, Mazurek T, Maczewska J, Peller M, Opolski G, Krolicki L. Takotsubo cardiomyopathy: FDG myocardial uptake pattern in fasting patients. Comparison of PET/CT, SPECT, and ECHO results. J Nucl Cardiol 2018; 25:1260-1270. [PMID: 28054182 DOI: 10.1007/s12350-016-0775-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the accumulation pattern of 18F-FDG in fasting patients with takotsubo cardiomyopathy (TTC) and to correlate the results with perfusion scintigraphy and echocardiography. METHODS 18 consecutive patients with TTC were identified by clinical symptoms, cardiac catheterization, and echocardiography. Coronary angiography (CA) and transthoracic echocardiography (TTE) were performed on the day of the onset of symptoms. An assessment of myocardial perfusion (99mTc-MIBI) and glucose metabolism (18F-FDG) was performed within 18 days. RESULTS SPECT showed no regional perfusion abnormalities in 10/18 patients, and a mild perfusion defect was found in 8/18 patients. Perfusion abnormalities were limited to apical and para-apical regions. In 8/18 cases, there was an increased selective apical 18F-FDG accumulation. In 10/18 cases, in spite of the fastened 18F-FDG protocol, slightly inhomogeneous 18F-FDG uptake was present in the entire myocardium: with relatively reduced uptake of 18F-FDG in the apical region and LV mid-segments. CONCLUSION This study demonstrated the heterogeneous nature of myocardial 18F-FDG accumulation in patients with TTC. Selective, preferential apical 18F-FDG uptake in almost half of the patients confirms an existing disorder of glucose metabolism, similar to that observed in stunned or hibernated myocardium.
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Affiliation(s)
- Malgorzata Kobylecka
- Nuclear Medicine Department, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Monika Budnik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
| | - Janusz Kochanowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Radoslaw Piatkowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Marek Chojnowski
- Nuclear Medicine Department, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | | | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Joanna Maczewska
- Nuclear Medicine Department, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Michał Peller
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Leszek Krolicki
- Nuclear Medicine Department, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
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20
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Bhambhvani P. Under the hood of the stunned takotsubo heart. J Nucl Cardiol 2018; 25:1271-1273. [PMID: 28188444 DOI: 10.1007/s12350-017-0821-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Pradeep Bhambhvani
- Department of Radiology, Division of Molecular Imaging and Therapeutics, The University of Alabama at Birmingham, Birmingham, USA.
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21
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Sugihara Y, Fukushima Y, Kumita SI, Takano H, Shimizu W. Diagnostic performance of hybrid cardiac SPECT/CT imaging for patients with takotsubo cardiomyopathy. Eur J Hybrid Imaging 2018; 2:5. [PMID: 29782596 PMCID: PMC5954745 DOI: 10.1186/s41824-017-0023-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/20/2017] [Indexed: 11/15/2022] Open
Abstract
Background The diagnostic performance of SPECT-only imaging for takotsubo cardiomyopathy (TC) is limited due to the lack of coronary artery distribution information. The aim of this study was to evaluate the diagnostic performance of hybrid cardiac SPECT/CT for patients with TC or acute coronary syndrome (ACS). Methods Twenty-two patients with apical ballooning left ventricular (LV) dysfunction who underwent cardiac perfusion SPECT using 99mTc-methoxy-isobutyl-isonitrile (MIBI), cardiac fatty-acid metabolism SPECT using 123I–beta-methyl-P-iodophenyl-pentadecanoic acid (BMIPP), cardiac CT, and hybrid cardiac SPECT/CT imaging were analyzed. On the SPECT images, MIBI and BMIPP defects were quantified using a 17-segment model with a 5-point grading system and a summed MIBI defect score (SMDS), summed BMIPP defect score (SBDS), and summed mismatch score (SMS) were calculated. Furthermore, apical and non-apical MDS, BDS, and mismatch scores (A- and NA-MDS, A- and NA-BDS, and A- and NA-MS) were calculated. These quantitative scores were compared between the TC (n = 11) and ACS (n = 11) groups, and the diagnostic performances of SPECT-only imaging and hybrid SPECT/CT imaging were compared. For all patients, the diagnoses of both SPECT-only and SPECT/CT imaging were categorized as TC: SPECT accumulation defects around apical LV wall deviated from the actual coronary artery territories, equivocal: unclear relationship of accumulation defects and the coronary artery territories, or non-TC: accumulation defects coincided with the coronary artery territories. Results SMDS and SBDS did not significantly differ between TC and ACS patients [SMDS: 5 (3–7) vs. 8 (4–16), p = 0.216; SBDS: 10 (8–12) vs. 18 (9–24), p = 0.354]. While A-MDS and A-BDS did not significantly differ between patients with TC and ACS (p = 0.567 and p = 0.386, respectively), NA-MDS and NA-BDS were significantly lower for patients with TC (p = 0.022 and p = 0.022, respectively). Compared with SPECT-only imaging (sensitivity: 30% and specificity: 81%), hybrid SPECT/CT imaging showed a higher accuracy (sensitivity: 90% and specificity: 100%) for the diagnosis of TC. Conclusions Hybrid cardiac SPECT/CT imaging may have superior diagnostic performance compared with SPECT-only imaging for patients with TC.
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Affiliation(s)
- Yasuro Sugihara
- 1Department of Clinical Radiology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-0022 Japan
| | - Yoshimitsu Fukushima
- 1Department of Clinical Radiology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-0022 Japan
| | - Shin-Ichiro Kumita
- 1Department of Clinical Radiology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-0022 Japan
| | - Hitoshi Takano
- 2Department of Cardiovascular Medicine, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ward, Tokyo, 113-0022 Japan
| | - Wataru Shimizu
- 2Department of Cardiovascular Medicine, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ward, Tokyo, 113-0022 Japan
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22
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Heckle MR, McCoy CW, Akinseye OA, Khouzam RN. Stress-induced thrombus: prevalence of thromboembolic events and the role of anticoagulation in Takotsubo cardiomyopathy. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:4. [PMID: 29404350 DOI: 10.21037/atm.2017.11.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy has a favorable prognosis with expected recovery in weeks. Left ventricular (LV) thrombus is a known complication of TCM, which can lead to embolization and potentially a stroke. The prevalence of LV thrombus and the role of anticoagulation have yet to be fully defined in this condition. Methods We performed a search of published literature through PubMed and Scopus, which identified 282 patients with TCM in whom the incidence of LV thrombus and/or thromboembolic event was reported. In order to contrast this to the current anticoagulation strategy of atrial fibrillation, the occurrence of LV thrombus was compared to the adjusted stroke rate using the CHADS2 score. Results Of the 282 patients identified through a literature search, 26 (9.2%) were noted to have a thromboembolic event in the setting of TCM. The incidence of thromboembolic event ranged from 5.3% to as high as 14.3%. When compared to the CH2sDS2-VASc score, the average incidence of LV thrombus in our study equated to a score between 4 and 5. Conclusions While the occurrence of LV thrombus in TCM is variable among studies, the average incidence remains relatively high. Thus, making LV thrombus a significant complication of stress-induced cardiomyopathy. Prophylactic anticoagulation until recovery may have a role in reducing the rate of LV thrombus. Further studies will be needed to determine the rate of embolization and utility of anticoagulation in TCM.
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Affiliation(s)
- Mark R Heckle
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cody W McCoy
- University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Rami N Khouzam
- University of Tennessee Health Science Center, Memphis, TN, USA
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23
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Novo G, Quagliana A, Buccheri D, Rizzo S, Giambanco S, Giambanco F, Evola S, Geraci G, Novo S. Characteristics of coronary microcirculatory function in patients with Takotsubo syndrome. J Thorac Dis 2017; 9:4531-4537. [PMID: 29268523 PMCID: PMC5721058 DOI: 10.21037/jtd.2017.10.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 10/16/2017] [Indexed: 08/30/2023]
Abstract
BACKGROUND Takotsubo syndrome (TS) is a recently described cardiac syndrome whose pathogenesis is still unclear. We investigated the characteristics of coronary microcirculatory function in patients with TS through the analysis of the TIMI frame count (TFC) compared to normal subjects and with to subjects with microvascular angina (MA). METHODS We enrolled 71 TS patients (F:M =69:2, mean age of 65.27±9.53 years), 70 controls (F:M =34:36, mean age of 56.63±13.5 years) and 71 patients with MA, (F:M =69:2, mean age of 65.9±9.2 years). The assessment of the microcirculation was carried out through the TFC. RESULTS microcirculation was significantly altered in patients with TS compared with healthy controls [left anterior descending coronary artery (LAD) 25.16±6.91 vs. 17.30±3.76, P<0.001; circumflex artery (CX) 25.48±6.10 vs. 17.05±4.60, P<0.001; right coronary artery (RCA) 26.43±8.95 vs. 15.74±4.27, P<0.001, average TFC in TS 25.70±5.34 vs. 16,70±3.26, P<0.001). A TFC >20 frames was able to discriminate TS patients from controls with a specificity of 88.57% and sensitivity of 85.92% (AUC 0.927, P<0.0001). Microvascular dysfunction was diffuse in TS as well as in MA and slightly more severe in this last (mean TFC in MA 28.25±9.3 vs. 25.7±5.34 in TS, P<0.046). CONCLUSIONS Coronary microcirculation in TS patients is diffuse and milder compared to MA patients. Cut-off values >20 frames discriminate between patients with normal microcirculation and patients with TS.
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Affiliation(s)
- Giuseppina Novo
- Chair and Division of Cardiology, University of Palermo, Palermo, Italy
| | - Angelo Quagliana
- Chair and Division of Cardiology, University of Palermo, Palermo, Italy
| | - Dario Buccheri
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Salvatore Rizzo
- Chair and Division of Cardiology, University of Palermo, Palermo, Italy
| | - Salvatore Giambanco
- Chair and Division of Cardiology, University of Palermo, Palermo, Italy
- Division of Cardiology, Ingrassia Hospital, Palermo, Italy
| | | | - Salvatore Evola
- Chair and Division of Cardiology, University of Palermo, Palermo, Italy
| | | | - Salvatore Novo
- Chair and Division of Cardiology, University of Palermo, Palermo, Italy
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24
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Aniskevich S, Chadha RM, Peiris P, Taner CB, Torp KL, Thomas CS, Yataco ML, Pai SL. Intra-operative predictors of postoperative Takotsubo syndrome in liver transplant recipients-An exploratory case-control study. Clin Transplant 2017; 31. [PMID: 28833618 DOI: 10.1111/ctr.13092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy or stress-induced cardiomyopathy, has been described following a variety of surgeries and disease states. The relationship between intra-operative anesthesia management and the development of this syndrome has never been fully elucidated. OBJECTIVES The primary objective of this study was to determine the relationship of multiple intra-operative factors on the pathogenesis of TTS. METHODS A single-center retrospective review of all liver transplants performed at Mayo Clinic Florida from January 2005 to December 2014. Patients developing left ventricular dilation and a concomitant decrease in ejection fraction, a negative cardiac catheterization, or stress test within 30 days of transplantation were identified. Cases were matched 2:1 to controls with respect to MELD, age, sex, and indication for transplantation. Our evaluation included liver graft characteristics, intra-operative medications, and intra-operative hemodynamic measurements. RESULTS We identified 24 cases of TTS from a pool of 1752 transplants, for an incidence of 1.4%. No statistically significant differences in intra-operative measures between the two groups were identified (all P ≥ .08). CONCLUSION Our exploratory, single-center retrospective review evaluating 46 intra-operative characteristics found no association with the development of TTS.
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Affiliation(s)
- Stephen Aniskevich
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ryan M Chadha
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Prith Peiris
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Cemal Burcin Taner
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Klaus L Torp
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Colleen S Thomas
- Department of Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Maria L Yataco
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sher-Lu Pai
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL, USA
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Grimaldi S, Doche E, Rey C, Laksiri N, Boussen S, Quilici J, Robinet E, Devemy F, Pelletier J. Association of Posterior Reversible Encephalopathy Syndrome and Transient Apical Ballooning Syndrome (Takotsubo): First Case Report of a Man and Review of the Literature. Case Rep Neurol 2017; 9:173-178. [PMID: 28868030 PMCID: PMC5567116 DOI: 10.1159/000474933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/31/2017] [Indexed: 01/23/2023] Open
Abstract
Introduction An association of posterior reversible encephalopathy syndrome (PRES) and takotsubo is rare. We present the first case of a male patient. Case Report A 69-year-old man presented to the hospital in a persistent comatose state following a generalized tonic-clonic seizure with high blood pressure. The electrocardiogram revealed transient left bundle branch block. Troponin and BNP were elevated. Cardiac ultrasound showed large apical akinesia with altered left ventricular ejection fraction, and the left ventriculogram showed characteristic regional wall motion abnormalities involving the mid and apical segments. Brain MRI showed bilateral, cortical, and subcortical vasogenic edema predominant in the posterior right hemisphere. The lumbar puncture and cerebral angiography were normal. Paraclinical abnormalities were reversible within 2 weeks with a clinical recovery in 3 months, confirming the takotsubo and the PRES diagnoses. Discussion Several theories hypothesize the underlying pathophysiology of takotsubo or PRES. Circulating catecholamines are up to 3 times higher in patients with takotsubo causing impaired microcirculation and apical hypokinesia. An association of both takotsubo and asthma crisis and PRES and asthma crisis underlines the role of catecholamines in the occurrence of these disorders. Conclusion Early recognition of this rare association, in which heart and neurological damage may require rapid intensive care support, is needed.
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Affiliation(s)
- Stephan Grimaldi
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie et Unité NeuroVasculaire, Marseille, France
| | - Emilie Doche
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie et Unité NeuroVasculaire, Marseille, France
| | - Caroline Rey
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie et Unité NeuroVasculaire, Marseille, France
| | - Nadia Laksiri
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie et Unité NeuroVasculaire, Marseille, France
| | - Salah Boussen
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle Anesthésie Réanimation, Service d'Anesthésie Réanimation 1, Marseille, France
| | - Jacques Quilici
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle Cardiovasculaire et Thoracique, Service de Cardiologie et Maladies Coronaires, Marseille, France
| | - Emmanuelle Robinet
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie et Unité NeuroVasculaire, Marseille, France
| | - Fabien Devemy
- Centre Hospitalier Alpes du Sud, Service de Cardiologie, Gap, France
| | - Jean Pelletier
- Aix Marseille Université, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie et Unité NeuroVasculaire, Marseille, France
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Min SY, Song JM, Shin Y, Sin MJ, Kim DH, Kang DH, Song JK. Quantitative segmental analysis of myocardial perfusion to differentiate stress cardiomyopathy from acute myocardial infarction: A myocardial contrast echocardiography study. Clin Cardiol 2017; 40:679-685. [PMID: 28430369 DOI: 10.1002/clc.22714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/04/2017] [Accepted: 03/08/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Both stress cardiomyopathy (SCMP) and acute myocardial infarction (AMI) present with similar clinical symptoms and signs, and apical akinesis. HYPOTHESIS Quantitative segmental analysis of myocardial contrast echocardiography (MCE) helps to differentiate AMI from SCMP. METHODS Real-time MCE was performed in 33 consecutive patients who presented with an acute symptom/sign and a new apical akinesis on echocardiography. In 18 left ventricular (LV) myocardial segments, a replenishment curve was obtained in each segment to measure peak plateau myocardial contrast intensity (MCI) (A) and the replenishment curve slope (β). The calibrated MCI was also measured in each segment. RESULTS Among 33 patients, 22 were diagnosed with SCMP and 11 were diagnosed with AMI according to comprehensive diagnostic criteria. A, β, Aβ, and the calibrated MCI were lower in akinetic than in normokinetic segments in both the SCMP and AMI groups. In the akinetic segments, A, β, Aβ, and the calibrated MCI in SCMP patients were each higher than those in AMI patients. In patient-based analyses, areas under the ROC curves of A, β, Aβ, and the calibrated MCI for diagnosing AMI were 0.769, 0.607, 0.822, and 0.934, respectively. The optimal cutoff values to diagnose AMI were Aβ < 3.7 dB/sec (sensitivity 82%, specificity 82%) and a calibrated MCI < -23 dB (sensitivity 91%, specificity 95%). CONCLUSIONS Although myocardial perfusion is relatively reduced in the akinetic segments of SCMP, a quantitative segmental analysis of myocardial perfusion using MCE helps to discriminate AMI from SCMP.
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Affiliation(s)
- Sun-Yang Min
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Song
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yewon Shin
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min-Jung Sin
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Kwan Song
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Derk GR, Aboulhosn J, Reardon LC. Takotsubo Cardiomyopathy in a 22-Year-Old Single-Ventricle Patient. Tex Heart Inst J 2016; 43:61-4. [PMID: 27047288 DOI: 10.14503/thij-14-4151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report a highly unusual case of a 22-year-old woman with single-ventricle anatomy and a history of Fontan palliation who developed takotsubo cardiomyopathy. To our knowledge, takotsubo cardiomyopathy has not previously been described in a patient with single-ventricle anatomy, or more generally in any patient with congenital heart disease. The patient presented at our clinic for urgent examination after a 2-day history of chest pain that had begun upon the death of her dog. Invasive evaluation was refused by the patient; instead, she underwent electrocardiogram-gated coronary computed tomographic angiography, to rule out obstructive coronary disease. A physician who suspects takotsubo cardiomyopathy in a patient should look for new-onset chest pain and dyspnea coupled with these features: immediate onset of segmental akinesia in the midventricular or apical aspects of the heart, elevation of brain natriuretic peptide level 12 to 24 hours after onset of akinesia, elevation of troponin level 24 to 48 hours after onset, and disappearance of the segmental akinesia a few days after onset.
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Sengupta S, Mungulmare K, Wadaskar N, Pande A. Inverted Takotsubo cardiomyopathy after attempted suicidal hanging--two cases. Indian Heart J 2016; 68 Suppl 1:S52-6. [PMID: 27056654 PMCID: PMC4824329 DOI: 10.1016/j.ihj.2015.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/07/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
We report two cases of "Inverted Takotsubo cardiomyopathy" following attempted suicidal hanging. Both the patients presented with heart failure and had desaturation 8-12h after the suicidal attempt. Electrocardiography (ECG) showed ischemic changes. On echocardiography, the left ventricle (LV) showed ballooning and hypokinesia of the basal segments with apical sparing. Both patients underwent coronary angiograms considering the possibility of acute coronary syndrome. However, their coronary angiograms were normal. After 3-4 days of hospitalization, both recovered; their ECG had reversed and the LV contractility was normal on echocardiography.
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Abstract
Takotsubo cardiomyopathy (TTC) is a relatively frequent acute cardiac condition, but its pathogenesis has not been established as yet. Since the first descriptions of TTC, microvascular dysfunction has been advocated as a possible pathophysiological mechanism underlying the left ventricular wall motion abnormalities that characterize the syndrome. Several noninvasive and invasive methods have confirmed the involvement of coronary microvascular abnormalities in the pathogenesis of TTC, but whether microvascular dysfunction is the primary cause or a secondary phenomenon is still debated. The greater prevalence of TTC among postmenopausal women, along with the relationship identified between physical and emotional triggers and other "neuro-cardiac" mechanisms, suggest that increased microvascular reactivity, possibly sympathetically mediated, may play a pathogenic role in susceptible individuals. This review critically evaluates the possible role of microvascular dysfunction in the development of TTC.
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Drinking to near death—acute water intoxication leading to neurogenic stunned myocardium. Am J Emerg Med 2016; 34:119.e3-4. [DOI: 10.1016/j.ajem.2015.05.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
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Girardey M, Jesel L, Campia U, Messas N, Hess S, Imperiale A, Blondet C, Trinh A, Ohlmann P, Morel O. Impact of Malignancies in the Early and Late Time Course of Takotsubo Cardiomyopathy. Circ J 2016; 80:2192-8. [DOI: 10.1253/circj.cj-16-0388] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mélanie Girardey
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Laurence Jesel
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Umberto Campia
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center
| | - Nathan Messas
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Sébastien Hess
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Alessio Imperiale
- Radiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Cyrille Blondet
- Radiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Annie Trinh
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Patrick Ohlmann
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
| | - Olivier Morel
- Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg
- UMR CNRS 7213, Pharmacy Department, University of Strasbourg
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Talahma M, Alkhachroum AM, Alyahya M, Manjila S, Xiong W. Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: Institutional experience and literature review. Clin Neurol Neurosurg 2015; 141:65-70. [PMID: 26741878 DOI: 10.1016/j.clineuro.2015.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/30/2015] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To review the current practice in the diagnosis, monitoring and management of TCM in SAH patients at our tertiary referral institution and the relevant literature, and to evaluate the effect of certain treatment modalities on the outcome of those patients. PATIENTS AND METHODS A retrospective institutional chart review of 800 patients with aneurysmal SAH from 2007 to 2014. Eighteen patients were identified to have both aneurysmal SAH and TCM based on echocardiogram. Demographic data, clinical parameters, radiographic findings, treatment modalities, and laboratory results were analyzed. RESULTS The incidence of typical TCM in our patients was 2.2%. Mortality rate of TCM in SAH was 22% compared to the total mortality rate of all non-traumatic SAH patients of 15% in our institution over the same time period. Use of beta blockers prior to or after the diagnosis of TCM did not seem to affect their outcome. Majority of patients (61%) were on vasopressors prior to the diagnosis of TCM. Of those, 73% had good outcomes. Even after the diagnosis of TCM, good outcomes were observed in 6 of 7 patients who remained on vasopressors. CONCLUSION Despite the general agreement on the importance of the avoidance of vasopressors in TCM, our experience showed that the use of vasopressors is safe in these patients. The use of beta blockers in our patients was not associated with significantly better outcomes despite multiple previous reports on beta blocker usage in TCM.
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Affiliation(s)
- Murad Talahma
- University Hospitals Case Medical Center, Cleveland, OH, USA.
| | | | - Mossaed Alyahya
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sunil Manjila
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Wei Xiong
- University Hospitals Case Medical Center, Cleveland, OH, USA.
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Minhas AS, Hughey AB, Kolias TJ. Nationwide Trends in Reported Incidence of Takotsubo Cardiomyopathy from 2006 to 2012. Am J Cardiol 2015; 116:1128-31. [PMID: 26279109 DOI: 10.1016/j.amjcard.2015.06.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/20/2015] [Accepted: 06/20/2015] [Indexed: 01/06/2023]
Abstract
Takotsubo cardiomyopathy (TC) is believed to be an increasingly diagnosed syndrome; however, data on its incidence are limited. The purpose of this study was to determine the reported incidence of TC in the United States and to examine its trend over several years. Data was obtained from the Nationwide Inpatient Sample, created by the Agency for Healthcare Research and Quality, for each of the years from 2006 to 2012. Hospital discharges with principal diagnosis of TC, identified using Internal Classification of Diseases, Ninth Revision, code 429.83, were included. We tabulated estimated total numbers of discharges, incidence per 100,000 persons, mean length of stay, inhospital death rates, and diagnoses stratified by age group and gender. The reported incidence of TC based on principal diagnosis at hospital discharge increased significantly over the study period, with 315 cases ± 43 (standard error) in 2006 and 6,230 cases ± 232 (standard error) in 2012 (p <0.001 for trend). Mean length of hospital stay was stable over the study period (3.4 days in 2006 vs 3.6 days in 2012; p = 0.74 for trend). The diagnosis was most frequent in patients aged 65 to 84 years (50% of all diagnoses in 2012), followed by those aged 45 to 64 years (39% of all diagnoses in 2012). Women accounted for >90% of diagnoses throughout the study period. In conclusion, the reported incidence of TC has increased significantly from 2006 to 2012, most likely because of increasing recognition of the syndrome.
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Supradesnivelamento do segmento ST durante anestesia geral para cirurgia não cardíaca: um caso de takotsubo. Braz J Anesthesiol 2015; 65:403-6. [DOI: 10.1016/j.bjan.2014.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/28/2014] [Indexed: 11/18/2022] Open
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Takotsubo Cardiomyopathy in the Setting of Tension Pneumothorax. Case Rep Crit Care 2015; 2015:536931. [PMID: 26366307 PMCID: PMC4561098 DOI: 10.1155/2015/536931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting. Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL), troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10-15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient's condition improved with a subsequent echocardiogram showing a LVEF of 60%. Conclusion. The patient was found to have Takotsubo cardiomyopathy in the setting of a tension pneumothorax. The exact mechanisms of ventricular dysfunction have not been clarified. However, multivessel coronary spasm or catecholamine cardiotoxicity has been suggested to have a causative role. We suggest that, in our patient, left ventricular dysfunction was induced by the latter mechanism related to the stress associated with acute pneumothorax.
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Rodrigues LBH, Batista A, Monteiro F, Duarte JS. ST-segment elevation during general anesthesia for non-cardiac surgery: a case of takotsubo. Braz J Anesthesiol 2015; 65:403-6. [PMID: 26323740 DOI: 10.1016/j.bjane.2014.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Takotsubo cardiomyopathy, also known as broken heart syndrome is a stress-induced cardiomyopathy, which can be interpreted as an acute coronary syndrome as it progresses with suggestive electrocardiographic changes. The purpose of this article is to show the importance of proper monitoring during surgery, as well as the presence of an interdisciplinary team to diagnose the syndrome. CASE REPORT Male patient, 66 years old, with diagnosis of gastric carcinoma, scheduled for diagnostic laparoscopy and possible gastrectomy. In the intraoperative period during laparoscopy, the patient always remained hemodynamically stable, but after conversion to open surgery he presented with ST segment elevation in DII. ECG during surgery was performed and confirmed ST-segment elevation in the inferior wall. The cardiology team was contacted and indicated the emergency catheterization. As the surgery had not yet begun irreversible steps, we opted for the laparotomy closure, and the patient was immediately taken to the hemodynamic room where catheterization was performed showing no coronary injury. The patient was taken to the hospital room where an echocardiogram was performed and showed slight to moderate systolic dysfunction, with akinesia of the mid-apical segments, suggestive of apical ballooning of the left ventricle. Faced with such echocardiographic finding and in the absence of coronary injury, the patient was diagnosed with intraoperative Takotsubo syndrome. CONCLUSION Because the patient was properly monitored, the early detection of ST-segment elevation was possible. The presence of an interdisciplinary team favored the syndrome early diagnosis, so the patient was again submitted to safely intervention, with the necessary security measures taken for an uneventful new surgical intervention.
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Affiliation(s)
| | - Ana Batista
- Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal
| | - Fátima Monteiro
- Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal
| | - João Silva Duarte
- Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal
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The broken heart syndrome: Takotsubo cardiomyopathy. Trends Cardiovasc Med 2015; 25:351-7. [DOI: 10.1016/j.tcm.2014.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 01/18/2023]
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von Blotzheim LG, Christen S, Wieser S, Ulrich S, Huber LC. Evidence for an association between tako-tsubo cardiomyopathy and bronchial asthma: retrospective analysis in a primary care hospital. Open Cardiovasc Med J 2015; 9:1-4. [PMID: 25767631 PMCID: PMC4353125 DOI: 10.2174/1874192401509010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 01/25/2023] Open
Abstract
Objective: We investigated the prevalence of bronchial asthma in patients with Tako-Tsubo Syndrome (TTS). Design: This retrospective case-series study was conducted in a primary care hospital in Zurich, Switzerland. Data of all patients with newly diagnosed TTS (2002 - 2012) were assessed electronically by the use of ICD-10. Asthma prevalence was compared to published epidemiologic data. Setting: Bronchial asthma is characterized by airway inflammation and, during attack, release of endogenous catecholamines. Sympathomimetic drugs are the mainstay of treatment for asthma patients. Likewise, catecholamine mediated diffuse microvascular myocardial dysfunction seems to be of critical importance for the development of TTS. Results: 20 cases of TTS were identified. 90% were female, showed a median age of 70±13y [25y - 90y], an apical and/or midventricular ballooning pattern with preserved basal function and a median initial LVEF of 34±9% [25% - 55%]. 65% of patients underwent coronary angiography to rule out significant coronary artery disease. Hypertension was present in 45% of patients, 35% were smokers, none was suffering from diabetes. Prevalence of asthma in patients with TTS was significantly higher compared to the normal population (25% vs. 7%, p=0.012). In 30% of the TTS patients an iatrogenic cause for development of TTS was identified. Conclusion: Prevalence of asthma was significantly higher in patients with TTS compared to epidemiologic data from an age-matched population. Phenotypes of patients developing obstructive ventilatory disease and TTS might share common pathogenic mechanisms beyond the use of bronchodilatators. In addition, we identified other iatrogenic etiologies in patients with TTS.
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Affiliation(s)
- Leonardo Glutz von Blotzheim
- Division of Cardiology, Waid City Hospital, Zurich, Switzerland ; Department of Internal Medicine, Citizen's Hospital Solothurn, Switzerland
| | - Stefan Christen
- Division of Cardiology, Waid City Hospital, Zurich, Switzerland
| | - Stephan Wieser
- Division of Pulmonology, Waid City Hospital, Zurich, Switzerland
| | - Silvia Ulrich
- Division of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Lars C Huber
- Division of Pulmonology, Waid City Hospital, Zurich, Switzerland ; Division of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
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Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. BMC Res Notes 2014; 7:932. [PMID: 25522887 PMCID: PMC4320635 DOI: 10.1186/1756-0500-7-932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/12/2014] [Indexed: 11/17/2022] Open
Abstract
Objective There is very little literature regarding Takotsubo Cardiomyopathy (TTC) from the Asian Countries other than Japan and Korea. We conducted this study to determine the demographics, clinical presentations, complications and recovery of left ventricular (LV) systolic function in TTC patients of Pakistani origin. Methods A ten years retrospective case series study of TTC was conducted at the Aga Khan University Hospital. Patients were followed for up to six months after presentation, with special emphasis on the recovery of LV function. Conclusion TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not always be identified. It usually presents in the guise of an acute coronary syndrome (ACS). Our data was congruent with the existing literature, except for more heart failure and cardiogenic shock. Average Troponin-I (Tn-I) levels were also higher as compared to western population. The reason for more severity in our patients may be late presentation or different level of response to stress.
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Bathina J, Weiss S, Weintraub WS. Understanding the pathophysiology of apical ballooning syndrome: a step closer. Expert Rev Cardiovasc Ther 2014; 13:5-8. [PMID: 25487296 DOI: 10.1586/14779072.2014.980237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although it has been almost 20 years since the first case of Takotsubo cardiomyopathy was described in Japan, its pathophysiology remains an enigma. While several hypotheses have been proposed to explain the pathophysiology, the exact mechanism of the syndrome is unknown. This editorial reviews the literature published on various theories on the pathophysiology of Takotsubo cardiomyopathy.
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Y-Hassan S, Henareh L. Plasma catecholamine levels in patients with takotsubo syndrome: Implications for the pathogenesis of the disease. Int J Cardiol 2014; 181:35-8. [PMID: 25481310 DOI: 10.1016/j.ijcard.2014.11.149] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/22/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Shams Y-Hassan
- Karolinska Institute at Karolinska University Hospital, Department of Cardiology, Sweden.
| | - Loghman Henareh
- Karolinska Institute at Karolinska University Hospital, Department of Cardiology, Sweden
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64:e139-e228. [PMID: 25260718 DOI: 10.1016/j.jacc.2014.09.017] [Citation(s) in RCA: 2088] [Impact Index Per Article: 208.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e344-426. [PMID: 25249585 DOI: 10.1161/cir.0000000000000134] [Citation(s) in RCA: 636] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Verschure DO, Somsen GA, van Eck-Smit BLF, Knol RJJ, Booij J, Verberne HJ. Tako-tsubo cardiomyopathy: how to understand possible pathophysiological mechanism and the role of (123)I-MIBG imaging. J Nucl Cardiol 2014; 21:730-8. [PMID: 24464623 DOI: 10.1007/s12350-014-9855-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 12/23/2013] [Indexed: 01/29/2023]
Abstract
Tako-tsubo cardiomyopathy (TCM) is an increasingly recognized clinical syndrome characterized by acute reversible apical ventricular dysfunction, commonly preceded by exposure to severe physical or emotional stress. In this review, we give a short overview on clinical presentation and treatment of TCM and discuss the possible pathophysiological mechanisms of TCM and the role of various non-invasive imaging modalities in TCM with a focus on the potential role of (123)I-meta-iodobenzylguanidine (MIBG) scintigraphy. Currently, the dominating hypothesis on the pathophysiology of TCM postulates that high levels of the neurotransmitter epinephrine may trigger a change in intracellular signaling in ventricular myocytes. More specific, epinephrine stimulates G-protein coupled β2 adenoreceptors (β2AR) which are located on ventricular myocytes. Normal levels of this neurotransmitter predominantly stimulate the intracellular G-protein, and induce a positive inotropic effect. However, with significant increasing levels of epinephrine, the predominance of stimulation is shifted from G-stimulating to the G-inhibitor protein coupling, which leads to a negative inotropic effect. Interestingly, this negative inotropic effect is the largest in the apical myocardium where the β2AR:β1AR ratio is the highest within the heart. Echocardiography and ventriculography are essential to diagnose TCM, but new imaging tools are promising to diagnose TCM and to evaluate therapeutic efficacy. Cardiovascular magnetic resonance can be used to differentiate TCM from other myocardial diseases, such as myocarditis. (123)I-meta-iodobenzylguanidine ((123)I-MIBG) scintigraphy can be used to assess ventricular adrenergic activity and may guide optimization of individual (pharmacological) therapy. These new insights into the possible pathophysiological mechanisms and novel diagnostic imaging modalities can be used as starting point for the development of international guidelines of TCM which may increase the awareness, and optimize the treatment of TCM.
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Affiliation(s)
- Derk O Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, F2-Noord, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Wybraniec M, Mizia-Stec K, Krzych L. Stress cardiomyopathy: yet another type of neurocardiogenic injury: 'stress cardiomyopathy'. Cardiovasc Pathol 2013; 23:113-20. [PMID: 24462197 DOI: 10.1016/j.carpath.2013.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 01/29/2023] Open
Abstract
Tako-tsubo syndrome pertains to rare acquired cardiomyopathies, characterized by left ventricular dyskinesia and symptomatology typical for acute myocardial infarction (AMI). Despite its low incidence and relatively benign course, stress cardiomyopathy should be thoroughly differentiated from AMI. The importance of tako-tsubo consists of the fact that its manifestation initially resembles AMI. Despite seemingly low incidence of tako-tsubo, acute coronary syndromes globally constitute a major epidemiological issue and both clinical entities should be accurately differentiated. Many patients present with only mild troponin release, certain extent of regional wall motion abnormalities (RWMA) and absence of hemodynamically significant coronary artery stenosis. In such instances, a careful interview aimed at preceding emotional or physical traumatic event should be undertaken. The subsequent verification of the diagnosis is based upon prompt recovery of contractile function. Although precise diagnostic criteria were formulated, symptomatology of tako-tsubo might be clinically misleading due to the possibility of concomitant coronary vasospasm, atypical pattern of RWMA and presence of non-significant coronary disease. For this reason, its exact rate might be underestimated. Stress cardiomyopathy reflects merely a single aspect of a much wider range of neurocardiogenic injury, which encompasses cardiac dysfunction associated with subarachnoid hemorrhage, intracranial hypertension and cerebral ischemia. Both psychological and physical insult to central nervous system may trigger a disastrous response of sympathetic nervous system, eventually leading to end-organ catecholamine-mediated damage. This review sought to delineate the phenomenon of tako-tsubo cardiomyopathy and deliver evidence for common pathophysiology of the broad spectrum of neurocardiogenic injury.
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Affiliation(s)
- Maciej Wybraniec
- First Department of Cardiology, Medical University of Silesia, Upper Silesian Medical Centre in Katowice, Poland.
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, Medical University of Silesia, Upper Silesian Medical Centre in Katowice, Poland
| | - Lukasz Krzych
- Department of Cardiac Surgery, Medical University of Silesia, Upper Silesian Medical Centre in Katowice, Poland
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Matsuo S, Nakajima K, Kinuya S, Yamagishi M. Diagnostic utility of 123I-BMIPP imaging in patients with Takotsubo cardiomyopathy. J Cardiol 2013; 64:49-56. [PMID: 24331764 DOI: 10.1016/j.jjcc.2013.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Takotsubo cardiomyopathy is a cardiac syndrome with an acute onset defined by chest symptoms and ST segment elevation on electrocardiograms. Takotsubo cardiomyopathy is sometimes misdiagnosed as acute myocardial infarction (AMI). Therefore a non-invasive diagnostic method is needed to be established for setting up appropriate strategies. The purpose of this study was to detect myocardial metabolic abnormalities and to determine the diagnostic usefulness of (123)I-beta-methy-iodophenyl pentadecanoic acid ((123)I-BMIPP) imaging in patients with takotsubo cardiomyopathy. METHODS AND RESULTS We examined 16 patients with takotsubo cardiomyopathy and 12 with AMI in the left anterior descending artery. All patients were studied with resting (123)I-BMIPP imaging. Total defect score (TDS) of (123)I-BMIPP and perfusion were semi-quantitatively determined with single-photon emission computed tomography (SPECT) imaging using a 17-segment 5-point model. TDS of (123)I-BMIPP were 4.8 ± 2.7 in patients with Takotsubo cardiomyopathy and 22.4 ± 10.7 in AMI. The ratio of summed BMIPP defect score of non-apical to apical segments in Takotsubo cardiomyopathy was smaller than that of the patients with AMI (0.1 ± 0.1 vs. 1.1 ± 0.7, p < 0.0001), indicating that (123)I-BMIPP abnormalities were exclusively observed the in apical area. The ratio of summed perfusion defect scores of non-apical to apical segments in takotsubo cardiomyopathy did not differ significantly from that of AMI (0.52 ± 0.6 vs. 0.57 ± 0.3, p = NS). Summed BMIPP defect score in the apical area of takotsubo cardiomyopathy was larger than that of perfusion defect score (3.9 ± 2.7 vs. 1.8 ± 1.8, p = 0.04). CONCLUSION Impaired metabolic metabolism exclusively in the apical region was observed by (123)I-BMIPP SPECT images in takotsubo cardiomyopathy. These typical metabolic SPECT features of the disease can be utilized on differential diagnosis of takotsubo cardiomyopathy.
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Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: A systematic review of the reported cases. Int J Cardiol 2013; 167:2441-8. [DOI: 10.1016/j.ijcard.2013.01.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/19/2012] [Accepted: 01/18/2013] [Indexed: 01/09/2023]
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Takotsubo Cardiomyopathy following a L2-L5 Laminectomy and Fusion In Situ with Bone Morphogenic Protein. Case Rep Orthop 2013; 2013:724960. [PMID: 23585979 PMCID: PMC3622306 DOI: 10.1155/2013/724960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/03/2013] [Indexed: 11/17/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a rare, transient cardiomyopathy, with symptoms mimicking myocardial infarction. It has been reported to typically occur in postmenopausal women and is often triggered by an intense physical or emotional event with stimulation of the sympathetic response; the exact etiology, however, is uncertain. Bone morphogenic protein (BMP) is widely used in spinal fusions and has been associated with numerous perioperative complications. BMP is known to stimulate sympathetic pathways. In this paper, we present the case of a patient with a 7-hour episode of TC after a spinal fusion with bone morphogenic protein. The patient's symptoms resolved and long-term followup has been uneventful. This is the first paper to describe TC in the setting of spine or other major orthopaedic surgery and it suggests another possible area for further investigation in peri-operative events potentially associated with the use of bone morphogenic protein.
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