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Kato K, Di Vece D, Kitagawa M, Yamamoto K, Aoki S, Goto H, Kitahara H, Kobayashi Y, Templin C. Cardiogenic shock in takotsubo syndrome: etiology and treatment. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01031-3. [PMID: 39039401 DOI: 10.1007/s12928-024-01031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024]
Abstract
Takotsubo syndrome (TTS) can mimic acute coronary syndrome despite being a distinct disease. While typically benign, TTS can lead to serious complications like cardiogenic shock. Cardiogenic shock occurs in 1-20% of TTS cases. Various mechanisms can cause shock, including pump failure, right ventricular involvement, left ventricular outflow tract obstruction, and acute mitral regurgitation. Because treatment depends on the mechanism, early identification of the mechanism developing cardiogenic shock is essential for optimal treatment and improved outcomes in TTS patients with cardiogenic shock. This review summarizes current knowledge on causes and treatment of cardiogenic shock in patients with TTS.
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Affiliation(s)
- Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Davide Di Vece
- Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Mari Kitagawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kayo Yamamoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Shuhei Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Christian Templin
- Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
- Swiss Cardiovascular Clinic, Private Hospital Bethanien, Zurich, Switzerland
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Watanabe Y, Yoshikawa T, Isogai T, Sakata K, Yamaguchi T, Arao K, Takaoka Y, Inohara T, Imori Y, Mochizuki H, Yamamoto T, Asai K, Nagao K, Takayama M. Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network. J Cardiol 2023; 82:356-362. [PMID: 37343932 DOI: 10.1016/j.jjcc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Hypoalbuminemia is common in critically ill patients and is associated with poor outcomes. However, the relationship between serum albumin levels and clinical outcomes in patients with takotsubo syndrome remains unclear. We examined the impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome. METHODS Using the multicenter registry of the Tokyo Cardiovascular Care Unit Network between January 2017 and December 2020, we identified 631 eligible patients with takotsubo syndrome (median age, 78 years; male proportion, 22 %) and documented serum albumin levels at admission, which were used to allocate patients to hypoalbuminemia (serum albumin <3.5 g/dL) or normal albumin (serum albumin ≥3.5 g/dL) groups. Patient characteristics and in-hospital mortality were compared between the groups. RESULTS Hypoalbuminemia was detected in 200 (32 %) patients at admission. The hypoalbuminemia group was older and had a higher proportion of men and preceding physical triggers than the normal albumin group. In-hospital all-cause mortality was greater in the hypoalbuminemia group than in the normal albumin group (9.5 % vs. 1.9 %, p < 0.001). Both cardiac (3.0 % vs. 0.5 %, p = 0.015) and non-cardiac (6.5 % vs. 1.4 %, p = 0.002) mortality was greater in the hypoalbuminemia group. In multivariable logistic regression analysis, hypoalbuminemia was independently associated with increased in-hospital mortality, even after adjusting for confounders, including age, sex, and triggering events (odds ratio, 3.23; 95 % confidence interval, 1.31-7.95; p = 0.011). CONCLUSIONS In patients with takotsubo syndrome, hypoalbuminemia is a common comorbidity and is associated with a substantial risk of in-hospital death. Close monitoring and comprehensive critical care are required in these patients.
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Affiliation(s)
- Yukihiro Watanabe
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Taku Inohara
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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Alim S, Shah H, Zahera SM, Rahmatova J, Irfan M, Mahmood Z, Zahra SA. An update on Takotsubo syndrome. J Cardiovasc Med (Hagerstown) 2023; 24:691-699. [PMID: 37577868 DOI: 10.2459/jcm.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
ABSTRACT Takotsubo syndrome (TTS) can be described as an acute, transiently occurring form of heart failure. It typically causes systolic dysfunction of the left ventricle (LV). Perhaps what is of most significance is the reversible nature of TTS, with many patients achieving recovery within a few weeks to months. TTS can be referred to by other names, attributed to its various precipitants, as well as the structural manifestations of the syndrome. Physical and emotional stressors have been identified as the most common of causes, hence the terms 'stress cardiomyopathy' and 'broken heart syndrome'. Precipitants can range from psychological, and hormonal, to molecular mechanisms. The symptoms of TTS can coalesce with other conditions and hence give rise to many differential diagnoses. Most patients present with dyspnoea and chest pain. The latter also presents in acute coronary syndrome (ACS); thus, ACS is a common differential diagnosis for TTS. The coronavirus disease 2019 (COVID-19) pandemic saw a drastic increase in mental health concerns which have persisted beyond this period. Further studies into personality disorders and their potential predisposition to COVID-19 and thus TTS would advance our understanding of the neuropsychiatric triggers of TTS. There is also a need for a single sensitive and specific diagnostic test for TTS as its diagnosis relies on the culmination of clinical presentation, echocardiography, cardiac catheterization, and cardiovascular magnetic resonance imaging (CMR).
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Affiliation(s)
- Samina Alim
- St George's, University of London Medical School
| | - Halia Shah
- St George's, University of London Medical School
| | | | | | | | | | - Syeda Anum Zahra
- The Hillingdon Hospital NHS Trust
- Imperial College School of Medicine, UK
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Ahn HJ, Kang J, Lee SR, Park JJ, Lee HY, Choi DJ, Cho HJ. Neutrophil-to-lymphocyte ratio as a predictor of in-hospital complications and overall mortality in Takotsubo syndrome preceded by physical triggers. BMC Cardiovasc Disord 2023; 23:51. [PMID: 36703129 PMCID: PMC9881304 DOI: 10.1186/s12872-023-03078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) with physical triggers has worse short- and long-term clinical courses than those with emotional triggers. However, predictive factors associated with poor outcomes of TTS with physical triggers are unknown. METHODS We included 231 patients identified as TTS preceded by physical triggers at two tertiary referral hospitals from 2010 to 2019. In-hospital complications (IHC)-a composite of malignant arrhythmia, need for mechanical circulatory support or mechanical ventilation, and in-hospital death-and overall mortality were retrospectively reviewed. The associations with clinical features were evaluated by multivariable logistic and Cox regression analyses. RESULTS The mean age was 69.3 ± 11.6 years, and 85 (36.8%) were male. The in-hospital complications rate was 46.8%. During a median follow-up of 883 days, 96 (41.6%) had died, and overall mortality was 13.6% per patient-year. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with a higher risk of IHC (area under the receiver operating characteristic curve = 0.73; positive and negative predictive value = 60.9% and 67.2% for NLR ≤ 12); odds ratio (OR) with 95% confidence interval (CI) was 1.03 (1.01-1.05), p = 0.010. Subsequently, higher NLR was also related to a greater risk of overall mortality; patients with high NLR (NLR > 12) exhibited poor long-term survival than those with low NLR (NLR ≤ 5): hazard ratio (95% CI), 3.70 (1.72-7.94) with p < 0.001. CONCLUSIONS A high NLR at initial presentation is associated with an increased risk of IHC and overall mortality in TTS preceded by physical triggers. Given that the treatment of TTS is mainly supportive, intensive monitoring with careful follow-up would be warranted in patients with high NLR.
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Affiliation(s)
- Hyo-Jeong Ahn
- grid.412484.f0000 0001 0302 820XDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jeehoon Kang
- grid.412484.f0000 0001 0302 820XDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- grid.412484.f0000 0001 0302 820XDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jin Joo Park
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hae-Young Lee
- grid.412484.f0000 0001 0302 820XDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Dong-Ju Choi
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun-Jai Cho
- grid.412484.f0000 0001 0302 820XDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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Zweiker D, Pogran E, Gargiulo L, Abd El-Razek A, Lechner I, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Czedik-Eysenberg C, Roithinger A, Weihs V, Kaufmann CC, Zirlik A, Bauer A, Metzler B, Lambert T, Steinwender C, Huber K. Neutrophile-Lymphocyte Ratio and Outcome in Takotsubo Syndrome. BIOLOGY 2022; 11:biology11081154. [PMID: 36009781 PMCID: PMC9404721 DOI: 10.3390/biology11081154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Background: Takotsubo syndrome (TTS) is an important type of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients and present long-term outcomes. Methods: In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of independent predictors on long-term survival was evaluated. Results: A total of 338 patients (median age 72 years, 86.9% female) from six centers were included. Severe in-hospital complications occurred in 14.5% of patients. In multivariable analysis, high neutrophile-lymphocyte-ratio (NLR; OR 1.04 [95% CI 1.02−1.07], p = 0.009) and low LVEF (OR 0.92 [0.90−0.95] per %, p < 0.001) were significant predictors of severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were significantly associated with reduced 5-year survival. Conclusions: Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short- and long-term outcome after TTS.
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Affiliation(s)
- David Zweiker
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
- Correspondence: ; Tel.: +43-664-8650460; Fax: +43-1-49150-2309
| | - Edita Pogran
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Laura Gargiulo
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Ahmed Abd El-Razek
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Ivan Lechner
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Ivan Vosko
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Stefan Rechberger
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Günter Christ
- 5th Medical Department for Cardiology, Clinic Favoriten, 1100 Vienna, Austria; (G.C.); (D.B.)
| | - Diana Bonderman
- 5th Medical Department for Cardiology, Clinic Favoriten, 1100 Vienna, Austria; (G.C.); (D.B.)
| | | | | | - Antonia Roithinger
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Valerie Weihs
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Core Facility, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christoph C. Kaufmann
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Axel Bauer
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Bernhard Metzler
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Thomas Lambert
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Clemens Steinwender
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
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6
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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: 14] [Impact Index Per Article: 4.7] [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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7
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Kinno R, Ono K. Takotsubo Syndrome: Optimizing Care with a Multidisciplinary Approach. J Multidiscip Healthc 2021; 14:2487-2499. [PMID: 34531661 PMCID: PMC8439972 DOI: 10.2147/jmdh.s283667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
Symptoms of takotsubo syndrome (TTS) include acute and transient regional systolic dysfunction of the left ventricle, as well as a variety of wall-motion abnormalities. The clinical features of TTS, including initial symptoms, cardiac biomarkers, and electrocardiogram (ECG) changes, are similar to those of acute coronary syndrome, with the exception that TTS patients typically have no obstructive coronary artery disease. TTS primarily affects elderly women, and emotional or physical stress is a common cause of the disease. Exaggerated sympathetic stimulation associated with dysfunction of the limbic system has also been reported to be related to TTS occurrence. Cancer also induces emotional and physical stress. Therefore, optimization of TTS care should involve cardiac, neurological, psychiatric, and oncological approaches. The first step in optimizing TTS care is to diagnose it by cardiac means. Multimodality imaging, including ECG, echocardiogram, angiography, ventriculography, and cardiac magnetic resonance imaging, is indispensable for diagnosis, therapy management, and the evaluation of prognosis in the acute and chronic phases of TTS. The current cardiac approach during the acute phase is primarily supportive, with the goal of preventing life-threatening complications. As central nervous system diseases frequently trigger TTS, a neurological approach is also required. Appropriate psychiatric medication may reduce the risk of TTS recurrence, as not only psychiatric disorders themselves but also psychiatric medications can be the trigger for TTS. Several conditions are associated with TTS, including the novel coronavirus disease 2019. We present current knowledge of TTS in this review and describe how to optimize TTS care through a multidisciplinary approach.
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Affiliation(s)
- Ryuta Kinno
- Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama City, Kanagawa, 224-8503, Japan
| | - Kenjiro Ono
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, 142-8555, Japan
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8
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Liang J, Zhang J, Xu Y, Teng C, Lu X, Wang Y, Zuo X, Li Q, Huang Z, Ma J, Li P. Conventional cardiovascular risk factors associated with Takotsubo cardiomyopathy: A comprehensive review. Clin Cardiol 2021; 44:1033-1040. [PMID: 34080694 PMCID: PMC8364728 DOI: 10.1002/clc.23661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by transient left ventricular dysfunction, was first reported in Japan in 1990. Current research suggests that TCM can be affected by conventional cardiovascular factors such as hypertension (HTN), diabetes, hyperlipidemia (HLD), and obesity. Despite the increasing interest in this disease, research on TCM remains limited. Conventional cardiovascular factors are clinically related to the outcome of TCM. We reviewed the publications published in PubMed database between January 01 2010 and January 15 2021, and summarized the most current available evidence on the correlation between TCM and the conventional cardiovascular factors. TCM patients are predominantly postmenopausal women. Men and young patients are less commonly seen, but are prone to acute adverse complications and poor prognosis. HTN is common in patients with recurrent TCM. Existing evidence suggests that obesity and chronic kidney disease are related to poor prognosis in TCM. HLD is reported to be associated with fewer complications, though current evidence is limited. Finally, the relationship between diabetes and TCM prognosis is ambivalent. Current evidence suggests conventional cardiovascular risk factors are associated with the outcome of TCM, especially with mortality and complications. More prospective studies are needed to clarify the relationship between each risk factor and the prognosis of TCM.
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Affiliation(s)
- Jing Liang
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Jingyi Zhang
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Yidan Xu
- Human Anatomy Laboratory, the First Clinical CollegeXinxiang Medical UniversityHenanChina
| | - Catherine Teng
- Department of MedicineYale New Haven Health‐Greenwich HospitalGreenwichConnecticutUSA
| | - Xiaojia Lu
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeGuangdongChina
| | - Yanxuan Wang
- Human Anatomy Laboratory, School of International EducationXinxiang Medical UniversityHenanChina
| | - Xinyu Zuo
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Qiuyue Li
- Human Anatomy Laboratory, School of International EducationXinxiang Medical UniversityHenanChina
| | - Zirui Huang
- Human Anatomy Laboratory, School of International EducationXinxiang Medical UniversityHenanChina
| | - Jianjun Ma
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Pengyang Li
- Department of MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
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9
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Santoro F, Núñez Gil IJ, Stiermaier T, El-Battrawy I, Guerra F, Novo G, Guastafierro F, Tarantino N, Novo S, Mariano E, Romeo F, Romeo F, Capucci A, Bahlmann E, Zingaro M, Cannone M, Caldarola P, Marchetti MF, Montisci R, Meloni L, Thiele H, Di Biase M, Almendro-Delia M, Sionis A, Akin I, Eitel I, Brunetti ND. Assessment of the German and Italian Stress Cardiomyopathy Score for Risk Stratification for In-hospital Complications in Patients With Takotsubo Syndrome. JAMA Cardiol 2020; 4:892-899. [PMID: 31389988 DOI: 10.1001/jamacardio.2019.2597] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Takotsubo syndrome (TTS) is an acute, reversible heart failure syndrome featured by significant rates of in-hospital complications. There is a lack of data for risk stratification during hospitalization. Objective To derive a simple clinical score for risk prediction of in-hospital complications among patients with TTS. Design, Setting, and Participants In this prognostic study, 1007 consecutive patients were enrolled in the German and Italian Stress Cardiomyopathy (GEIST) registry from July 1, 2007, through December 31, 2017, and identified as the derivation cohort; 946 patients were enrolled in the Spanish Registry for Takotsubo Cardiomyopathy (RETAKO) as the external score validation. An admission risk score was developed using a stepwise multivariable regression analysis from 2 registries. Data analysis was performed from March 1, 2018, through July 31, 2018. Main Outcomes and Measures In-hospital complications were defined as death, pulmonary edema, need for invasive ventilation, and cardiogenic shock. Four variables were identified as independent predictors of in-hospital complications and were used for the score: male sex, history of neurologic disorder, right ventricular involvement, and left ventricular ejection fraction (LVEF). Results Of the 1007 patients enrolled in the GEIST registry, 107 (10.6%) were male, with mean (SD) age of 69.8 (11.4) years. Overall rate of in-hospital complications was 23.3% (235 of 1007) (death, 4.0%; pulmonary edema, 5.8%; invasive ventilation, 6.4%; and cardiogenic shock, 9.1%). The GEIST prognosis score was derived by providing 20 points each for male sex and history of neurologic disorders and 30 points for right ventricular involvement and then subtracting the value in percent of LVEF (decimal values between 0.15 and 0.70). Score accuracy on area under the receiver operating characteristic curve analysis was 0.71, with a negative predictive power of 87% with scores less than 20. External validation in the RETAKO population (124 [13.1%] male; mean [SD] age, 69.5 [14.9] years) revealed an area under the curve of 0.73 (P = .46 vs GEIST derivation cohort). Stratification into 3 risk groups (<20, 20-40, and >40 points) classified 316 patients (40.9%) as having low risk; 342 (44.3%) as having intermediate risk, and 114 (14.8%) as having high risk of complications. The observed in-hospital complication rates were 12.7% for low-risk patients, 23.4% for intermediate-risk patients, and 58.8% for high-risk patients (P < .001 for trend). After 2.6 years of follow-up, patients with in-hospital complications had significantly higher rates of mortality than those without complications (40% vs 10%, P = .01). Conclusions and Relevance The GEIST prognostic score may be useful in early risk stratification for TTS. High-risk patients with TTS may require an intensive care unit stay, and low-risk patients with TTS could be discharged within a few days. In-hospital complications in patients with TTS may be associated with increased risk of long-term mortality.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Iván J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital, Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Giuseppina Novo
- Biomedical Department of Internal Medicine and Medical Specialties, Cardiology Unit, University of Palermo, Palermo, Italy
| | | | - Nicola Tarantino
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Salvatore Novo
- Biomedical Department of Internal Medicine and Medical Specialties, Cardiology Unit, University of Palermo, Palermo, Italy
| | - Enrica Mariano
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Romeo
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
| | - Fabiana Romeo
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital, Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Klinik-St Georg, Hamburg, Germany
| | | | | | | | | | - Roberta Montisci
- Department of Cardiology, San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
| | - Luigi Meloni
- Department of Cardiology, San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany
| | - Matteo Di Biase
- Gruppo Villa Maria Care and Research, Santa Maria Hospital, Bari, Italy
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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10
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D'Ascenzo F, Gili S, Bertaina M, Iannaccone M, Cammann VL, Di Vece D, Kato K, Saglietto A, Szawan KA, Frangieh AH, Boffini B, Annaratone M, Sarcon A, Levinson RA, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun‐Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, El‐Battrawy I, Akin I, Borggrefe M, Horowitz JD, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Biondi‐Zoccai G, Winchester DE, Ukena C, Neuhaus M, Bax JJ, Prasad A, Di Mario C, Böhm M, Gasparini M, Ruschitzka F, Bossone E, Citro R, Rinaldi M, De Ferrari GM, Lüscher T, Ghadri JR, Templin C. Impact of aspirin on takotsubo syndrome: a propensity score‐based analysis of the InterTAK Registry. Eur J Heart Fail 2020; 22:330-337. [PMID: 31863563 DOI: 10.1002/ejhf.1698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | | | - Maurizio Bertaina
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Mario Iannaccone
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Victoria L. Cammann
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Konrad A. Szawan
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Antonio H. Frangieh
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | | | | | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of MedicineUniversity of California‐San Francisco San Francisco CA USA
| | - Rena A. Levinson
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Division of Biological SciencesUniversity of California San Diego San Diego CA USA
| | - Jennifer Franke
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | - L. Christian Napp
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Milosz Jaguszewski
- First Department of CardiologyMedical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Hugo A. Katus
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/CardiologyHeart Center Leipzig – University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Carsten Tschöpe
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M. Pieske
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional CardiologyUniversity Heart Center Hamburg Hamburg Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II – CardiologyUniversity of Ulm, Medical Center Ulm Germany
| | - Samir M. Said
- Internal Medicine/Cardiology, Angiology, and PneumologyMagdeburg University Magdeburg Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe HospitalOxford University Hospitals Oxford UK
| | - Florim Cuculi
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Thomas A. Fischer
- Department of CardiologyKantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart CenterTurku University Hospital and University of Turku Turku Finland
| | | | - Grzegorz Opolski
- Department of CardiologyMedical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Christoph Kaiser
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Wolfgang M. Franz
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Klaus Empen
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Ibrahim El‐Battrawy
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Martin Kozel
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Giuseppe Biondi‐Zoccai
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of Rome Latina Italy
| | - David E. Winchester
- Department of Medicine, College of MedicineUniversity of Florida Gainesville FL USA
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Michael Neuhaus
- Department of CardiologyKantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical Centre Leiden The Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | - Carlo Di Mario
- Structural Interventional CardiologyUniversity Hospital Careggi Florence Italy
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Mauro Gasparini
- Department of Mathematical SciencesPolitecnico di Torino Turin Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Eduardo Bossone
- Division of Cardiology‘Antonio Cardarelli’ Hospital Naples Italy
| | - Rodolfo Citro
- Heart DepartmentUniversity Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental CardiologyIRCCS Fondazione Policlinico San Matteo Pavia Italy
| | - Thomas Lüscher
- Center for Molecular Cardiology, Schlieren CampusUniversity of Zurich Zurich Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College London UK
| | - Jelena R. Ghadri
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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11
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Finkel-Oron A, Olchowski J, Jotkowitz A, Barski L. Takotsubo cardiomyopathy triggered by wasabi consumption: can sushi break your heart? BMJ Case Rep 2019; 12:12/9/e230065. [PMID: 31540920 DOI: 10.1136/bcr-2019-230065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Takotsubo cardiomyopathy is a left ventricular dysfunction that typically occurs after sudden intense emotional or physical stress and mimics myocardial infarction. We describe a case of a 60-year-old woman that presented to the emergency department with chest pain after she attended a wedding and ate a large amount of wasabi, assuming it to be an avocado. To the best of our knowledge, this is the first report of takotsubo cardiomyopathy triggered by wasabi consumption.
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Affiliation(s)
- Alona Finkel-Oron
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
| | - Judith Olchowski
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
| | - Alan Jotkowitz
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
| | - Leonid Barski
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
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12
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Matsuura T, Ueno M, Iwanaga Y, Miyazaki S. Importance of sympathetic nervous system activity during left ventricular functional recovery and its association with in-hospital complications in Takotsubo syndrome. Heart Vessels 2019; 34:1317-1324. [DOI: 10.1007/s00380-019-01359-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
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