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Chen J, Wang Y, Shou X, Liu Q, Mei Z. Development and validation of a prognostic nomogram for Takotsubo syndrome patients in the intensive care units: a retrospective cohort study. Sci Rep 2023; 13:477. [PMID: 36627324 PMCID: PMC9832151 DOI: 10.1038/s41598-022-27224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Patients with Takotsubo syndrome (TTS) admitted to the intensive care unit (ICU) always confront a higher risk of in-hospital death than those hospitalized in the cardiology unit. The prognosis of the latter was analyzed by a large number of studies. However, there was no utility model to predict the risk of in-hospital death for patients with TTS in the ICU. This study aimed to establish a model predicting in-hospital death in patients with TTS admitted to ICU. We retrospectively included ICU patients with TTS from the MIMIC-IV database. The outcome of the nomogram was in-hospital death. Least Absolute Shrinkage Selection Operator (LASSO) analysis selected predictors preliminarily. The model was developed by multivariable logistic regression analysis. Calibration, decision curve analysis (DCA), and receiver operating characteristic (ROC) measured the performance of the nomogram on the accuracy, clinical utility, and discrimination, respectively. Eventually, 368 ICU patients with TTS were enrolled in this research. The in-hospital mortality was 13.04%. LASSO regression and multivariate logistic regression analysis verified risk factors significantly associated with in-hospital mortality. They were potassium, prothrombin time (PT), age, myocardial infarction, white cell count (WBC), hematocrit, anion gap, and sequential organ failure assessment (SOFA) score. This nomogram excellently discriminated against patients with a risk of in-hospital death. The area under curve (AUC) was 0.779 (95%CI: 0.732-0.826) in training set and 0.775 (95%CI: 0.711-0.839) in test set. The calibration plot and DCA showed good clinical benefits for this nomogram. We developed a nomogram that predicts the probability of in-hospital death for ICU patients with TTS. This nomogram was able to discriminate patients with a high risk of in-hospital death and performed clinical utility.
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Affiliation(s)
- Jun Chen
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Yimin Wang
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Xinyang Shou
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Qiang Liu
- grid.268505.c0000 0000 8744 8924Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Ziwei Mei
- Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China.
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Anderson JL, Horne BD, Le VT, Bair TL, Min DB, Minder CM, Dhar R, Mason S, Muhlestein JB, Knowlton KU. Spectrum of radionuclide perfusion study abnormalities in takotsubo cardiomyopathy. J Nucl Cardiol 2022; 29:1034-1046. [PMID: 33090340 DOI: 10.1007/s12350-020-02385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Takotsubo (stress) cardiomyopathy (TCM) is characterized by transient apical left ventricular dysfunction precipitated by emotional or physical stress. Its presentation makes it difficult to differentiate from an acute coronary syndrome. A suggestive echocardiogram plus normal coronary angiography most often are used for diagnosis. Radionuclide perfusion study (RPS) findings in TCM, including by positron emission tomography (PET), have been poorly characterized. METHODS AND RESULTS Intermountain Healthcare electronic medical records were searched from 2009 to 2019 for patients with a discharge diagnosis of TCM, stress CM, or takotsubo syndrome. 16 TCM patients with an RPS, including by PET in 8, were identified: 13 (81%) were women; age averaged 72 years (50-89 years); 14 had an identified stressor. TCM diagnosis was definite in 11 and probable/possible in 5. RPS was abnormal in 11, with 9 showing an apical perfusion deficit, whereas angiography in 14 showed normal coronaries in 12 and non-obstructive disease in 2. Echo ejection fraction averaged 41% (29%-60%); an apical wall motion abnormality was present in 14 (88%). Troponin elevations were noted in 14/15. The presenting ECG was abnormal is 14, frequently showing ST-T-wave abnormalities. 13 patients were discharged on a beta-blocker. Follow-up echo (in 12) showed recovered ejection fraction in 9 and recovered apical wall motion in 11. CONCLUSIONS Despite having normal or non-obstructive epicardial coronary arteries on angiography, TCM patients frequently present with apical wall motion abnormalities and matching RPS perfusion defects. These findings suggest microvascular abnormalities, whose pathophysiology, temporal course, and clinical implications should be the subject of further investigation.
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Affiliation(s)
- Jeffrey L Anderson
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA.
- University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, USA.
| | - Benjamin D Horne
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Viet T Le
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA.
- Rocky Mountain University of Health Professions, Provo, UT, USA.
| | - Tami L Bair
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - David B Min
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - C Michael Minder
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - Ritesh Dhar
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - Steve Mason
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - Joseph B Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
- University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, USA
| | - Kirk U Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
- University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, USA
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Kwon SS, Bang DW, Park BW, Lee MH, Hyon MS, Lee SS, Park S. Association of low T3 level with increased in-hospital mortality in patients with stress cardiomyopathy. Acta Cardiol 2021; 76:1052-1060. [PMID: 32835614 DOI: 10.1080/00015385.2020.1807124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stress cardiomyopathy (SCMP) is an acute but reversible heart failure syndrome with varying clinical outcomes. Although low triiodothyronine (T3) levels are closely associated with heart failure, it is uncertain whether total T3 levels on admission might be correlated with clinical outcomes in patients with SCMP. The aim of this study was to investigate the prognostic value of total T3 level for in-hospital mortality in patients with SCMP. METHODS Patients presenting with SCMP at a single tertiary hospital between January 2013 and May 2019 were retrospectively reviewed. The diagnosis of SCMP was confirmed using the International Takotsubo Diagnostic Criteria and echocardiography was performed at least twice at the time of admission. Comorbidities, antecedent triggers, and other cardiac and metabolic parameters were measured in the survivor group compared with the non-survivor group. We evaluated the correlation between these parameters, especially total T3 and the prevalence of in-hospital mortality and the predictive values of total T3. RESULTS Of the 134 SCMP patients (69.4 ± 15.5 years old, 94 women), 29 (21.6%) died during hospitalisation. The median follow-up period (interquartile range) was 480 days (63.25-1052.50). Total T3 levels were significantly lower in the non-survival group than in the survival group (33.38 ± 22.58 ng/dL vs. 65.72 ± 34.68 ng/dL, p < 0.0001). Receiver operating characteristic curve analysis showed the cut-offs of total T3 levels (≤64.37 ng/dL) for in-hospital mortality (area under curve [AUC] = 0.764, p < 0.001). In multivariable analysis, the T3 level (odds ratio [OR], 0.957; 95% confidential interval [CI], 0.934 to 0.982; p < 0.001), left ventricular ejection in follow-up echocardiography (OR, 0.935; 95% CI, 0.889-0.983; p = 0.008), and shock at initial presentation (OR, 3.389; 95% CI, 1.076-10.669; p = 0.037) were independent predictors for in-hospital mortality in SCMP patients. In patients with low T3 (<64.37 ng/dL), the 30-day survival rate was also significantly lower (81.58 vs. 100%, Log rank p = 0.001). CONCLUSIONS Lower levels of total T3 were strongly correlated with in-hospital mortality in patients with SCMP. A low T3 level might suggest poor prognosis in patients with SCMP.
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Affiliation(s)
- Seong Soon Kwon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Duk Won Bang
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Byoung-Won Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Min-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Min-Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Seong Soo Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Korea
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Ebert D, Mungard N, Mensch A, Homeister L, Willsch J, Ibe R, Baust H, Stiller M, Rebelo A, Ukkat J, Rigopoulos AG, Weber E, Bucher M, Noutsias M. Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report. BMC Cardiovasc Disord 2021; 21:528. [PMID: 34743690 PMCID: PMC8572692 DOI: 10.1186/s12872-021-02346-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The value of mechanical circulatory support (MCS) in cardiogenic shock, especially the combination of the ECMELLA approach (Impella combined with ECMO), remains controversial. CASE PRESENTATION A previously healthy 33-year-old female patient was submitted to a local emergency department with a flu-like infection and febrile temperatures up to 39 °C. The patient was tested positive for type-A influenza, however negative for SARS-CoV-2. Despite escalated invasive ventilation, refractory hypercapnia (paCO2: 22 kPa) with severe respiratory acidosis (pH: 6.9) and a rising norepinephrine rate occurred within a few hours. Due to a Horovitz-Index < 100, out-of-centre veno-venous extracorporeal membrane oxygenation (vv-ECMO)-implantation was performed. A CT-scan done because of anisocoria revealed an extended dissection of the right vertebral artery. While the initial left ventricular function was normal, echocardiography revealed severe global hypokinesia. After angiographic exclusion of coronary artery stenoses, we geared up LV unloading by additional implantation of an Impella CP and expanded the vv-ECMO to a veno-venous-arterial ECMO (vva-ECMO). Clinically relevant bleeding from the punctured femoral arteries resulted in massive transfusion and was treated by vascular surgery later on. Under continued MCS, LVEF increased to approximately 40% 2 days after the initiation of ECMELLA. After weaning, the Impella CP was explanted at day 5 and the vva-ECMO was removed on day 9, respectively. The patient was discharged in an unaffected neurological condition to rehabilitation 25 days after the initial admission. CONCLUSIONS This exceptional case exemplifies the importance of aggressive MCS in severe cardiogenic shock, which may be especially promising in younger patients with non-ischaemic cardiomyopathy and potentially reversible causes of cardiogenic shock. This case impressively demonstrates that especially young patients may achieve complete neurological restoration, even though the initial prognosis may appear unfavourable.
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Affiliation(s)
- Daniel Ebert
- Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Nils Mungard
- Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Alexander Mensch
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Lorenz Homeister
- Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Jan Willsch
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Richard Ibe
- Department of Neurology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Henning Baust
- Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Markus Stiller
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Artur Rebelo
- Department of Vascular Surgery, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Joerg Ukkat
- Department of Vascular Surgery, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Angelos G Rigopoulos
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III (KIM III), Mid-German Heart Center, Faculty of Medicine, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.,Department of Adult Cardiology, Mitera General Hospital, Hygeia Group, 6 Erythrou Stavrou Street, 15123, Marousi, Athens, Greece
| | - Elke Weber
- Department of Anesthesiology, St. Elisabeth & St. Barbara Hospital Halle, Mauerstrasse 5, 06110, Halle (Saale), Germany
| | - Michael Bucher
- Department of Anesthesiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III (KIM III), Mid-German Heart Center, Faculty of Medicine, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
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Abstract
PURPOSE OF REVIEW To summarize gender- and sex-specific differences in the presentation, diagnosis, management, and pathophysiology of women presenting with acute coronary syndrome (ACS). RECENT FINDINGS Sex differences exist in many aspects of ACS that impact the identification, treatment, and outcomes in women. There are delays in the initiation of care, under recognized diagnostic differences based on sex, and inconsistencies in the management of ACS in women compared with men, that ultimately impact outcomes. Additionally, women with ACS are more likely than men to present with non-obstructive coronary artery disease (CAD), which appears to be due to diverse underlying pathophysiology. Women with ACS face diagnostic and treatment dilemmas from time of symptom onset to hospital discharge. Under-recognition, under-diagnosis, and under-treatment ultimately result in poorer outcomes in women. Underlying pathophysiologic differences in women require additional testing to elucidate underlying etiologies.
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Alasnag M, Truesdell AG, Williams H, Martinez SC, Qadri SK, Skendelas JP, Jakobleff WA, Alasnag M. Mechanical Circulatory Support: a Comprehensive Review With a Focus on Women. Curr Atheroscler Rep 2020; 22:11. [DOI: 10.1007/s11883-020-0828-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Miyake R, Ohtani K, Hashimoto T, Yada R, Sato T, Shojima Y, Hayashidani S, Higo T, Tsutsui H. Takotsubo syndrome in a heart transplant recipient with poor cardiac sympathetic reinnervation. ESC Heart Fail 2020; 7:1145-1149. [PMID: 32154667 PMCID: PMC7261543 DOI: 10.1002/ehf2.12632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 11/06/2022] Open
Abstract
Takotsubo syndrome (TTS), also referred to as stress cardiomyopathy, is characterized by transient left ventricular apical ballooning in the absence of obstructive coronary artery disease. Catecholamine-induced cardiac injury or vasospasm has been implicated in this pathophysiology. We present a case of a 67-year-old man 10 years after heart transplantation diagnosed with TTS. Sympathetic reinnervation could not be detected by iodine-123 meta iodobenzylguanidine uptake, suggesting that TTS can occur in the absence of functional sympathetic nerve systems reconstruction.
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Affiliation(s)
- Ryo Miyake
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kisho Ohtani
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ryoko Yada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tasuku Sato
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoko Shojima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shunji Hayashidani
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Rigopoulos AG, Ali M, Ali K, Ikonomidis I, Makavos G, Matiakis M, Abate E, Mammadov M, Manginas A, Mavrogeni S, Noutsias M. Authors' response to the letter on HREV-D-19-00059R-1: Advancements in the diagnostic workup, prognostic evaluation and treatment of Takotsubo syndrome. Heart Fail Rev 2019; 25:887-889. [PMID: 31650422 DOI: 10.1007/s10741-019-09861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Khaldoun Ali
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, GR-12462 Haidari, Athens, Greece
| | - George Makavos
- 2nd Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, Rimini 1, GR-12462 Haidari, Athens, Greece
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Athanassios Manginas
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Ilias Street 8-12, GR- 16675 Glyfada, Athens, Greece
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, GR-17561 Palaeo Faliro, Athens, Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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Marafioti V. Muscle, vessels, or nerves: which one of these plays a key role in the heart of patients with takotsubo syndrome? Heart Fail Rev 2019; 25:917-918. [PMID: 31595405 DOI: 10.1007/s10741-019-09859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Vincenzo Marafioti
- Cardiovascular and Thoracic Department, University Hospital of Verona, P. Stefani 1, 37126, Verona, Italy.
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