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Humayra S, Yahya N, Ning CJ, Mir IA, Mohamed AL, Manan HA. Systematic review of cardiovascular magnetic resonance imaging T1 and T2 mapping in patients with Takotsubo syndrome. Heliyon 2024; 10:e29755. [PMID: 38707280 PMCID: PMC11068528 DOI: 10.1016/j.heliyon.2024.e29755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Background Current imaging advancements quantify the use of cardiovascular magnetic resonance (CMR) derived T1 and T2 tissue characterization as robust indicators for cardiomyopathies, but limited literature exists on its clinical application in Takotsubo syndrome (TTS). This systematic review evaluated the T1 and T2 parametric mapping to delineate the current diagnostic and prognostic CMR imaging outcomes in TTS. Methods A comprehensive literature search until October 2023 was performed on ScienceDirect, PubMed, Web of Science, and Cochrane Library by two independent reviewers adhering to the PRISMA framework. The Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of studies. Results Out of 198 results, 8 studies were included in this qualitative synthesis, accounting for a total population of 399 subjects (TTS = 201, controls = 175, acute myocarditis = 14, and acute regional myocardial oedema without infarction = 9). Approximately 50.4 % were TTS patients aged between 61 and 73 years, whereof, females (n = 181, 90.0 %) and apical variants (n = 180, 89.6 %) were significantly higher, and emotional stressor (n = 42; 20.9 %) was more prevalent than physical (n = 27; 13.4 %). The NOS identified 62.5 % of studies as moderate and 37.5 % as high quality. Parametric tissue mapping revealed significantly prolonged T1 and T2 relaxation times at 1.5T and 3T respectively in TTS (1053-1164 msec, 1292-1438 msec; and 56-67 msec, 60-90 msec) with higher extracellular volume (ECV) fraction (29-36 %), compared to healthy subjects (944-1211 msec, 1189-1251 msec; and 46-54 msec, 32-68 msec; 23-29 %) and myocarditis (1058 msec, 60 msec). Other significant myocardial abnormalities included increased left ventricular (LV) end-systolic and diastolic volume and reduced global longitudinal strain. Overall, myocardial oedema, altered LV mass and strain, and worse LV systolic function, with higher native T1, T2, and ECV values were consistent. Conclusions Future research with substantially larger clinical trials is vital to explore the CMR imaging findings in diverse TTS patient cohorts and correlate the T1 and T2 mapping outcomes with demographic/clinical covariates. CMR is a valuable imaging tool for TTS diagnosis and prognostication. T1 and T2 parametric mapping facilitates the quantification of oedema, inflammation, and myocardial injury in Takotsubo.
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Affiliation(s)
- Syeda Humayra
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Chai Jia Ning
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
- Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (UKM Specialist Children's Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Imtiyaz Ali Mir
- Department of Physiotherapy, M Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, 43000, Selangor, Malaysia
- Faculty of Health Sciences, Lincoln University College, Petaling Jaya, 47301, Selangor, Malaysia
| | - Abdul Latiff Mohamed
- Faculty of Medicine, University of Cyberjaya, Persiaran Bestari, Cyber 11, 63000, Cyberjaya, Selangor, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
- Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (UKM Specialist Children's Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
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Paiva MS, Maltês S, Brízido C, Madeira M, Tralhão A. Biventricular Takotsubo syndrome complicated with cardiogenic shock and ventricular septal rupture: a case report. Eur Heart J Case Rep 2024; 8:ytae154. [PMID: 38586534 PMCID: PMC10996925 DOI: 10.1093/ehjcr/ytae154] [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: 09/27/2023] [Revised: 03/09/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
Background Takotsubo syndrome (TTS) mimics acute coronary syndromes but can lead to serious cardiac complications, emphasizing the need for improved understanding and management. Case summary We describe a TTS case presented with cardiogenic shock due to ventricular septal rupture (VSR). Successful treatment involved mechanical circulatory support followed by VSR surgical closure. Discussion Ventricular septal rupture is the rarest and deadliest complication associated with TTS. Prompt recognition and a multidisciplinary approach are crucial to achieve the best possible outcome.
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Affiliation(s)
- Mariana Sousa Paiva
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal
| | - Sérgio Maltês
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal
| | - Catarina Brízido
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal
| | - Márcio Madeira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal
| | - António Tralhão
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal
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Scafa-Udriste A, Horodinschi RN, Babos M, Dinu B. Diagnostic challenges between takotsubo cardiomyopathy and acute myocardial infarction-where is the emergency?: a literature review. Int J Emerg Med 2024; 17:22. [PMID: 38360558 PMCID: PMC10870686 DOI: 10.1186/s12245-024-00595-4] [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: 12/21/2023] [Accepted: 02/09/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is an emergency cardiovascular disease, with clinical and paraclinical manifestations similar to acute myocardial infarction (AMI), but it is characterized by reversible systolic dysfunction of the left ventricle (LV) in the absence (most of the time) of obstructive coronary artery disease (CAD). MANAGEMENT OF PATIENTS WITH TC TC seems to be more frequent in post-menopausal women and it is triggered by emotional or physical stress. The diagnosis of TC is based on the Mayo Clinic criteria. Initially, patients with TC should be treated as those with AMI and carefully monitored in intensive care unit. Urgent clinical and paraclinical distinction between TC and AMI is mandatory in all patients, because of the different therapeutical management between the two diseases. Chest pain and dyspnea are the most common symptoms in TC. Paraclinical diagnosis is based on cardiac biomarkers, electrocardiogram (ST-segment elevation/T wave inversion in precordial leads without reciprocal ST-segment depression in inferior leads and absence of Q waves), echocardiography (LV systolic dysfunction, regional wall motion abnormalities extended in more than one coronary territory), cardiac magnetic resonance and in most of the cases the positive diagnosis is established by performing CA to exclude obstructive CAD. The prognosis of patients with TC is considered benign in most cases, with a complete LV function recovery, but severe complications may occur, such as cardiogenic shock, LV free wall rupture, life-threatening arrhythmia, and cardiac arrest. Postoperative TC may develop after any type of surgical intervention due to acute stress and it should be differentiated from postoperative AMI. The management of patients with TC is medical and it is based on supportive care and the treatment of heart failure, while patients with AMI require myocardial revascularization. CONCLUSIONS TC leads to transient LV dysfunction that mimics AMI from which it should be differentiated for a good therapeutic approach. Patients with TC should be carefully monitored during hospitalization because they have a high recovery potential if optimally treated.
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Affiliation(s)
- Alexandru Scafa-Udriste
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
- Department of Cardiology, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania
| | - Ruxandra-Nicoleta Horodinschi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania.
- Department of Cardiology, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania.
| | - Miruna Babos
- Department of Emergency Medicine, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania
| | - Bogdan Dinu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
- Department of Emergency Medicine, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania
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Sunnasy R, Mohiaddin RH. Parametric cardiovascular magnetic resonance imaging in takotsubo syndrome: a case report. Eur Heart J Case Rep 2024; 8:ytae016. [PMID: 38425871 PMCID: PMC10903182 DOI: 10.1093/ehjcr/ytae016] [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: 07/17/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Abstract
Background Takotsubo syndrome (TTS) causes angina with ventricular dysfunction that can mimic acute coronary syndrome. Normal coronary angiography leads to cardiovascular magnetic resonance imaging (CMR) in the diagnostic pathway. Historically, TTS was thought to be associated with the absence of late gadolinium enhancement on CMR. This case report highlights the presence of late gadolinium enhancement in a case of TTS while demonstrating the other characteristic findings, including quantitative parametric T1/T2 mapping. Case summary A 69-year-old lady was admitted with chest pain and shortness of breath. She was found to have classical TTS with the characteristic wall motion abnormalities on echocardiogram, left ventricular angiogram, and CMR. Her CMR also demonstrated strongly positive myocardial T1/T2 mapping that matched the wall motion abnormalities and the less frequently described positive early and late gadolinium enhancement. Discussion This case highlights the diagnostic pathway in TTS and the ability of CMR to make a diagnosis in myocardial infarction with non-obstructed coronary arteries. We describe the characteristic cardiac imaging features of TTS while discussing the positive late gadolinium enhancement patterns that may help confirm the diagnosis.
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Affiliation(s)
- Ritesh Sunnasy
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
| | - Raad Hashem Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Oldman J, Morwood S, Willis J, Augustine DX. Myocardial oedema in the setting of immersion pulmonary oedema - Cause or effect? BMJ Case Rep 2023; 16:16/1/e251274. [PMID: 36623912 PMCID: PMC9896232 DOI: 10.1136/bcr-2022-251274] [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] [Indexed: 01/11/2023] Open
Abstract
Immersion pulmonary oedema (IPE) is an under-reported and poorly understood phenomenon thought to be related to exercise-induced haemodynamic changes while submersed in water. Previous work has demonstrated reversible myocardial dysfunction during acute episodes. We present a case of IPE with concomitant, transient, left ventricular myocardial oedema characterised via MRI. This is a novel finding and may be evidence of left ventricular strain due to pressure overload or secondary to a subclinical myocarditis.
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Affiliation(s)
- James Oldman
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sarah Morwood
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - James Willis
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Daniel Xavier Augustine
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK,University of Bath, Bath, Bath and North East Somerset, UK
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Velasco-Malagón SA, Mora-Pabón G. Recurrent Takotsubo syndrome: case report and literature review. CASE REPORTS 2022. [DOI: 10.15446/cr.v8n2.92955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
Introduction: Takotsubo syndrome is a cardiomyopathy that can lead to severe myocardial involvement. It is characterized by the presence of signs and symptoms suggestive of ventricular dysfunction associated with an adrenergic discharge during a stressful event. This case report presents a literature review, as well as a comparison with other similar cases.
Case presentation. A 56-year-old female with a previous episode of Takotsubo was admitted to the emergency department due to symptoms of acute coronary syndrome and a history of Takotsubo syndrome. Her electrocardiogram showed T-wave inversion in leads V1-V4 and a raise in troponins. Percutaneous coronary angiography revealed no coronary lesions, and an echocardiogram revealed segmental alterations compatible with Takotsubo syndrome, requiring medical therapy with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, with subsequent improvement in ventricular function.
Conclusions. Recurrence in Takotsubo cardiomyopathy is a rare complication that should be suspected. The risk factors associated with recurrence are not known. Although therapy with ACE inhibitors and beta-blockers seems to have an impact on the recovery of ventricular function in patients with this condition, further studies are necessary to establish the best pharmacological treatment.
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Markousis-Mavrogenis G, Giannakopoulou A, Belegrinos A, Pons MR, Bonou M, Vartela V, Papavasiliou A, Christidi A, Kourtidou S, Kolovou G, Bacopoulou F, Chrousos GP, Mavrogeni SI. Cardiovascular Magnetic Resonance Imaging Patterns in Rare Cardiovascular Diseases. J Clin Med 2022; 11:6403. [PMID: 36362632 PMCID: PMC9657782 DOI: 10.3390/jcm11216403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023] Open
Abstract
Rare cardiovascular diseases (RCDs) have low incidence but major clinical impact. RCDs' classification includes Class I-systemic circulation, Class II-pulmonary circulation, Class III-cardiomyopathies, Class IV-congenital cardiovascular diseases (CVD), Class V-cardiac tumors and CVD in malignancy, Class VI-cardiac arrhythmogenic disorders, Class VII-CVD in pregnancy, Class VIII-unclassified rare CVD. Cardiovascular Magnetic Resonance (CMR) is useful in the diagnosis/management of RCDs, as it performs angiography, function, perfusion, and tissue characterization in the same examination. Edema expressed as a high signal in STIRT2 or increased T2 mapping is common in acute/active inflammatory states. Diffuse subendocardial fibrosis, expressed as diffuse late gadolinium enhancement (LGE), is characteristic of microvascular disease as in systemic sclerosis, small vessel vasculitis, cardiac amyloidosis, and metabolic disorders. Replacement fibrosis, expressed as LGE, in the inferolateral wall of the left ventricle (LV) is typical of neuromuscular disorders. Patchy LGE with concurrent edema is typical of myocarditis, irrespective of the cause. Cardiac hypertrophy is characteristic in hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA) and Anderson-Fabry Disease (AFD), but LGE is located in the IVS, subendocardium and lateral wall in HCM, CA and AFD, respectively. Native T1 mapping is increased in HCM and CA and reduced in AFD. Magnetic resonance angiography provides information on aortopathies, such as Marfan, Turner syndrome and Takayasu vasculitis. LGE in the right ventricle is the typical finding of ARVC, but it may involve LV, leading to the diagnosis of arrhythmogenic cardiomyopathy. Tissue changes in RCDs may be detected only through parametric imaging indices.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Flora Bacopoulou
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George P. Chrousos
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sophie I. Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Curkovic NB, Clark DE, Hughes SG. Syncope in an elderly man with hypertrophic obstructive cardiomyopathy. Heart 2022; 108:1437-1500. [PMID: 36007934 DOI: 10.1136/heartjnl-2022-321222] [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: 11/04/2022] Open
Affiliation(s)
- Nina B Curkovic
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel E Clark
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sean G Hughes
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Nguyen Nguyen N, Assad JG, Femia G, Schuster A, Otton J, Nguyen TL. Role of cardiac magnetic resonance imaging in troponinemia syndromes. World J Cardiol 2022; 14:190-205. [PMID: 35582465 PMCID: PMC9048277 DOI: 10.4330/wjc.v14.i4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/13/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is an evolving technology, proving to be a highly accurate tool for quantitative assessment. Most recently, it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia. Although an elevation in troponin is a nonspecific marker of myocardial tissue damage, it is a frequently ordered investigation leaving many patients without a specific diagnosis. Fortunately, the advent of newer cardiac MRI protocols can provide additional information. In this review, we discuss several conditions associated with an elevation in troponin such as myocardial infarction, myocarditis, Takotsubo cardiomyopathy, coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.
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Affiliation(s)
- Nhung Nguyen Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Joseph George Assad
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Campbelltown Hospital, Campbelltown 2560, NSW, Australia
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Göttingen 37075, Germany
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Tuan Le Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
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Assad J, Femia G, Pender P, Badie T, Rajaratnam R. Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468211065782. [PMID: 35002350 PMCID: PMC8733363 DOI: 10.1177/11795468211065782] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.
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Affiliation(s)
- Joseph Assad
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia.,South-West Clinical School, University of New South Wales, Kensington, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia.,Department of Cardiology, Campbelltown Hospital, Campbelltown, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Patrick Pender
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia.,South-West Clinical School, University of New South Wales, Kensington, NSW, Australia
| | - Tamer Badie
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia.,South-West Clinical School, University of New South Wales, Kensington, NSW, Australia.,Department of Cardiology, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Rohan Rajaratnam
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia.,South-West Clinical School, University of New South Wales, Kensington, NSW, Australia.,Department of Cardiology, Campbelltown Hospital, Campbelltown, NSW, Australia
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11
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Arcari L, Limite LR, Adduci C, Sclafani M, Tini G, Palano F, Cosentino P, Cristiano E, Cacciotti L, Russo D, Rubattu S, Volpe M, Autore C, Musumeci MB, Francia P. Novel Imaging and Genetic Risk Markers in Takotsubo Syndrome. Front Cardiovasc Med 2021; 8:703418. [PMID: 34485402 PMCID: PMC8415918 DOI: 10.3389/fcvm.2021.703418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022] Open
Abstract
Takotsubo syndrome (TTS) is an increasingly recognized condition burdened by significant acute and long-term adverse events. The availability of novel techniques expanded the knowledge on TTS and allowed a more accurate risk-stratification, potentially guiding clinical management. The present review aims to summarize the recent advances in TTS prognostic evaluation with a specific focus on novel imaging and genetic markers. Parametric deformation analysis by speckle-tracking echocardiography, as well as tissue characterization by cardiac magnetic resonance imaging T1 and T2 mapping techniques, currently appear the most clinically valuable applications. Notwithstanding, computed tomography and nuclear imaging studies provided limited but promising data. A genetic predisposition to TTS has been hypothesized, though available evidence is still not sufficient. Although a genetic predisposition appears likely, further studies are needed to fully characterize the genetic background of TTS, in order to identify genetic markers that could assist in predicting disease recurrences and help in familial screening.
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Affiliation(s)
- Luca Arcari
- Cardiology Unit, Mother Giuseppina Vannini Hospital, Rome, Italy
| | - Luca Rosario Limite
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmen Adduci
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Matteo Sclafani
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giacomo Tini
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesca Palano
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Pietro Cosentino
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Ernesto Cristiano
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luca Cacciotti
- Cardiology Unit, Mother Giuseppina Vannini Hospital, Rome, Italy
| | - Domitilla Russo
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Speranza Rubattu
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Massimo Volpe
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Camillo Autore
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Beatrice Musumeci
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Pietro Francia
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Pradhan S, Zalloum N, Kciku G, Trappe H. A valuable cardiac magnetic resonance investigation after MINOCA/takotsubo Syndrome: a case report. ESC Heart Fail 2020; 7:4336-4342. [PMID: 32964606 PMCID: PMC7754767 DOI: 10.1002/ehf2.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries is a working diagnosis that includes takotsubo cardiomyopathy/syndrome (TTS). Cardiac magnetic resonance (CMR) is useful for establishing the underlying aetiology of myocardial infarction with non-obstructive coronary arteries during the acute phase, but its role in follow-up is less well established. A 35-year-old man with several cardiac risk factors presented 3 days after his sister's death with biochemical and clinical features of acute myocardial infarction without coronary artery obstruction on angiography but with diagnostic features of TTS on CMR, including oedema but no late gadolinium enhancement. Subsequent CMR 3 months later revealed left ventricular late gadolinium enhancement suggesting previous acute myocardial infarction. Although the initial diagnosis of TTS was robust according to established criteria, it remained uncertain whether the later ischaemic injury was related to an ischaemic event at presentation or occurred in the intervening period. Nevertheless, CMR may have an extended role in the follow-up of these patients and may reveal additional, actionable pathology.
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Affiliation(s)
- Snehasis Pradhan
- Department of Cardiology and AngiologyMarien Hospital Herne, Ruhr‐University of BochumHerneGermany
| | - Nedall Zalloum
- Department of Cardiology and AngiologyMarien Hospital Herne, Ruhr‐University of BochumHerneGermany
| | - Gresa Kciku
- Department of Cardiology and AngiologyMarien Hospital Herne, Ruhr‐University of BochumHerneGermany
| | - Hans‐Joachim Trappe
- Department of Cardiology and AngiologyMarien Hospital Herne, Ruhr‐University of BochumHerneGermany
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