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Lu X, Li P, Teng C, Cai P, Jin L, Li C, Liu Q, Pan S, Dixon RA, Wang B. Prognostic factors of Takotsubo cardiomyopathy: a systematic review. ESC Heart Fail 2021; 8:3663-3689. [PMID: 34374223 PMCID: PMC8497208 DOI: 10.1002/ehf2.13531] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by reversible ventricular dysfunction, has similar mortality to acute coronary syndrome. With the growing interest in the diagnosis of and interventions for TCM, many risk factors had been found to affect the prognosis of TCM patients, such as age, sex, and pre-existing diseases. Because of the incomplete understanding of the pathophysiologic mechanism in TCM, evidence-based medical therapy for this condition is lacking. Early intervention on risk factors may improve the outcomes of TCM. In this review, we sought to provide up-to-date evidence on risk factors and medical therapies that affect TCM outcome. We found that male sex, physical triggers, and certain comorbidities such as chronic kidney disease, malignant disease, higher body mass index, sepsis, chronic obstructive pulmonary disease, and anaemia were associated with poor TCM prognosis. In contrast, race, hyperlipidaemia, diabetes mellitus, and mood disorders were not clearly associated with TCM prognosis. We also reviewed the effect of medical therapies on TCM outcome, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, calcium channel blockers, and statins. The evidence that these medications confer a survival benefit on TCM patients is limited. Understanding these prognostic factors could help develop risk-stratification tools for TCM and establish effective prevention and interventions for this not-so-benign condition. Further multicentre clinical studies with large samples and meta-analyses of findings from previous studies are needed to address the inconsistent findings among the many potential risk factors for TCM.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Pengyang Li
- Division of CardiologyPauley Heart Center, Virginia Commonwealth UniversityRichmondVAUSA
| | - Catherine Teng
- Department of MedicineYale New Haven Health Greenwich HospitalGreenwichCTUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Ling Jin
- Department of MedicineMetrowest Medical CenterFraminghamMAUSA
| | - Chenlin Li
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Qi Liu
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Su Pan
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Richard A.F. Dixon
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
- Clinical Research Centerthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Napierkowski S, Banerjee U, Anderson HV, Charitakis K, Madjid M, Smalling RW, Dhoble A. Trends and Impact of the Use of Mechanical Circulatory Support for Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy. Am J Cardiol 2021; 139:28-33. [PMID: 33035466 DOI: 10.1016/j.amjcard.2020.09.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/24/2023]
Abstract
Data on the trend and impact of mechanical circulatory support (MCS) in patients with Takotsubo cardiomyopathy (TC) are scarce. We evaluated the incidence and outcomes of cardiogenic shock (CS) in TC patients and the trend in use of MCS over time. The National Inpatient Sample from 2005 to 2014 was used to identify patients admitted with TC and those receiving MCS. Multivariate logistic regression was performed to identify predictors of mortality. The Cochran-Armitage test was used for the trend analysis across the years. Admissions for TC showed a linear increase for the study period. From 2005 to 2014 the proportion of TC managed with MCS remained stable, with some yearly fluctuations. Crude in-hospital mortality rate was 2.5% in the patients admitted with TC but was significantly higher in those with CS (15.81% vs 1.68%, p < 0.001). There was no difference in mortality in TC patients with CS, both with and without the use of MCS. However, patients managed with MCS were more likely to be discharged to a skilled nursing facility (31% vs 25.55, p = 0.015) compared with TC patients with CS who were medically managed. The cost of care for patients with TC and CS, managed with MCS was significantly higher than those managed medically ($171K vs $128K, p <0.001). In patients managed with MCS, only sepsis was associated with a higher likelihood of death using multivariate analysis (Odds Ratio 2.538, Confidence Interval 1.245 to 5.172; p = 0.011). In conclusion, the incidence of TC has increased over the years, but the proportion of patients requiring MCS has declined. Crude mortality rate for TC was 2.5%, but was 15.8% in the TC patients with CS. The use of MCS did not lead to improved mortality but was associated with higher cost and increased likelihood of skilled nursing facility discharge.
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Stiermaier T, Santoro F, El-Battrawy I, Möller C, Graf T, Novo G, Santangelo A, Mariano E, Romeo F, Caldarola P, Fanelli M, Thiele H, Brunetti ND, Akin I, Eitel I. Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry. Diabetes Care 2018; 41:1084-1088. [PMID: 29449312 DOI: 10.2337/dc17-2609] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/27/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In view of low prevalence rates, diabetes is discussed as a protective factor for the occurrence of Takotsubo syndrome (TTS). Furthermore, it was associated with improved outcome in a small single-center analysis. Therefore, this study assessed the prevalence and prognostic relevance of concomitant diabetes in TTS. RESEARCH DESIGN AND METHODS A total of 826 patients with TTS were enrolled in an international, multicenter, registry-based study (eight centers in Italy and Germany). All-cause mortality was compared between patients with diabetes and patients without diabetes, and the independent predictive value of diabetes was evaluated in multivariate regression analysis. RESULTS The prevalence of diabetes was 21.1% (n = 174). TTS patients with diabetes were older (P < 0.001), were more frequently male (P = 0.003), had a higher prevalence of hypertension (P < 0.001), physical triggers (P = 0.041), and typical apical ballooning (P = 0.010), had a lower left ventricular ejection fraction (P = 0.008), had a higher rate of pulmonary edema (P = 0.032), and had a longer hospital stay (P = 0.009). However, 28-day all-cause mortality did not differ between patients with diabetes and patients without diabetes (6.4% vs. 5.7%; hazard ratio [HR] 1.11 [95% CI 0.55-2.25]; P = 0.772). Longer-term follow-up after a median of 2.5 years revealed a significantly higher mortality among TTS patients with diabetes (31.4% vs. 16.5%; P < 0.001), and multivariate regression analysis identified diabetes as an independent predictor of adverse outcome (HR 1.66 [95% CI 1.16-2.39]; P = 0.006). CONCLUSIONS Diabetes is not uncommon in patients with TTS, is associated with increased longer-term mortality rates, and is an independent predictor of adverse outcome irrespective of additional risk factors.
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Affiliation(s)
- Thomas Stiermaier
- Cardiology/Angiology/Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, and German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Ibrahim El-Battrawy
- Faculty of Medicine, First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, and German Center for Cardiovascular Research, Mannheim, Germany
| | - Christian Möller
- Cardiology/Angiology/Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, and German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Tobias Graf
- Cardiology/Angiology/Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, and German Center for Cardiovascular Research (DZHK), Lübeck, Germany
| | - Giuseppina Novo
- Cardiology Unit, Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Andrea Santangelo
- Cardiology Unit, Biomedical Department of Internal Medicine and Medical Specialties, 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
| | | | - Mario Fanelli
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | | | - Ibrahim Akin
- Faculty of Medicine, First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, and German Center for Cardiovascular Research, Mannheim, Germany
| | - Ingo Eitel
- Cardiology/Angiology/Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, and German Center for Cardiovascular Research (DZHK), Lübeck, Germany
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Gupta S, Gupta MM. Takotsubo syndrome. Indian Heart J 2017; 70:165-174. [PMID: 29455773 PMCID: PMC5902911 DOI: 10.1016/j.ihj.2017.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 01/01/2023] Open
Abstract
Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6-12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1-4.5% and recurrence rate of 5-10% during five year follow-up.
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Affiliation(s)
- Sanjiv Gupta
- NH Narayana Multispeciality Hospital, Jaipur, India.
| | - Madan Mohan Gupta
- Heart and Diabetic Clinic, B-19, Rajender Marg, Bapu Nagar, Jaipur, India
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Cecconi A, Franco E, de Agustín JA, Vilchez JP, Palacios-Rubio J, Sánchez-Enrique C, Fernández-Ortiz A, Macaya C, Fernández-Jiménez R. Hyponatremia-induced stress cardiomyopathy due to psychogenic polydipsia. Int J Cardiol 2016; 202:618-20. [PMID: 26447674 DOI: 10.1016/j.ijcard.2015.09.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Alberto Cecconi
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Eduardo Franco
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Jean Paul Vilchez
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | - Antonio Fernández-Ortiz
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Carlos Macaya
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Nam SW, Lee JW, Sim JH, Pack HS, Im C, Lim JS, Ahn SG. A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seoung Wan Nam
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jun-Won Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jeong Han Sim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Sung Pack
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Changjo Im
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Gyun Ahn
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Madias JE. Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: A plausible 'protective' effect with pathophysiologic connotations. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:164-70. [PMID: 25673782 DOI: 10.1177/2048872615570761] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 01/11/2015] [Indexed: 12/13/2022]
Abstract
AIMS The pathophysiology of Takotsubo syndrome is still elusive; coronary vasospasm, microvascular dysfunction, or catecholamine-mediated injury to the cardiomyocytes, effected by local release from the autonomic nerves and/or blood-borne catecholamines, are considered as tentative cause(s). Diabetes mellitus-induced autonomic neuropathy leads to a brain-heart disconnection, and it can conceivably ameliorate/block the effect of an unbridled adrenergic storm to the heart, and the emergence of Takotsubo syndrome. This study sought to evaluate the prevalence of diabetes mellitus in patients with Takotsubo syndrome. METHODS AND RESULTS All the papers accessed in PubMed were reviewed, to evaluate the prevalence of diabetes mellitus and hypertension in Takotsubo syndrome patients, employing the rate of the latter as an index of how representative of the general population were the study patients, and the rate of the former as the focus of this investigation. Out of the 1932 papers, 959 were suitable for analysis, reporting on 33,894 patients (88.9% women) with Takotsubo syndrome. In five subanalyses, of all patients, patients reported individually, patients reported collectively in case series, patients ⩾ 60 years old reported individually, and patients ⩾ 65 years old reported individually, the prevalence of hypertension was 57.4%, 42.8%, 57.9%, 50.4%, and 52.2%, correspondingly, and comparable to the 65.4% shown by the National Health and Nutrition Examination Survey (NHANES). The prevalence of diabetes mellitus in the five subgroups was 16.8%, 10.2%, 17.0%, 11.9%, and 12.5%, correspondingly, and lower than the 26.9% found by the NHANES. CONCLUSION The prevalence of diabetes mellitus in patients with Takotsubo syndrome is low. This insight may be useful for the diagnosis, pathophysiology unraveling, and employment of autonomic adrenergic blocking agents in the management of patients with Takotsubo syndrome.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, USA; Division of Cardiology, Elmhurst Hospital Center, USA
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Han L, Cui L, Yin L, Zhou C. Takotsubo cardiomyopathy induced by epileptic seizure. Int J Cardiol 2014; 177:e145-6. [PMID: 25294179 DOI: 10.1016/j.ijcard.2014.09.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Liju Han
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Lijun Cui
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Li Yin
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Changyu Zhou
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
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De Giorgi A, Fabbian F, Tiseo R, Parisi C, Misurati E, Molino C, Pala M, Salmi R, Volpi R, Manfredini R. Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reports. Am J Emerg Med 2014; 32:1413-7. [PMID: 25261397 DOI: 10.1016/j.ajem.2014.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/17/2014] [Accepted: 07/26/2014] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria (AOU), Ferrara, Italy.
| | - Fabio Fabbian
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Ruana Tiseo
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Claudia Parisi
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Elisa Misurati
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | | | - Marco Pala
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Raffaella Salmi
- Second Internal Medicine, Department of Medicine, AOU, Ferrara, Italy.
| | - Riccardo Volpi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis. Case Rep Nephrol 2014; 2013:640976. [PMID: 24527248 PMCID: PMC3914169 DOI: 10.1155/2013/640976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022] Open
Abstract
Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG) may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence.
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