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Pei Q, Yang J, Li B, Lin P, Zou L, Zhang J, Yin H, Sun J, Wang X, Vera A N, Dong Z, Yin D. Histological and functional assessment of a Takotsubo cardiomyopathy model established by immobilization stress. Pacing Clin Electrophysiol 2024; 47:373-382. [PMID: 38341623 DOI: 10.1111/pace.14930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, resembles acute heart failure syndrome but lacks disease-specific diagnosis and treatment strategies. TTC accounts for approximately 5-6% of all suspected cases of acute coronary syndrome in women. At present, animal models of TTC are often created by large amounts of exogenous catecholamines such as isoproterenol. However, isoproterenol injection cannot fully simulate the onset of stress-induced cardiomyopathy in humans since stress is not an instantaneous event. METHODS Rats were immobilized for 6 h per day for 1-14 days. To examine whether the TTC model was successful, echocardiography was employed; Elisa detected serum sympathetic activation markers; and the Open-Field test (OFT) was used to analyze behavioral changes in rats after stress. Western blot and histology were used to assess sympathetic remodeling, inflammation levels, and fibrosis; qRT-PCR was used to explore the levels of fibrosis and myocardial hypertrophy. The electrical stability of ventricular was determined by electrophysiological testing. RESULTS The rats showed severe stress behavior and local sympathetic remodeling of the heart after only 1 day of stress. After 3 days of stress, the induction of ventricular tachyarrhythmia increased prominently. The highest incidence of TTC in rats was at 5 days of immobilization stress. The pathological left ventricular remodeling caused by immobilization (IMO) stress includes inflammatory infiltration, fibrosis, and myocardial hypertrophy. CONCLUSIONS Our study confirms the hypothesis that IMO stress can mimic Takotsubo cardiomyopathy, and the various effects on the heart depending on the duration of IMO stress. We observed the highest incidence of TTC occurred after 5 days of stress. Furthermore, there is a gradual occurrence of electrical and structural remodeling as the stress duration prolongs.
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Affiliation(s)
- Quanwei Pei
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiemei Yang
- Department of Echocardiography, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bin Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pengqi Lin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lina Zou
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junpei Zhang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongpeng Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingmei Sun
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Wang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Nevzorova Vera A
- Institute Therapy and Instrumental Diagnostic, Pacific State Medical University, Vladivostok, Russia
| | - Zengxiang Dong
- The Key Laboratory of Cardiovascular Disease Acousto-Optic Electromagnetic Diagnosis and Treatment in Heilongjiang Province, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Dechun Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Omerovic E, Citro R, Bossone E, Redfors B, Backs J, Bruns B, Ciccarelli M, Couch LS, Dawson D, Grassi G, Iacoviello M, Parodi G, Schneider B, Templin C, Ghadri JR, Thum T, Chioncel O, Tocchetti CG, Van Der Velden J, Heymans S, Lyon AR. Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications. Eur J Heart Fail 2021; 24:274-286. [PMID: 34655287 DOI: 10.1002/ejhf.2368] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 01/09/2023] Open
Abstract
While the first part of the scientific statement on the pathophysiology of Takotsubo syndrome was focused on catecholamines and the sympathetic nervous system, in the second part we focus on the vascular pathophysiology including coronary and systemic vascular responses, the role of the central and peripheral nervous systems during the acute phase and abnormalities in the subacute phase, the gender differences and integrated effects of sex hormones, genetics of Takotsubo syndrome including insights from microRNA studies and inducible pluripotent stem cell models of Takotsubo syndrome. We then discuss the chronic abnormalities of cardiovascular physiology in survivors, the limitations of current clinical and preclinical studies, the implications of the knowledge of pathophysiology for clinical management and future perspectives and directions of research.
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Affiliation(s)
- Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, A. Cardarelli Hospital, Naples, Italy
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Bastian Bruns
- Institute of Experimental Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Heidelberg, Germany.,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Michele Ciccarelli
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Liam S Couch
- National Heart and Lung Institute, Imperial College, London, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania and University of Medicine Carol Davila, Bucharest, Romania
| | - C Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | - Jolanda Van Der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK
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Madias JE. Takotsubo syndrome or myocardial stunning due to spasm of a non-obstructive left anterior descending coronary artery? J Nucl Cardiol 2020; 27:1053. [PMID: 29923102 DOI: 10.1007/s12350-018-1347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Icahn School of Medicine at Mount Sinai/Cardiology Division, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA.
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Madias JE. Autonomic adrenergic sympathetic hyperstimulation, myocardial edema, and "muscle cramps" in takotsubo syndome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:88. [PMID: 29997051 DOI: 10.1016/j.carrev.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America.
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Vilela E, Silva M, Guerreiro C, Caeiro D, Fonseca M, Primo J, Braga P, Gama V. Takotsubo syndrome and coronary vasospasm: Two faces of the same coin? Indian Heart J 2018; 70:455-458. [PMID: 29961469 PMCID: PMC6034106 DOI: 10.1016/j.ihj.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- Eduardo Vilela
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | - Marisa Silva
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Marlene Fonseca
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - João Primo
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
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Hung MJ, Ko T, Liang CY, Kao YC. Two-dimensional myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy: A case report of a serial echocardiographic study. Medicine (Baltimore) 2017; 96:e8232. [PMID: 28984779 PMCID: PMC5738015 DOI: 10.1097/md.0000000000008232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Although transient reduction in the left ventricular ejection fraction is characteristic of Takotsubo cardiomyopathy, little is known about the time-course changes of myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy. PATIENT CONCERNS We retrospectively analyzed the time-course changes in left ventricle, right ventricle, and left atrium strain values in a patient with coronary vasospasm-related Takotsubo cardiomyopathy. We found that not only left ventricular strain but also left atrial strain was abnormal during acute Takotsubo cardiomyopathy due to coronary vasospasm. Right ventricular free wall strain was normal. DIAGNOSES Coronary vasospasm-related Takotsubo cardiomyopathy. INTERVENTIONS A serial echocardiographic study. OUTCOMES The left ventricular strain was still subnormal despite a normalized left ventricular ejection fraction 2 months later. The left atrial strain was normal when the left ventricular ejection fraction normalized. LESSONS From this limited experience, it is suggested that echocardiographic myocardial deformation analysis can provide more information than the standard ejection fraction in evaluating myocardial contractile function.
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Affiliation(s)
- Ming-Jui Hung
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ta Ko
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Yu Liang
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Cheng Kao
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
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Mejía-Rentería HD, Núñez-Gil IJ. Takotsubo syndrome: Advances in the understanding and management of an enigmatic stress cardiomyopathy. World J Cardiol 2016; 8:413-424. [PMID: 27468334 PMCID: PMC4958692 DOI: 10.4330/wjc.v8.i7.413] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/30/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy is a syndrome mimicking an acute myocardial infarction in absence of obstructive epicardial coronary artery disease to explain the degree of the wall motion abnormalities. Typically more common in the elderly women, this condition is usually triggered by unexpected emotional or physical stress situations, and is associated with electrocardiogram abnormalities and slight elevation of cardiac biomarkers. The pathophysiological mechanism is not clear yet, but it is believed that a high circulating concentration of catecholamines causes an acute dysfunction of the coronary microcirculation and metabolism of cardiomyocytes, leading to a transient myocardial stunning. Typically, it presents with acute left ventricular systolic dysfunction that in most cases is completely resolved at short term. Recurrences are rare and it is thought that the long-term prognosis is good. We present here a review of the clinical features, pathophysiology and management of this enigmatic condition.
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Madias JE. Scorpion envenomation cardiomyopathy: a promising model for takotsubo syndrome. Clin Toxicol (Phila) 2015; 53:787. [PMID: 26135709 DOI: 10.3109/15563650.2015.1052500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, and the Division of Cardiology, Elmhurst Hospital Center , Elmhurst, NY , USA
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Madias JE. Plausible speculations on the pathophysiology of Takotsubo syndrome. Int J Cardiol 2015; 188:19-21. [DOI: 10.1016/j.ijcard.2015.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 12/28/2022]
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Takotsubo syndrome-induced acute myocardial infarction. Int J Cardiovasc Imaging 2015; 31:867. [DOI: 10.1007/s10554-015-0626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/16/2015] [Indexed: 10/24/2022]
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Hung MJ, Chen WS, Hung MY, Kao YC, Mao CT. New electrocardiographic ST-elevation mimicking acute myocardial infarction in patients with non-fixed coronary artery stenosis: an important issue in the primary coronary interventional era. Int J Cardiol 2015; 182:284-7. [PMID: 25585373 DOI: 10.1016/j.ijcard.2014.12.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 12/31/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Ming-Jui Hung
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Keelung City, Taiwan.
| | - Wei-Siang Chen
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Keelung City, Taiwan
| | - Ming-Yow Hung
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Cheng Kao
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Keelung City, Taiwan
| | - Chun-Tai Mao
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Keelung City, Taiwan
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Current hypotheses regarding the pathophysiology behind the takotsubo syndrome. Int J Cardiol 2014; 177:771-9. [DOI: 10.1016/j.ijcard.2014.10.156] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 01/15/2023]
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