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Farjoud Kouhanjani M, Hosseini SA, Mousavi SM, Noroozi Z, Sadeghi P, Jokar-Derisi A, Jamshidi Mouselou MS, Ahmadi M, Attar A. Takotsubo Cardiomyopathy and Autoimmune Disorders: A Systematic Scoping Review of Published Cases. Int J Clin Pract 2024; 2024:7259200. [PMID: 38414580 PMCID: PMC10898954 DOI: 10.1155/2024/7259200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) features transient left ventricular apical dysfunction or ballooning. The underlying mechanism remains elusive; however, evidence suggests the role of different physical and psychological stressors. We systematically reviewed patients presenting with TCM and autoimmunity to explore the link between the two conditions. Methods We applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to report this review. Using keywords related to autoimmune/immune-mediated diseases and TCM, we searched PubMed, Scopus, and WOS in March 2022. The final results were added to a data extraction sheet. Data were analyzed by SPSS version 26.0. Results Our search yielded 121 studies, including 155 patients. Females were considerably predominant. Most patients had a history of autoimmune disease, and almost a third had a history of cardiovascular disease. Dyspnea and chest pain were the most common chief complaints. More than 70% of patients had experienced physical stress. Myasthenia gravis, systemic lupus erythematosus, and multiple sclerosis were the most frequently reported autoimmune diseases. Conclusion There were similarities in age and sex compared to classic TCM. TCM should be considered as a differential diagnosis for ACS, especially in patients with a positive background of autoimmunity. A precise reporting system is required for further studies.
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Affiliation(s)
- Mohsen Farjoud Kouhanjani
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Zahra Noroozi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Paniz Sadeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armita Jokar-Derisi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Meysam Ahmadi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiology, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Brandner J, Lu H, Muller O, Eskioglou E, Chiche JD, Antiochos P, Chocron Y. Cardiogenic shock due to reverse takotsubo syndrome triggered by multiple sclerosis brainstem lesions: a case report and mini review. Front Cardiovasc Med 2023; 10:1175644. [PMID: 37206102 PMCID: PMC10188972 DOI: 10.3389/fcvm.2023.1175644] [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: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Background Takotsubo syndrome (TTS) is mainly characterized by chest pain, left ventricular dysfunction, ST-segment deviation on electrocardiogram (ECG) and elevated troponins in the absence of obstructive coronary artery disease. Diagnostic features include left ventricular systolic dysfunction shown on transthoracic echocardiography (TTE) with wall motion abnormalities, generally with the typical "apical ballooning" pattern. In very rare cases, it involves a reverse form which is characterized by basal and mid-ventricular severe hypokinesia or akinesia, and sparing of the apex. TTS is known to be triggered by emotional or physical stressors. Recently, multiple sclerosis (MS) has been described as a potential trigger of TTS, especially when lesions are located in the brainstem. Case summary We herein report the case of a 26-year-old woman who developed cardiogenic shock due to reverse TTS in the setting of MS. After being admitted for suspected MS, the patient presented with rapidly deteriorating clinical condition, with acute pulmonary oedema and hemodynamic collapse, requiring mechanical ventilation and aminergic support. TTE found a severely reduced left ventricular ejection fraction (LVEF) of 20%, consistent with reverse TTS (basal and mid ventricular akinesia, apical hyperkinesia). Cardiac magnetic resonance imaging (MRI) performed 4 days later showed myocardial oedema in the mid and basal segments on T2-weighted imaging, with partial recovery of LVEF (46%), confirmed the diagnosis of TTS. In the meantime, the suspicion of MS was also confirmed, based on cerebral MRI and cerebral spinal fluid analyses, with a final diagnosis of reverse TTS induced by MS. High-dose intravenous corticotherapy was initiated. Subsequent evolution was marked by rapid clinical improvement, as well as normalization of LVEF and segmental wall-motion abnormalities. Conclusion Our case is an example of the brain-heart relationship: it shows how neurologic inflammatory diseases can trigger a cardiogenic shock due to TTS, with potentially serious outcomes. It sheds light on the reverse form, which, although rare, has already been described in the setting of acute neurologic disorders. Only a handful of case reports have highlighted MS as a trigger of reverse TTS. Finally, through an updated systematic review, we highlight the unique features of patients with reversed TTS triggered by MS.
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Affiliation(s)
- Joas Brandner
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Correspondence: Joas Brandner
| | - Henri Lu
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jean-Daniel Chiche
- Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Yaniv Chocron
- Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
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3
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Reversible increase in stress-associated neurobiological activity in the acute phase of Takotsubo syndrome; a brain 18F-FDG-PET study. Int J Cardiol 2021; 344:31-33. [PMID: 34619263 DOI: 10.1016/j.ijcard.2021.09.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is triggered mostly by physical and/or emotional stress that is processed in stress-associated brain regions, including the amygdala. However, it remains unclear whether such stress-induced brain activity is associated with TTS onset. METHODS AND RESULTS We acquired brain [18F]-2-fluoro-deoxy-d-glucose (18F-FDG) positron emission tomography in 4 TTS patients (44-82 yrs., 3 women) on days 2-4 (acute phase) and days 29-40 (recovery phase) after diagnosis of TTS was made by coronary angiography and left ventriculogram. The 18F-FDG uptake was measured globally and also in the pre-defined regions of interest of the bilateral amygdala on the common Montreal Neurological Institute space; all 18F-FDG images were normalized using automated image pre-processing. Amygdalar activity was calculated by dividing the 18F-FDG uptake of the amygdala by the global brain uptake. Left ventriculograms showed that apical ballooning was typical at diagnosis and was then relieved in the recovery phase. Amygdalar activity in the acute phase (0.872 ± 0.032) was higher than in the recovery phase (0.805 ± 0.037) (P = 0.013). CONCLUSIONS We report here 4 cases of TTS showing higher amygdalar activity in the acute phase as compared with the recovery phase, suggesting that increased stress-induced neurobiological activity is associated with TTS onset.
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COVID-19-related severe MS exacerbation with life-threatening Takotsubo cardiomyopathy in a previously stable patient and interference of MS therapy with long-term immunity against SARS-CoV-2. J Neurol 2021; 269:1138-1141. [PMID: 34617145 PMCID: PMC8494626 DOI: 10.1007/s00415-021-10779-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/03/2023]
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Risseeuw F, Masrori P, Baar I, Nicolay S, Franssen C, Willekens B. The Brain-Heart Link: A Case Report of a Critically Located Multiple Sclerosis Lesion in the Brainstem Leading to Recurrent Takotsubo Syndrome. Front Cardiovasc Med 2021; 8:674118. [PMID: 34434971 PMCID: PMC8381246 DOI: 10.3389/fcvm.2021.674118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/28/2021] [Indexed: 01/30/2023] Open
Abstract
Various central nervous system (CNS) diseases, including neurovascular and neuroinflammatory diseases, can lead to stress cardiomyopathy, also known as Takotsubo syndrome (TTS). We present a case of a 69-year-old woman with cardiovascular comorbidities, suffering from repeated episodes of TTS and respiratory failure due to a critical lesion in the brainstem, leading to a diagnosis of multiple sclerosis (MS). Despite aggressive treatment, intractable and recurrent symptoms in our patient occurred. Repeated bouts of autonomic dysfunction and respiratory failure ultimately led to installment of palliative care and the patient passing away. TTS should raise suspicion for underlying neurological diseases. Thorough questioning of previous neurological symptoms and extensive neurological workup is warranted. MS should be considered as a trigger of TTS also in elderly patients with cardiovascular risk factors.
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Affiliation(s)
| | - Pegah Masrori
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Ingrid Baar
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium.,Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Constantijn Franssen
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.,Cardiovascular Diseases, Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Wilrijk, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Suzuki H, Yasuda S, Shimokawa H. Brain-heart connection in Takotsubo syndrome before onset. Eur Heart J 2021; 42:1909-1911. [PMID: 33532845 DOI: 10.1093/eurheartj/ehab026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,International University of Health and Welfare, Narita, Japan
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An S, Ma HI, Song J, Choi HM, Kim YE. Stress cardiomyopathy associated with area postrema syndrome as a presentation of neuromyelitis optica: case report. BMC Neurol 2020; 20:201. [PMID: 32438902 PMCID: PMC7240979 DOI: 10.1186/s12883-020-01784-3] [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: 01/21/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022] Open
Abstract
Background Stress cardiomyopathy (Takotsubo cardiomyopathy) is very rare in the central nervous system (CNS) demyelinating disorders. Although this dysfunction of the heart-brain axis has been reported in several case series related to multiple sclerosis (MS), stress cardiomyopathy by neuromyelitis optica (NMO), which is rarer CNS demyelinating disorder than MS, is extremely rare. Herein, we report a case of stress cardiomyopathy associated with a medullary lesion as a presentation of NMO. Case presentation A 30-year-old woman was treated by veno-arterial extracorporeal membrane oxygenation due to catastrophic cardiopulmonary dysfunction after prolonged and unexplained nausea, vomiting, and cough. Myoclonus on the limbs developed afterward. Taken with suspicion of area postrema syndrome (APS), the brain MRI showed a demyelinating lesion in the medulla oblongata. APS and severe heart failure by stress cardiomyopathy were completely resolved by ECMO and hydrocortisone therapy. However, the CNS demyelinating lesion recurred after 1 month. The patient was diagnosed with NMO evident by the presence of aquaporin-4 antibody; Steroid therapy improved her symptoms. Conclusion NMO should be considered as one of the differential diagnoses in patients with APS preceding severe cardiopulmonary distress.
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Affiliation(s)
- Sungsik An
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.,Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.,Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea
| | - Jooyeon Song
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.,Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea
| | - Hong-Mi Choi
- Department of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea. .,Hallym Neurological Institute, Hallym University College of Medicine, Anyang, South Korea.
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Valencia-Sanchez C, Goodman BP, Carter JL, Wingerchuk DM. The spectrum of acute cardiopulmonary events associated with multiple sclerosis exacerbations. Mult Scler 2019; 25:758-765. [PMID: 30657008 DOI: 10.1177/1352458518823482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Diverse acute neurological injuries may cause acute cardiopulmonary events including neurogenic pulmonary edema (NPE) and neurogenic stunned myocardium (NSM). The mechanism is probably mediated by sympathetic nervous system activation. Focal central nervous system (CNS) lesions, such as demyelinating lesions in multiple sclerosis (MS), may also cause cardiopulmonary disturbances. We aim to review the acute cardiopulmonary events associated with MS relapses. We performed a literature search using PubMed, and selected case reports of acute cardiac and/or pulmonary events related to MS exacerbations. We grouped these events into three categories: 1) NPE with normal cardiac function; 2) NSM and Takotsubo cardiomyopathy (TTC); 3) coexisting myocardial dysfunction and pulmonary edema. In some cases, cardiac and pulmonary symptoms preceded the onset of neurological symptoms. The majority of cases were associated with acute demyelinating lesions located in the medulla. Acute brainstem MS relapses, with demyelinating lesions affecting the medulla, may cause acute cardiac and pulmonary events presumably secondary to sympathetic hyperstimulation. Specific regions in the medulla that regulate cardiac function, systemic blood pressure and pulmonary hydrostatic pressure seem to be responsible for these events.
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Affiliation(s)
| | - Brent P Goodman
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Akel T, Barsoum E, Mroue J, Nalluri N, Tamburino F, Bogin M. Reverse Takotsubo Cardiomyopathy Following Exploratory Laparotomy. J Investig Med High Impact Case Rep 2018; 6:2324709618757259. [PMID: 29707590 PMCID: PMC5912290 DOI: 10.1177/2324709618757259] [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: 11/06/2017] [Revised: 12/26/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022] Open
Abstract
Reverse takotsubo cardiomyopathy is an uncommon cardiomyopathy characterized by reversible regional wall motion abnormalities in the basilar segment of the left ventricle. This happens in the absence of any coronary artery pathology. Although it shares some pathogenic mechanisms with its more common variant, takotsubo cardiomyopathy, differences exist in terms of echocardiographic features, demographics, clinical manifestations, laboratory features, and prognosis. Cases of postoperative reverse takotsubo cardiomyopathy are less described in the literature. Herein, we report a case of reverse takotsubo cardiomyopathy in a 44-year-old woman occurring after exploratory laparotomy.
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Affiliation(s)
- Tamer Akel
- Staten Island University Hospital, Staten Island, NY, USA
| | - Emad Barsoum
- Staten Island University Hospital, Staten Island, NY, USA
| | - Jad Mroue
- Staten Island University Hospital, Staten Island, NY, USA
| | - Nikhil Nalluri
- Staten Island University Hospital, Staten Island, NY, USA
| | | | - Marc Bogin
- Staten Island University Hospital, Staten Island, NY, USA
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10
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Androdias G, Bernard E, Biotti D, Collongues N, Durand-Dubief F, Pique J, Sanchez I, Delmas C, Ninet J, Marignier R, Vukusic S. Multiple sclerosis broke my heart. Ann Neurol 2017; 81:754-758. [DOI: 10.1002/ana.24935] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/26/2017] [Accepted: 04/07/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Géraldine Androdias
- Rhône-Alpes Multiple Sclerosis Network, Pierre Wertheimer Neurological Hospital; Hospices Civils de Lyon; Lyon/Bron
- Neurology Center; Clinique de la Sauvegarde; Lyon
| | - Emilien Bernard
- Department of Neurology C, Pierre Wertheimer Neurological Hospital; Hospices Civils de Lyon; Lyon/Bron
| | - Damien Biotti
- Neurosciences pole, Neurology Unit B4, Pierre-Paul Riquet Hospital; Purpan University Hospital; Toulouse
| | - Nicolas Collongues
- Department of Neurology; Strasbourg University Hospitals; Strasbourg
- Center for Clinical Investigation; INSERM U1434; Strasbourg
| | - Françoise Durand-Dubief
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation; Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon; Lyon/Bron
- Lyon Neurosciences Research Center; INSERM 1028 and CNRS UMR5292; Lyon
- Claude Bernard University Lyon 1; University of Lyon; Lyon
| | - Julie Pique
- Neurosciences pole, Neurology Unit B4, Pierre-Paul Riquet Hospital; Purpan University Hospital; Toulouse
| | - Ingrid Sanchez
- Cardiovascular Functional Exploration Department, Louis Pradel Hospital; INSERM CIC1407 and U1060-CarMeN, Claude Bernard University Lyon 1, Hospices Civils de Lyon; Lyon
| | - Clément Delmas
- Cardiology Intensive Care Unit; Federation of Cardiology, Rangeuil University Hospital; Toulouse
| | - Jacques Ninet
- Department of Internal Medicine; Edouard Herriot Hospital; Lyon France
| | - Romain Marignier
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation; Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon; Lyon/Bron
- Lyon Neurosciences Research Center; INSERM 1028 and CNRS UMR5292; Lyon
- Claude Bernard University Lyon 1; University of Lyon; Lyon
| | - Sandra Vukusic
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation; Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon; Lyon/Bron
- Lyon Neurosciences Research Center; INSERM 1028 and CNRS UMR5292; Lyon
- Claude Bernard University Lyon 1; University of Lyon; Lyon
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