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De Filippo O, Peano V, Pasquero M, Templin C, Cammann VL, D'Ascenzo F, De Ferrari GM. Takotsubo syndrome: Impact of medical therapies on prognosis. A state of art review. Curr Probl Cardiol 2024; 49:102623. [PMID: 38718931 DOI: 10.1016/j.cpcardiol.2024.102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
Tako-Tsubo syndrome (TTS) presents as transient ventricular dysfunction, yet its underlying pathophysiology remains enigmatic. The prognosis of patients presenting with TTS appears to be impaired as compared to the general population and is similar to patients with acute coronary syndromes. Recent investigations have predominantly focused on elucidating therapeutic strategies associated with improved outcomes, particularly among post-menopausal female patients. Current evidence suggests that angiotensin-converting enzyme inhibitors (ACEi) may confer a survival advantage in TTS. Notably, ACEi emerges as the sole therapeutic modality demonstrating efficacy in both acute and chronic clinical courses of TTS. Despite this, the magnitude of survival benefit remains less pronounced than anticipated. This underscores the need for further research to explore additional therapeutic pathways and optimize management strategies for this unique patient cohort. Randomized clinical trials and meta-analysis are paramount in discerning the most effective therapeutic interventions aimed at enhancing survival and ameliorating outcomes in TTS. This review aims to comprehensively synthesize evidence pertaining to the prognostic implications of cardiovascular medications in TTS management.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
| | - Vanessa Peano
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marta Pasquero
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
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Jabbour JP, Arcari L, Cacciotti L, Magrì D, Recchioni T, Valeri L, Maggio E, Vizza CD, Badagliacca R, Papa S. Long-Term Functional Limitations on Cardiopulmonary Exercise Testing in Emotion-Triggered Takotsubo Syndrome. J Clin Med 2024; 13:1163. [PMID: 38398482 PMCID: PMC10889098 DOI: 10.3390/jcm13041163] [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: 01/25/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: In patients with prior Takotsubo syndrome (TTS), long-lasting functional cardiac limitations were described as compared with normal subjects. Emotion-triggered Takotsubo syndrome (E-TTS) has more favorable outcomes than TTS preceded by a physical trigger or by no identifiable factors. The aim of the present study was to assess long-term cardiac functional limitations in a cohort of asymptomatic E-TTS patients. Methods: We enrolled n = 40 asymptomatic patients with a diagnosis of E-TTS. Cardiopulmonary exercise tests (CPET) were performed at 30 (12-40) months median follow-up from the acute event. A cohort of n = 40 individuals matched for age, sex, body mass index and comorbidities served as control. Results: Despite recovery of left ventricular ejection fraction, patients with prior E-TTS had lower peak VO2 and percentage of predicted peak VO2 (17.8 ± 3.6 vs. 22.1 ± 6.5; p < 0.001 and 75.2 ± 14.1% vs. 100.6 ± 17.1%, p < 0.001), VO2 at anaerobic threshold (AT) (11.5 [10.1-12.9] vs. 14.4 [12.5-18.7]; p < 0.001), peak O2 pulse (9.8 ± 2.5 vs. 12.9 ± 3.5; p < 0.001) and higher VE/VCO2 slope (30.5 ± 3.7 vs. 27.3 ± 3.5; p < 0.001) compared with matched controls. We found no statistically significant differences in heart rate reserve (HRR), respiratory equivalent ratio (RER), mean blood pressure and peak PetCO2 between patients and controls. Conclusions: Despite its favorable outcome, patients with E-TTS in our population were found to have subclinical long-term functional cardiac limitations as compared with a control cohort.
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Affiliation(s)
- Jean Pierre Jabbour
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Luca Arcari
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, Italy;
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Tommaso Recchioni
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Livia Valeri
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Enrico Maggio
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Carmine Dario Vizza
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Roberto Badagliacca
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Silvia Papa
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
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