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Chedid M, Buda KG, Iqbal O, Simegn M. Predictors of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation in Patients With Takotsubo Syndrome. Am J Cardiol 2024; 222:101-107. [PMID: 38703882 DOI: 10.1016/j.amjcard.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) are life-threatening complications of takotsubo syndrome (TTS). Data regarding risk factors for PVT/VF based on the TTS variant are lacking. This study aimed to identify demographic and clinical factors associated with PVT and VF in patients with TTS. Patients meeting the InterTak criteria for TTS between 2010 and 2022 were retrospectively identified. The occurrence of PVT/VF with each risk factor was analyzed using logistic regression. Sensitivity analysis was performed to assess the interaction between risk factors. PVT/VF occurred in 27 of 296 patients with TTS (9.1%). Patients with PVT/VF were younger (52 vs 62 years, p = 0.019) and more frequently used stimulants in the 4 weeks before admission (22.2% vs 8.2%, odds ratio [OR] 3.20, p = 0.023). All PVT/VF occurred within 24 hours of hospitalization. An initial QTc threshold of 490 ms had the highest sensitivity and specificity for the occurrence of PVT/VF (area under the curve = 0.687). Patients with PVT/VF were more likely to have a QTc >490 ms on admission (55.6% vs 18.7%, OR 5.45, p <0.01), apical variant TTS (78% vs 56%, OR 2.69, p = 0.038), and an admission ejection fraction <30% (63% vs 41.5%, OR 2.39, p = 0.032); each factor was independently associated with PVT/VF irrespective of QTc duration on sensitivity analysis. In conclusion, nearly 1 in 10 patients with TTS had PVT/VF. A QTc >490 ms, recent stimulant use, apical variant TTS, and severe left ventricular systolic dysfunction on admission are associated with higher PVT/VF risk, with the first 24 hours being a high-risk period.
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Affiliation(s)
- Maroun Chedid
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN
| | - Kevin G Buda
- Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota; Division of Cardiology, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Omer Iqbal
- Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota; Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mengistu Simegn
- Division of Cardiology, Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota; Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Cardiology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.
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2
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Nishimura YK, Komatsu J, Sugane H, Hosoda H, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi Y. Takotsubo Syndrome in Older Men - Clinical Characteristics Differ by Sex and Age. Circ Rep 2024; 6:201-208. [PMID: 38860182 PMCID: PMC11162854 DOI: 10.1253/circrep.cr-23-0093] [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: 11/16/2023] [Revised: 04/21/2024] [Accepted: 05/05/2024] [Indexed: 06/12/2024] Open
Abstract
Background: Takotsubo syndrome (TTS) in male patients is under-studied, particularly in the older population. Methods and Results: From 226 patients with TTS, 44 older male patients (prevalence rate: 19.5%, age: median 77 years) were compared with 182 older female patients (prevalence rate: 80.5%, age: median 80 years). Emotional triggers of TTS were less frequent (2% vs. 19%; P=0.007), whereas physical triggers were more frequent (75% vs. 58%; P=0.040) in older men than in women. Among physical triggers, serious respiratory infection was more common in older men than in women. As initial clues to the diagnosis, ECG T-wave inversion was more frequent (48% vs. 29%; P=0.018) and chest pain and/or dyspnea were less common (23% vs. 38%; P=0.050) in older men than in women. In total, 14 patients (6%) had cardiogenic shock and 41 (18%) had severe heart failure as complications, although there were no significant differences in the frequency of these complications between older men and women. Although cardiac death occurred in 3 female patients (1%) and noncardiac death in 3 male and 5 female patients (4%), there were no significant differences in death rate between older men and women. Conclusions: Emotional triggers of TTS were extremely infrequent whereas physical triggers were common in older men. Although severe heart failure was common, there were no significant differences in the frequency of complications and in-hospital deaths between older men and women.
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Affiliation(s)
| | - Junya Komatsu
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Hiroki Sugane
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Hayato Hosoda
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoko Nakaoka
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | | | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoshinori Doi
- Department of Cardiology, Chikamori Hospital Kochi Japan
- Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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Crea F, Iannaccone G, La Vecchia G, Montone RA. An update on the mechanisms of Takotsubo syndrome: "At the end an acute coronary syndrome". J Mol Cell Cardiol 2024; 191:1-6. [PMID: 38641224 DOI: 10.1016/j.yjmcc.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/13/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Takotsubo syndrome (TTS) is an acute reversible form of myocardial dysfunction, often preceded by a physical or emotional stressful event, that acts as a trigger. Despite, recent advances in the comprehension of the mechanisms leading to TTS, its pathophysiology is far from being completely understood. However, several studies seem to suggest that an acute coronary microvascular dysfunction may represent a crucial pathogenic mechanism involved in TTS occurrence. In this article, we aim to review the complex pathophysiology of TTS and the possible different mechanisms underlying this clinical condition, focusing on the role of coronary microvascular dysfunction and the remaining knowledge's gaps in the field.
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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4
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Kong H, Han YY, Yang GL, Li K, Yu L, Xie XK, Xia GY, Wei PJ, Zhang WR, Li CH. Tenuifolin improves learning and memory by regulating long-term potentiation and dendritic structure of hippocampal CA1 area in healthy female mice but not male mice. Behav Brain Res 2024; 466:114974. [PMID: 38554850 DOI: 10.1016/j.bbr.2024.114974] [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: 11/17/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Polygala tenuifolia Wild is an ancient traditional Chinese medicine. Its main component, tenuifolin (TEN), has been proven to improve cognitive impairment caused by neurodegenerative diseases and ovariectomy. However, there was hardly any pharmacological research about TEN and its potential gender differences. Considering the reduction of TEN on learning and memory dysfunction in ovariectomized animals, therefore, we focused on the impact of TEN in different mice genders in the current study. Spontaneous alternation behavior (SAB), light-dark discrimination, and Morris water maze (MWM) tests were used to evaluate the mice's learning and memory abilities. The field excitatory postsynaptic potential (fEPSP) of the hippocampal CA1 region was recorded using an electrophysiological method, and the morphology of the dendritic structure was examined using Golgi staining. In the behavioral experiments, TEN improved the correct rate in female mice in the SAB test, the correct rate in the light-dark discrimination test, and the number of crossing platforms in the MWM test. Additionally, TEN reduced the latency of female mice rather than male mice in light-dark discrimination and MWM tests. Moreover, TEN could significantly increase the slope of fEPSP in hippocampal Schaffer-CA1 and enhance the total length and the number of intersections of dendrites in the hippocampal CA1 area in female mice but not in male mice. Collectively, the results of the current study showed that TEN improved learning and memory by regulating long-term potentiation (LTP) and dendritic structure of hippocampal CA1 area in female mice but not in males. These findings would help to explore the improvement mechanism of TEN on cognition and expand the knowledge of the potential therapeutic value of TEN in the treatment of cognitive impairment.
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Affiliation(s)
- Heng Kong
- School of Life Science, South China Normal University, Guangzhou, China
| | - Yuan-Yuan Han
- School of Life Science, South China Normal University, Guangzhou, China
| | - Gai-Ling Yang
- School of Life Science, South China Normal University, Guangzhou, China
| | - Kang Li
- School of Life Science, South China Normal University, Guangzhou, China
| | - Lu Yu
- School of Life Science, South China Normal University, Guangzhou, China
| | - Xun-Kai Xie
- School of Life Science, South China Normal University, Guangzhou, China
| | - Guang-Yuan Xia
- School of Life Science, South China Normal University, Guangzhou, China
| | - Peng-Ju Wei
- Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | | | - Chu-Hua Li
- School of Life Science, South China Normal University, Guangzhou, China.
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5
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Qin S, Teng H, Li A, Wang L, Hu R, Fu D. Subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation: A case and literature review. Heliyon 2024; 10:e30057. [PMID: 38694106 PMCID: PMC11059115 DOI: 10.1016/j.heliyon.2024.e30057] [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: 01/07/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background Takotsubo syndrome, which is often induced by physical or psychological stress, is typically a cardiac syndrome with transient left ventricular dysfunction in the absence of obstructive coronary artery disease. Subarachnoid hemorrhage with typical symptoms and signs is frequently reported, whereas the incidence of subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation without a typical headache is rarely reported. Case description We present a rare case of a 63-year-old male patient with cough and fever as the first manifestations, accompanied by mild dizziness, headache, and mental discomfort; however, the patient was eventually diagnosed with atypical subarachnoid hemorrhage with Takotsubo syndrome. The patient underwent general anesthesia downwards stent-assisted spring coil embolization and was discharged from the hospital after postoperative treatment consisting of anti-cerebrovascular spasm, anti-platelet aggregation, and cerebrospinal fluid replacement. Conclusion This case demonstrates the association between Takotsubo syndrome and subarachnoid hemorrhage. When patients present with unexplained pulmonary edema with mild neurologic symptoms, clinicians should be alerted to subarachnoid hemorrhage and Takotsubo syndrome.
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Affiliation(s)
- Shihong Qin
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Huifang Teng
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Aiping Li
- The Fourth Department of Neurology, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fourth Department of Neurology, Hunan Provincial People's Hospital, Changsha, China
| | - Lile Wang
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Ruicheng Hu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Daiyan Fu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
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6
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Li Z, Min XW, He PG, Zhang CH. Chest pain with diffuse ST segment elevation. BMJ 2024; 385:e078403. [PMID: 38697642 DOI: 10.1136/bmj-2023-078403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Zhi Li
- Department of Cardiology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Xin-Wen Min
- Department of Cardiology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Pei-Gen He
- Department of Cardiology, Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, China
| | - Chuan-Hai Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, China
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7
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Jaafar N, Sharma R, Sairam J, Duddu A. Volvulus is Stressful: Stress-Induced Cardiomyopathy Secondary to Gastric Volvulus and Paraesophageal Hernia. Cureus 2024; 16:e61031. [PMID: 38915959 PMCID: PMC11194533 DOI: 10.7759/cureus.61031] [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] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Stress-induced cardiomyopathy (SCM) is a cardiac systolic dysfunction caused by various stressful triggers. It is often transient and reversible upon the reversal of the underlying stressor. We present the case of a 70-year-old female with SCM in the setting of gastric volvulus and incarcerated para-esophageal hernia.
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Affiliation(s)
- Nadim Jaafar
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Rahul Sharma
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Jayashrei Sairam
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Akshay Duddu
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
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8
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Robba C, Busl KM, Claassen J, Diringer MN, Helbok R, Park S, Rabinstein A, Treggiari M, Vergouwen MDI, Citerio G. Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist. Intensive Care Med 2024; 50:646-664. [PMID: 38598130 PMCID: PMC11078858 DOI: 10.1007/s00134-024-07387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) is a rare yet profoundly debilitating condition associated with high global case fatality and morbidity rates. The key determinants of functional outcome include early brain injury, rebleeding of the ruptured aneurysm and delayed cerebral ischaemia. The only effective way to reduce the risk of rebleeding is to secure the ruptured aneurysm quickly. Prompt diagnosis, transfer to specialized centers, and meticulous management in the intensive care unit (ICU) significantly improved the prognosis of aSAH. Recently, multimodality monitoring with specific interventions to correct pathophysiological imbalances has been proposed. Vigilance extends beyond intracranial concerns to encompass systemic respiratory and haemodynamic monitoring, as derangements in these systems can precipitate secondary brain damage. Challenges persist in treating aSAH patients, exacerbated by a paucity of robust clinical evidence, with many interventions showing no benefit when tested in rigorous clinical trials. Given the growing body of literature in this field and the issuance of contemporary guidelines, our objective is to furnish an updated review of essential principles of ICU management for this patient population. Our review will discuss the epidemiology, initial stabilization, treatment strategies, long-term prognostic factors, the identification and management of post-aSAH complications. We aim to offer practical clinical guidance to intensivists, grounded in current evidence and expert clinical experience, while adhering to a concise format.
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Affiliation(s)
- Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
- IRCCS Policlinico San Martino, Genoa, Italy.
| | - Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Claassen
- Department of Neurology, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Michael N Diringer
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Raimund Helbok
- Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
- Clinical Research Institute for Neuroscience, Johannes Kepler University Linz, Linz, Austria
| | - Soojin Park
- Department of Neurology, New York Presbyterian Hospital, Columbia University, New York, NY, USA
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Miriam Treggiari
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Giuseppe Citerio
- Department of Medicine and Surgery, Milano Bicocca University, Milan, Italy
- NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
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9
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Jnani J, Mtisi T, Bhuiya T, Makaryus J, Laighold S. Atypical Stress Cardiomyopathy and the Need for Multidisciplinary Care. Cureus 2024; 16:e61225. [PMID: 38939286 PMCID: PMC11209747 DOI: 10.7759/cureus.61225] [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] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Reverse takotsubo cardiomyopathy is a rare variant of the classic stress-induced takotsubo cardiomyopathy. It is associated with transient left ventricular (LV) systolic dysfunction characterized by basal hypokinesis and apical hyperkinesis. We present a case of a 27-year-old woman who presented to an outside facility for a scheduled cesarean section and developed perioperative chest tightness, hypoxemia, and hypotension. Her electrocardiogram (ECG) showed sinus rhythm with marked ST segment depressions in leads V4-V6. High sensitivity troponin was elevated to 474 ng/L. Transthoracic echocardiography revealed an LV ejection fraction of 52% (Simpson's) with hypokinesis of the basal myocardial segments and hyperdynamic systolic function of the apical segments. Subsequent coronary angiography showed angiographically normal epicardial coronaries. Left ventriculography showed ballooning of the basal segments with apical hyperkinesis. She was subsequently diagnosed with reverse takotsubo cardiomyopathy and managed conservatively with beta-blockers. In this case, we highlight the need for collaboration between the cardiology and obstetric teams for tailored management strategies to ensure the well-being of both mother and baby.
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Affiliation(s)
- Jack Jnani
- Internal Medicine, North Shore University Hospital, Manhasset, USA
| | - Tafadzwa Mtisi
- Cardiology, North Shore University Hospital, Manhasset, USA
| | - Tanzim Bhuiya
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - John Makaryus
- Cardiology, North Shore University Hospital, Manhasset, USA
- Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
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Sridech W, Intamul K, Saengsin K, Wiwattanadittakul N, Sittiwangkul R, Katanyuwong K, Silvilairat S, Sanguansermsri C. Cardiac dysfunctions in children with drug-resistant epilepsy. Front Neurol 2024; 15:1381293. [PMID: 38689875 PMCID: PMC11058992 DOI: 10.3389/fneur.2024.1381293] [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: 02/03/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Objective There were reports of cardiac dysfunction that led to sudden unexpected death in epilepsy (SUDEP) in patients with epilepsy. Early detection of cardiac dysfunction can lead to early management to prevent sudden cardiac death in these patients. The objective of our study is to assess cardiac functions in children with drug-resistant epilepsy (DRE) compared with the normal population by using a standard echocardiogram (SE), tissue Doppler imaging (TDI) and myocardial strain evaluations (MSE). Method Twenty-seven children who have been diagnosed with DRE based on the International League against Epilepsy (ILAE) were included in the study, along with 27 children whose ages match those of the normal control group. Results Seventeen children, median age 12 years old, were using more than four anti-seizure medications. Structural brain lesions were the most common cause of epilepsy, 55.6% (15). Generalized tonic-clonic seizures were the most common seizure type, 55.6% (15). Children with DRE had a lower early mitral valve E wave inflow velocity compared with the control group (p < 0.05). They also had lowered early diastolic velocities (e') and myocardial performance index (MPI) when compared with the control group (p < 0.05). There was a statistically significant difference in left ventricular myocardial strain in children with DRE, with an average of -21.1 (IQR -23.5 and -19.4) and control, -25.5 (IQR -27.3 and -24.2). Significance Children with DRE have an impairment of left ventricular diastolic function and myocardial strain, which could indicate decreased myocardial deformation and contraction compared with controls. These cardiological assessments can be used to evaluate children with DRE for early diagnosis and management of their cardiac dysfunction.
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Affiliation(s)
- Watthana Sridech
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kamonchanok Intamul
- Cardiology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kwannapas Saengsin
- Cardiology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Rekwan Sittiwangkul
- Cardiology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kamornwan Katanyuwong
- Neurology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suchaya Silvilairat
- Cardiology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chinnuwat Sanguansermsri
- Neurology Division, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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11
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Kakderis C, Kouparanis A, Theodoropoulos KC, Didagelos M, Ziakas A. Τakotsubo Syndrome After Surgical Removal of the Thyroid Gland and Major Bleeding. Cureus 2024; 16:e59090. [PMID: 38800257 PMCID: PMC11128312 DOI: 10.7759/cureus.59090] [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] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
A 58-year-old male with a medical history of arterial hypertension, dyslipidemia, and psoriasis was admitted for a scheduled surgical removal of the thyroid gland. During the surgery, the patient suffered severe blood loss caused by vascular complications. After the operation, his electrocardiogram showed diffuse ST segment elevation along with high-sensitivity cardiac troponin T elevation and severe left ventricular systolic dysfunction. An emergency coronary angiography showed unobstructed coronary arteries. However, the left ventriculography demonstrated akinesia of the apical segments and hyperkinesia of the basal segments during systole. The patient was diagnosed with Takotsubo syndrome and he was successfully stabilized over the course of the next few days. Takotsubo cardiomyopathy is characterized by transient left ventricular systolic dysfunction and although the clinical and electrocardiographical presentation is similar to an acute coronary syndrome, the coronary arteries are unobstructed. Stressful events, both physical or psychological, could trigger an excessive catecholaminergic response which can cause the syndrome. Repetitive echocardiograms in our patient demonstrated complete recovery of the systolic function after a few days.
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Affiliation(s)
- Charalampos Kakderis
- Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, GRC
| | - Antonios Kouparanis
- Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, GRC
| | | | - Matthaios Didagelos
- Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, GRC
| | - Antonios Ziakas
- Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, GRC
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12
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Ved YP, Sharan S, Bandebuche A, Ram SH, Rathod A, Keshan R. Perioperative Takotsubo Stress Cardiomyopathy During Endoscopic Spinal Surgery: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00047. [PMID: 38848407 DOI: 10.2106/jbjs.cc.24.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
CASE A 37-year-old man American Society of Anesthesiologists grade 1 patient with lumbar canal stenosis at the L4-L5 level underwent endoscopic decompression. Toward the end of the procedure, the patient developed sudden-onset bradycardia, followed by ventricular arrhythmia and acute pulmonary edema. The patient was successfully managed with resuscitation and supportive management and recovered uneventfully thereafter. A diagnosis of perioperative stress cardiomyopathy was subsequently made after evaluation of the patient. CONCLUSION The possibility of takotsubo cardiomyopathy should be considered in cases of acute perioperative cardiac decompensation and pulmonary edema in patients undergoing spinal surgery.
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Affiliation(s)
- Yash Prakash Ved
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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13
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Marshall ER, Maliel KT, Burtson KM. A Case of Reverse Takotsubo Cardiomyopathy After Administering a Local Anesthetic Containing Epinephrine. Cureus 2024; 16:e57476. [PMID: 38707064 PMCID: PMC11068121 DOI: 10.7759/cureus.57476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/07/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a rare syndrome characterized by acute and transient distinctive wall motion abnormalities accompanied by other defined objective findings. There are many variants of TCM, including the reverse (or basal) subtype. While the pathogenesis is not fully understood, both endogenous and exogenous catecholamines have been implicated. This case report describes a 30-year-old active-duty military female who developed reverse TCM immediately following local anesthetic with epinephrine administration in preparation for an elective septorhinoplasty. She developed electrocardiogram (ECG) changes, temporary hemodynamic instability, and cardiac troponin elevation. Transthoracic echocardiogram (TTE) demonstrated significantly reduced systolic and diastolic function, with akinesis of the basal segments and normal wall motion of the apical segments, consistent with a reverse Takotsubo pattern. Coronary computed tomography (CT) angiography showed normal coronary arteries. Repeat TTE was performed two days after the initial event and showed near-complete resolution of the wall motion abnormalities. Fourteen days later, TTE showed normalization of cardiac function. While there is a favorable prognosis for most patients with this diagnosis, there does remain the potential for significant adverse outcomes, risk of recurrence, and a non-negligible mortality rate. It is widely known that physical and emotional triggers can precipitate TCM through the release of catecholamines. This case, in addition to numerous other case reports, provides further documentation and support that exogenous epinephrine administration is also associated with the development of TCM. Clinicians should consider the diagnosis of Takotsubo cardiomyopathy if hemodynamic or ECG changes arise following epinephrine administration.
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Affiliation(s)
- Emma R Marshall
- Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
- Internal Medicine, Wright Patterson Medical Center, Dayton, USA
| | | | - Kathryn M Burtson
- Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
- Internal Medicine, Wright Patterson Medical Center, Dayton, USA
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Zhang Y, Yang J, Ouyang C, Meng N. The association between ferroptosis and autophagy in cardiovascular diseases. Cell Biochem Funct 2024; 42:e3985. [PMID: 38509716 DOI: 10.1002/cbf.3985] [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: 02/06/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
Autophagy is a process in which cells degrade intracellular substances and play a variety of roles in cells, such as maintaining intracellular homeostasis, preventing cell overgrowth, and removing pathogens. It is highly conserved during the evolution of eukaryotic cells. So far, the study of autophagy is still a hot topic in the field of cytology. Ferroptosis is an iron-dependent form of cell death, accompanied by the accumulation of reactive oxygen species and lipid peroxides. With the deepening of research, it has been found that ferroptosis, like autophagy, is involved in the occurrence and development of cardiovascular diseases. The relationship between autophagy and ferroptosis is complex, and the association between the two in cardiovascular disease remains to be clarified. This article reviews the mechanism of autophagy and ferroptosis and their correlation, and discusses the relationship between them in cardiovascular diseases, which is expected to provide new and important treatment strategies for cardiovascular diseases.
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Affiliation(s)
- Yifan Zhang
- School of Biological Science and Technology, University of Jinan, Jinan, China
| | - Junjun Yang
- School of Biological Science and Technology, University of Jinan, Jinan, China
| | - Chenxi Ouyang
- Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Meng
- School of Biological Science and Technology, University of Jinan, Jinan, China
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Sambola A, Halvorsen S, Adlam D, Hassager C, Price S, Rosano G, Schiele F, Holmvang L, de Riva M, Rakisheva A, Sulzgruber P, Swahn E. Management of cardiac emergencies in women: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the Heart Failure Association (HFA), and the European Heart Rhythm Association (EHRA) of the ESC, and the ESC Working Group on Cardiovascular Pharmacotherapy. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae011. [PMID: 38628674 PMCID: PMC11020263 DOI: 10.1093/ehjopen/oeae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
Cardiac emergencies in women, such as acute coronary syndromes, acute heart failure, and cardiac arrest, are associated with a high risk of adverse outcomes and mortality. Although women historically have been significantly underrepresented in clinical studies of these diseases, the guideline-recommended treatment for these emergencies is generally the same for both sexes. Still, women are less likely to receive evidence-based treatment compared to men. Furthermore, specific diseases affecting predominantly or exclusively women, such as spontaneous coronary dissection, myocardial infarction with non-obstructive coronary arteries, takotsubo cardiomyopathy, and peripartum cardiomyopathy, require specialized attention in terms of both diagnosis and management. In this clinical consensus statement, we summarize current knowledge on therapeutic management of these emergencies in women. Key statements and specific quality indicators are suggested to achieve equal and specific care for both sexes. Finally, we discuss several gaps in evidence and encourage further studies designed and powered with adequate attention for sex-specific analysis.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology and Research Institute, University Hospital Vall d’Hebron, Universitat Autònoma, CIBER Cardiovascular diseases (CIBER-CV), Barcelona, Spain
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institue of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George’s University Hospital, London, UK
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, Besancon, France
| | - Lene Holmvang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marta de Riva
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Amina Rakisheva
- Department of Cardiology, City Cardiology Center, Almaty, Kazakhstan
- Department of Cardiology, Qonaev City Hospital, Almaty Region, Kazakhstan
| | - Patrick Sulzgruber
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Eva Swahn
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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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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Rallidis LS, Iordanidis D, Papathanasiou KA, Simitsis P, Varounis C, Simou A, Kosmas N. NT-proBNP/cardiac troponin T ratio >7.5 on the second day of admission can differentiate Takotsubo from acute coronary syndrome with good accuracy. Hellenic J Cardiol 2024; 76:22-30. [PMID: 37269943 DOI: 10.1016/j.hjc.2023.05.010] [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: 02/08/2023] [Revised: 05/01/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is not usually diagnosed until patients with suspected acute coronary syndrome (ACS) and echocardiographically detected apical aneurysm are found to have "normal" coronary angiography (CA). Our aim was to explore whether cardiac biomarkers can contribute to the early diagnosis of TTS. METHODS Ratios of N-terminal-pro brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (cTnT) both expressed in pg/mL [admission and the 3 following days] were compared in 38 patients with TTS and 114 ACS patients of whom 58 had non-ST-elevation myocardial infarction (NSTEMI). RESULTS NT-proBNP/cTnT ratio at admission and during the following 3 days was significantly higher in TTS compared to patients with ACS [18.4 (8.7-41.7) vs 2.9 (0.8-6.8), 29.6 (14.3-53.7) vs 1.2 (0.5-2.7), 30.0 (11.6-50.9) vs 1.7 (0.5-3.0), 27.8 (11.3-42.6) vs 1.4 (0.6-2.8), respectively, all <0.001]. Βest discrimination of TTS from ACS was possible with the ratio of NT-proBNP/cTnT on the 2nd day. A cut-off value of NT-proBNP/cTnT ratio >7.5 had a sensitivity of 97.3%, a specificity of 95.4% and an accuracy of ∼96% in detecting TTS as opposed to ACS. Furthermore, the ratio of NT-proBNP/cTnT preserved its discriminatory value in the subgroup of patients with NSTEMI. In particular, an NT-proBNP/cTnT ratio >7.5 on the 2nd day had a sensitivity of 97.3%, a specificity of 91.4%, and an accuracy of 93.7% in differentiating TTS from NSTEMI. CONCLUSIONS An NT-proBNP/cTnT ratio >7.5 on the 2nd day of admission can be useful for the early identification of TTS among selected patients initially presenting with ACS, a ratio more clinically useful in the setting of NSTEMI.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Dimitrios Iordanidis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Konstantinos A Papathanasiou
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece.
| | - Panagiotis Simitsis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Christos Varounis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Aggeliki Simou
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Nikolaos Kosmas
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
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McMurray M, Orthober R, Huecker M. Ketamine's love story with the heart: A Takotsubo twist. Am J Emerg Med 2024; 77:232.e5-232.e7. [PMID: 38184443 DOI: 10.1016/j.ajem.2023.12.041] [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: 11/29/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Ketamine is a dissociative anesthetic with N-methyl-d-aspartate and glutamate receptor antagonist properties. It has been the most popular agent to facilitate emergency department procedures for three decades. Considered a safe and effective option for procedural sedation, ketamine has rapid onset, short effective sedation time, and a low risk profile. Ketamine's sympathomimetic effects could theoretically induce stress-related cardiac dysfunction, including cardiomyopathy. A review of the literature demonstrates one prior report of stress (Takotsubo) cardiomyopathy after ketamine sedation. CASE REPORT In this case report, we present a case of Takotsubo cardiomyopathy after ketamine sedation for distal radius fracture reduction. The patient presented hemodynamically normal with an unremarkable cardiac ultrasound and progressed to hypoxia from bilateral pulmonary edema, eventually requiring intubation. Inpatient evaluation revealed elevated high sensitivity troponin, non-obstructive coronary arteries on catheterization, and echocardiogram findings of Takotsubo cardiomyopathy. She received operative fixation of her radius fracture by orthopedics and was discharged home on hospital day 9. She had an unremarkable follow up with cardiology but had no echocardiogram to determine full resolution. CONCLUSION Although ketamine has robust evidence of safety and efficacy, physicians should be aware of the potential complications of its sympathomimetic effects, from hypertension and tachycardia to overt Takotsubo cardiomyopathy.
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Affiliation(s)
- Mitchell McMurray
- Department of Emergency Medicine, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, United States of America.
| | - Raymond Orthober
- Department of Emergency Medicine, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, United States of America.
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, United States of America.
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Gómez-Álvarez U, Razo-Ortega DA, Álvarez-Sangabriel A, de la Fuente-Mancera JC, Guizar-Sánchez CA. [Happy heart syndrome, a rare variant of takotsubo cardiomyopathy: a case report]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:243-246. [PMID: 38330423 PMCID: PMC11160537 DOI: 10.24875/acm.23000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/12/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Ulises Gómez-Álvarez
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Denisse A. Razo-Ortega
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Amada Álvarez-Sangabriel
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Juan C. de la Fuente-Mancera
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Carlos A. Guizar-Sánchez
- Clínica de Insuficiencia Cardiaca y Trasplante, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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20
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Stępień K, Nowak K, Karcińska A, Horosin G, del Carmen Yika A, Lenart J, Górowska A, Iwańczyk S, Podolec M, Siniarski A, Nessler J, Zalewski J. Coronary Slow-Flow Phenomenon in Takotsubo Syndrome: The Prevalence, Clinical Determinants, and Long-Term Prognostic Impact. Int J Mol Sci 2024; 25:1297. [PMID: 38279297 PMCID: PMC10816693 DOI: 10.3390/ijms25021297] [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: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/28/2024] Open
Abstract
Patients with takotsubo syndrome (TTS) may present coronary slow flow (CSF) in angiography performed in the acute myocardial infarction (MI). However, the detailed clinical relevance and its long-term impact remain poorly understood. Among 7771 MI patients hospitalized between 2012 and 2019, TTS was identified in 82 (1.1%) subjects. The epicardial blood flow was assessed with thrombolysis in myocardial infarction (TIMI) scale and corrected TIMI frame count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). CSF was defined as TIMI-2 or corrected TFC > 27 frames in at least one epicardial vessel. CSF was identified in 33 (40.2%) TTS patients. In the CSF-TTS versus normal-flow-TTS group, lower values of left ventricular ejection fraction on admission (33.5 (25-40) vs. 40 (35-45)%, p = 0.019), more frequent midventricular TTS (27.3 vs. 8.2%, p = 0.020) and the coexistence of both physical and emotional triggers (9.1 vs. 0%, p = 0.032) were noted. Within a median observation of 55 months, higher all-cause mortality was found in CSF-TTS compared with normal-flow TTS (30.3 vs. 10.2%, p = 0.024). CSF was identified as an independent predictor of long-term mortality (hazard ratio 10.09, 95% confidence interval 2.12-48.00, p = 0.004). CSF identified in two-fifths of TTS patients was associated with unfavorable long-term outcomes.
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Affiliation(s)
- Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Department of Thromboembolic Disorders, Jagiellonian University Medical College, 31-202 Krakow, Poland
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Department of Thromboembolic Disorders, Jagiellonian University Medical College, 31-202 Krakow, Poland
| | - Aleksandra Karcińska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Grzegorz Horosin
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Alicia del Carmen Yika
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Julia Lenart
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Anna Górowska
- Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (A.K.); (G.H.); (A.d.C.Y.); (J.L.); (A.G.)
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland;
| | - Mateusz Podolec
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (M.P.); (A.S.); (J.N.); (J.Z.)
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22
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Lagi F, Formica G, Rostagno A, Milia A, Pradella S, Guazzini G, Tekle Kiros S, Corsi P, Bartoloni A, Zammarchi L, Pieralli F. When it rains, it pours: Early treatment with tecovirimat of cardiac complications associated with monkeypox infection in a person with HIV and previously undiagnosed Lyme disease. A case report. Heliyon 2024; 10:e23965. [PMID: 38226256 PMCID: PMC10788526 DOI: 10.1016/j.heliyon.2023.e23965] [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: 04/21/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
Cardiac involvement, such as myocarditis and pericarditis, can be a severe complication of monkeypox virus (mpox) infection and could be related to other co-infections with cardiac involvement. Tecovirimat is an antiviral specifically designed to inhibit smallpox infection diffusion and approved by the FDA for other Orthopoxvirus infections; its efficacy in mpox-infected patients is not well established. We present the case of a cardiac complication during mpox infection in a previously undiagnosed Lyme disease in a 42-year-old man living with HIV. Two days after the typical maculopapular rash, the patient reported a rise in body temperature up to 39 °C, chest pain without irradiation, and shortness of breath. We found an increase in troponin level, a slight reduction in ejection fraction, and grade 2 AV block (Mobitz 1 and 2) with frequent sinus pauses (the longest of 10.1 s). Given the suspicion of myopericarditis with cardiac conduction system involvement, the patient was admitted to the Intermediate Care Unit for continuous monitoring and further evaluation. Treatment included Ibuprofen 600 mg every 12 hours (bid) and colchicine 1 mg once daily for anti-inflammatory purposes. Concomitantly, treatment with tecovirimat was started at 600 mg bid for a total of 14 days. Cardiac MRI with gadolinium showed mild interstitial edema and pericardial enhancement. However, despite the clinical and laboratory resolution of the acute phase, bradycardia with episodes of AV block persisted at follow-up, suggesting the possibility of an additional etiology. Thus, the patient was investigated for Lyme disease because high-degree AV block is the most common presentation of Lyme carditis. Serological results evidenced a previous Borrelia burgdorferi senso latu. We decided to start treatment with doxycycline 100 mg every 12h, even pending the uncertainty of the role of a previous Lyme disease in determining the cardiac rhythm disturbances. At the evaluation on day 44, the patient was systemically well, and after cardiologist consultation, pace-maker implantation was not deemed indicated. This case underscores the importance of considering alternative causes of carditis when the clinical picture remains unclear or persists after the acute phase.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Giuseppe Formica
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Andrea Rostagno
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Milia
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Giulia Guazzini
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Seble Tekle Kiros
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Paola Corsi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
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23
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Abusnina W, Elhouderi E, Walters RW, Al-Abdouh A, Mostafa MR, Liu JL, Mazozy R, Mhanna M, Ben-Dor I, Dufani J, Kabach A, Michos ED, Aboeata A, Mamas MA. Sex Differences in the Clinical Outcomes of Patients With Takotsubo Stress Cardiomyopathy: A Meta-Analysis of Observational Studies. Am J Cardiol 2024; 211:316-325. [PMID: 37923154 DOI: 10.1016/j.amjcard.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared with females. Gender-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether gender-based differences are observed in TSCM clinical outcomes. A comprehensive literature search of PubMed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between male and female patients with TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. Twelve observational studies involving 51,213 patients (4,869 males and 46,344 females) were included in the meta-analysis. Male gender was associated with statistically significant higher in-hospital all-cause mortality compared with females in patients with TSCM (RR 2.17, 95% CI 1.77 to 2.67, p <0.001). The rate of cardiogenic shock was significantly higher in males with TSCM compared with females (RR 1.66, 95% CI 1.29 to 2.12, p <0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Male gender was associated with a two-fold greater in-hospital all-cause mortality risk compared with female gender. The higher mortality risk associated with male gender deserves further study, particularly whether it represents later recognition of the condition and disparities in treatments.
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Affiliation(s)
- Waiel Abusnina
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA; Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC.
| | - Eiman Elhouderi
- Department of Medicine, Beaumont Hospital, Dearborn, MI, USA
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mostafa R Mostafa
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | - John L Liu
- Creighton University School of Medicine, Omaha, NE, USA
| | - Ruqayah Mazozy
- Department of Cardiology, Zliten Medical Center, Zliten, Libya
| | - Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, IA, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC
| | - Jalal Dufani
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Amjad Kabach
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahemd Aboeata
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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24
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Tini G, Arcari L, Mistrulli R, Follesa F, Cianca A, Sclafani M, Tocci G, Spallarossa P, Battistoni A, Cacciotti L, Musumeci B, Barbato E. A contemporary update on cancer and takotsubo syndrome. Front Cardiovasc Med 2024; 10:1301383. [PMID: 38259302 PMCID: PMC10800806 DOI: 10.3389/fcvm.2023.1301383] [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: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Takotsubo syndrome (TTS) is characterized by a transient left ventricular systolic dysfunction, burdened by significant acute and long-term mortality and morbidity. The prognosis of TTS, especially in the long-term, is influenced by both non-cardiovascular (non-CV) and CV comorbidities, among which cancer is one of the most common. The presence of a malignancy is proven to be associated with higher mortality in TTS. Moreover, a number of anticancer treatments has been reported to possibly cause TTS as a form of cardiotoxicity, even though clearcut associations are lacking. The aim of this narrative review is to sum up contemporary knowledge on the association of cancer and TTS, addressing unmet needs and practical implications. The importance of a close collaboration between cardiologists and oncologists is herein highlighted, both to allow an adequate management of the acute TTS phase, and to actively and safely return to the oncologic management once the acute setting is resolved.
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Affiliation(s)
- Giacomo Tini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Raffaella Mistrulli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Federico Follesa
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cianca
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Sclafani
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiology Network, Genova, Italy
| | - Allegra Battistoni
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Cacciotti
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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25
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Moady G, Yelin B, Sweid R, Atar S. C-Reactive Protein Can Predict Outcomes in Patients With Takotsubo Syndrome. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:28-33. [PMID: 38303919 PMCID: PMC10827700 DOI: 10.36628/ijhf.2023.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 02/03/2024]
Abstract
Background and Objectives Takotsubo syndrome (TTS) is a form of reversible cardiomyopathy often preceded by mental or physical stressors and predominantly affects elderly women. Several cardiac and inflammatory biomarkers are involved in the pathogenesis of the disease. We aimed to investigate the correlation of C-reactive protein (CRP) level with left ventricular ejection fraction (LVEF) and clinical outcomes in patients with TTS. Methods The study included patients with discharge-diagnosis of Takotsubo through 2017-2022 from the cardiology department. Demographic, laboratory, echocardiographic, and clinical outcomes were retrospectively obtained. We investigated the relation between CRP and LVEF, length of stay (LOS), in-hospital complications, and recurrence. Results A total of 86 patients (93% female, mean age 68.8±12.3 years) were included in the study. The median CRP level was 17.4 (interquartile range [IQR], 6.1-40.1) mg/L, and the mean LVEF was 41.5%, (IQR, 38-50%). Complications occurred in 24 (27.9%) of the patients, and the median LOS was 3 (IQR, 3-5) days. The level of CRP was associated with lower LVEF (r=-0.39, p<0.001), longer hospital stay (r=0.25, p=0.021), and recurrence. There was no correlation between CRP and in-hospital complications. In multivariate logistic regression, poor LVEF was associated with TTS recurrence (odds ratio, 1.22; 95% confidence interval, 1.08-1.37; p=0.001). Using linear regression, only CRP was correlated with longer LOS and lower LVEF (p<0.001). Conclusions Among patients hospitalized with TTS, CRP level was associated with poor LVEF and prolonged hospital stay but not with in-hospital complications. Poor LVEF was also associated with TTS recurrence.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - BateL Yelin
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Rania Sweid
- Biostatistics Unit, Galilee Medical Center, Nahariya, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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26
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Fakhra S, Faisaluddin M, Sattar Y, DeCicco D, Ahmed A, Patel N, Balasubramanian S, Ludhwani D, Masood H, Raina S, Gonuguntla K, Feitell SC, Tarun T, Balla S. Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis. Expert Rev Cardiovasc Ther 2024; 22:103-109. [PMID: 38105722 DOI: 10.1080/14779072.2023.2295378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known. METHODS We queried Nationwide Inpatient Sample (NIS) from 2009-2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality. RESULTS Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (n = 17,775, 77%). On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36-1.52), AKI (aOR 1.53, 95% CI 1.48-1.58), pressor requirement (aOR 1.37, 95% CI 1.25-1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40-0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73-0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS. CONCLUSION MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.
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Affiliation(s)
- Sadaf Fakhra
- Department of Internal Medicine, University of Nevada, Reno, NV, USA
| | | | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Danielle DeCicco
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | - Senthil Balasubramanian
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Dipesh Ludhwani
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Hassan Masood
- Department of Critical Care, Pakistan Railway Hospital, Rawalpindi, Pakistan
| | - Sameer Raina
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | | | - Scott C Feitell
- Department Of Cardiology, Rochester General Hospital, Rochester, NY, USA
| | - Tushar Tarun
- Division of cardiovascular medicine, University of Arkansas School of Medicine, Little Rock, AR, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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27
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Banai A, Retsky R, Lupu L, Levi E, Zahler D, Feder O, Merin R, Topilsky Y, Rosso R, Banai S, Viskin S, Chorin E. Electromechanical Window and Spontaneous Ventricular Tachyarrhythmias in Takotsubo Syndrome. Am J Cardiol 2024; 210:100-106. [PMID: 38682708 DOI: 10.1016/j.amjcard.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 05/01/2024]
Abstract
QT interval prolongation is common in patients hospitalized with Takotsubo syndrome (TTS), however, only a minority experience ventricular tachyarrhythmias. Our aim was to characterize the electromechanical window (EMW) in patients with TTS and to evaluate its association with ventricular tachyarrhythmias. We preformed aretrospective analysis of 84 patients hospitalized with TTS in the Tel-Aviv Medical Center between 2013 and 2022. All patients underwent a comprehensive echocardiographic evaluation and the EMW was calculated by subtracting the QT interval from the QRS onset to the aortic valve closure obtained from a continuous-wave Doppler for the same beat. Of the 84 patients with TTS, 74 (88%) were female and the mean age was 70 ± 11 years. The mean left ventricular ejection fraction was 42 ± 8%. The EMW was negative in 81 patients (96%), and the mean EMW was -69 ± 50 ms. Ventricular tachyarrhythmias occurred in 7 patients (8%). The EMW of patients who experienced ventricular tachyarrhythmias was more negative than patients who did not (-133 ± 23 ms vs -63 ± 48 ms, p = 0.001). In the univariate analysis, EMW and QT were associated with ventricular tachyarrhythmias (univariate odds ratio [OR]EMW 1.03, 95% confidence interval [CI] 1.01 to 1.05, p = 0.003 and univariate ORQTc 1.02, 95% CI 1.01 to 1.03, p = 0.02); however, only EMW remained significant in the multivariate analysis (OREMW 1.03 95% CI 1.03 to 1.05, p = 0.023). EMW was more effective than corrected QT interval in identifying patients who had ventricular tachyarrhythmias (AUCEMW: 0.89, 95% CI 0.82 to 0.97 vs AUCQTc 0.77, 95% CI 0.61 to 0.93, p = 0.02), and a cut-off value of -108 ms was predictive of ventricular tachyarrhythmias with a sensitivity of 86% and a specificity of 79%. In conclusion, EMW is negative in patients with TTS and is associated with increased risk for ventricular tachyarrhythmias. The role of EMW in the risk stratification of patients with TTS warrants further investigation.
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Affiliation(s)
- Ariel Banai
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Rachel Retsky
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lior Lupu
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Erez Levi
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Zahler
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omri Feder
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roei Merin
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yan Topilsky
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raphael Rosso
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Banai
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Chorin
- Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Cardiology Division, Tel-Aviv Sourasky Medical Center Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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28
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Pinho AI, Oliveira C, Santos LD, Marques C, Cabrita A, Dias P, Pestana G, Sousa C, Rodrigues RA. QT interval prolongation in Takotsubo syndrome: a frightening feature with no major prognostic impact. Monaldi Arch Chest Dis 2023. [PMID: 38058291 DOI: 10.4081/monaldi.2023.2834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Despite the frequent and often severe repolarization abnormalities seen in Takotsubo syndrome (TTS), the underlying mechanism of life-threatening arrhythmias is incompletely understood, and the risk remains uncertain. TTS is considered a potential cause of acquired long QT syndrome; however, there is no robust evidence that QT prolongation has a major prognostic impact on these patients' outcomes. Our aim was to assess the prevalence and clinical implications of acquired long QT during TTS events and compare in-hospital and long-term outcomes between patients with and without corrected QT interval (QTc) prolongation. This is a retrospective cohort study that included 113 patients admitted to our tertiary care hospital with a diagnosis of TTS. The cohort was divided into two groups: a long QTc group (QTc≥460 milliseconds in any electrocardiogram at admission or during hospitalization) and a normal QTc group. Baseline characteristics, occurrences during hospitalization, and outcome data were obtained from the revision of medical registries and hospital visits. Of the 113 patients, 107 (94.7%) were female. The mean age was 67.6±11.7 years. QTc prolongation was found in 38%. Demographic characteristics, relevant chronic medication, prevalence of cardiovascular risk factors, and other comorbidities were similar between the groups, except for history of atrial fibrillation, which was more common in the long QTc group. Syncope was more prevalent in the long QTc group. In-hospital complications were not statistically different between patients with long and normal QTc (48.8% versus 44.2%, p=0.637), including ventricular arrhythmias and complete atrioventricular block (both 4.7% versus 1.4%, p=0.556). In-hospital mortality was 0.9%, corresponding to one patient in the long QTc group. The mean follow-up time was 4.8±3.8 years. 5-year all-cause mortality and the occurrence of the composite endpoint of major adverse cardiac and cerebrovascular events did not differ between the groups (p=0.511 and p=0.538, respectively). Our study found no association between prolonged QTc interval during TTS events and adverse prognosis, since in-hospital and long-term outcomes were similar between the groups. Our findings suggest that, although QT prolongation is usually a frightening feature on ECG, this repolarization abnormality during the acute phase has no major prognostic implications in the TTS population.
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Affiliation(s)
- Ana Isabel Pinho
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Cátia Oliveira
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Luís Daniel Santos
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Catarina Marques
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - André Cabrita
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Paula Dias
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Gonçalo Pestana
- Department of Cardiology, University Hospital Center of São João, Porto.
| | - Carla Sousa
- Department of Cardiology, University Hospital Center of São João, Porto; Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto.
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29
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Wang T, Xiong T, Yang Y, Chen X, Ma Z, Zuo B, Ning D, Zhou B, Song R, Liu X, Wang D. Estradiol-mediated small GTP-binding protein GDP dissociation stimulator induction contributes to sex differences in resilience to ferroptosis in takotsubo syndrome. Redox Biol 2023; 68:102961. [PMID: 38007983 PMCID: PMC10719533 DOI: 10.1016/j.redox.2023.102961] [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: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Declining beneficial cardiovascular actions of estradiol (E2) have been associated with disproportionate susceptibility to takotsubo syndrome (TTS) in postmenopausal women. However, the underlying mechanisms between E2 and this marked disproportion remain unclear. SmgGDS (small GTP-binding protein GDP dissociation stimulator), as a key modulator of cardiovascular disease, plays protective roles in reducing oxidative stress and exerts pleiotropic effects of statins. Whether SmgGDS levels are influenced by E2 status and the effect of SmgGDS on sex differences in TTS are poorly understood. METHODS Clinical data were reviewed from TTS inpatients. Echocardiography, immunofluorescence, and immunohistochemistry were performed together with expression analysis to uncover phenotypic and mechanism changes in sex differences in TTS-like wild-type (WT) and SmgGDS± mice. HL-1 cardiomyocytes were used to further examine and validate molecular mechanisms. RESULTS In 14 TTS inpatients, TTS had a higher incidence in postmenopausal women as compared to premenopausal women and men. In murine TTS, female WT mice exhibited higher cardiac SmgGDS levels than male WT mice. Ovariectomy reduced SmgGDS expression in female WT mice similar to that observed in male mice, whereas E2 replacement in these ovariectomized (OVX) female mice reversed this effect. The physiological importance of this sex-specific E2-mediated SmgGDS response is underscored by the disparity in cardiac adaptation to isoproterenol (ISO) stimulation between both sexes of WT mice. E2-mediated SmgGDS induction conferred female protection against TTS-like acute cardiac injury involving ferritinophagy-mediated ferroptosis. No such cardioprotection was observed in male WT mice and OVX female. A causal role for SmgGDS in this sex-specific cardioprotective adaptation was indicated, inasmuch as SmgGDS deficiency abolished E2-modulated cardioprotection against ferritinophagy and aggravates TTS progression in both sexes. Consistently, knockdown of SmgGDS in HL-1 cardiomyocytes exacerbated ferroptosis in a ferritinophagy-dependent manner and abrogated the protective role of E2 against ferritinophagy. Mechanistically, our findings revealed that SmgGDS regulated E2-dependent cardioprotective effects via AMPK/mTOR signaling pathway. SmgGDS deficiency abolished E2-conferred protection against ferritinophagy through activating AMPK/mTOR pathway, while treatment with recombinant SmgGDS in HL-1 cells significantly mitigated this pathway-associated ferritinophagy activity. CONCLUSIONS These results demonstrate that SmgGDS is a central mediator of E2-conferred female cardioprotection against ferritinophagy-mediated ferroptosis in TTS.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China; Cardiology Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Ting Xiong
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Ziwei Ma
- Clinical Medical College, Dalian Medical University, Dalian, Liaoning, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Dong Ning
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Beibei Zhou
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China
| | - Ruilong Song
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xuesong Liu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), Taizhou, Jiangsu, China.
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Cao C, Qi YT, Wang AA, Wang ZY, Liu ZX, Meng HX, Li L, Liu JX. Huoxin Pill Reduces Myocardial Ischemia Reperfusion Injury in Rats via TLR4/NFκB/NLRP3 Signaling Pathway. Chin J Integr Med 2023; 29:1066-1076. [PMID: 37608040 DOI: 10.1007/s11655-023-3640-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To explore the protective effect of Huoxin Pill (HXP) on acute myocardial ischemia-reperfusion (MIRI) injury in rats. METHODS Seventy-five adult SD rats were divided into the sham-operated group, model group, positive drug group (diltiazem hydrochloride, DH), high dose group (24 mg/kg, HXP-H) and low dose group (12 mg/kg, HXP-L) of Huoxin Pill (n=15 for every group) according to the complete randomization method. After 1 week of intragastric administration, the left anterior descending coronary artery of the rat's heart was ligated for 45 min and reperfused for 3 h. Serum was separated and the levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH), superoxide dismutase (SOD), and malondialdehyde (MDA), hypersensitive C-reactive protein (hs-CRP) and interleukin-1β (IL-1β) were measured. Myocardial ischemia rate, myocardial infarction rate and myocardial no-reflow rate were determined by staining with Evans blue and 2,3,5-triphenyltetrazolium chloride (TTC). Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and Bioinformatics Analysis Tool for Molecular mechANism of Traditional Chinese Medicine (BATMAN) databases were used to screen for possible active compounds of HXP and their potential therapeutic targets; the results of anti-inflammatory genes associated with MIRI were obtained from GeneCards, Drugbank, Online Mendelian Inheritance in Man (OMIM), and Therapeutic Target Datebase (TTD) databases was performed; Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment were used to analyze the intersected targets; molecular docking was performed using AutoDock Tools. Western blot was used to detect the protein expression of Toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NFκB)/NOD-like receptor protein 3 (NLRP3). RESULTS Compared with the model group, all doses of HXP significantly reduced the levels of LDH, CK and CK-MB (P<0.05, P<0.01); HXP significantly increased serum activity of SOD (P<0.05, P<0.01); all doses of HXP significantly reduced the levels of hs-CRP and IL-1β (P<0.05, P<0.01) and the myocardial infarction rate and myocardial no-reflow rate (P<0.01). GO enrichment analysis mainly involved positive regulation of gene expression, extracellular space and identical protein binding, KEGG pathway enrichment mainly involved PI3K-Akt signaling pathway and lipid and atherosclerosis. Molecular docking results showed that kaempferol and luteolin had a better affinity with TLR4, NFκB and NLRP3 molecules. The protein expressions of TLR4, NFκB and NLRP3 were reduced in the HXP group (P<0.01). CONCLUSIONS HXP has a significant protective effect on myocardial ischemia-reperfusion injury in rats, and its effect may be related to the inhibition of redox response and reduction of the inflammatory response by inhibiting the TLR4NFκB/NLRP3 signaling pathway.
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Affiliation(s)
- Ce Cao
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
- Institute of Chinese Medicine Sciences, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yu-Tong Qi
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
| | - Ao-Ao Wang
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
| | - Zi-Yan Wang
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
| | - Zi-Xin Liu
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
| | - Hong-Xu Meng
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
| | - Lei Li
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China
| | - Jian-Xun Liu
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, 100091, China.
- Institute of Chinese Medicine Sciences, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
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Chen W, Ni M, Huang H, Cong H, Fu X, Gao W, Yang Y, Yu M, Song X, Liu M, Yuan Z, Zhang B, Wang Z, Wang Y, Chen Y, Zhang C, Zhang Y. Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition). MedComm (Beijing) 2023; 4:e438. [PMID: 38116064 PMCID: PMC10729292 DOI: 10.1002/mco2.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/11/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Since the four working groups of the Chinese Society of Cardiology issued first expert consensus on coronary microvascular diseases (CMVD) in 2017, international consensus documents on CMVD have increased rapidly. Although some of these documents made preliminary recommendations for the diagnosis and treatment of CMVD, they did not provide classification of recommendations and levels of evidence. In order to summarize recent progress in the field of CMVD, standardize the methods and procedures of diagnosis and treatment, and identify the scientific questions for future research, the four working groups of the Chinese Society of Cardiology updated the 2017 version of the Chinese expert consensus on CMVD and adopted a series of measures to ensure the quality of this document. The current consensus has raised a new classification of CMVD, summarized new epidemiological findings for different types of CMVD, analyzed key pathological and molecular mechanisms, evaluated classical and novel diagnostic technologies, recommended diagnostic pathways and criteria, and therapeutic strategies and medications, for patients with CMVD. In view of the current progress and knowledge gaps of CMVD, future directions were proposed. It is hoped that this expert consensus will further expedite the research progress of CMVD in both basic and clinical scenarios.
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Affiliation(s)
- Wenqiang Chen
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Mei Ni
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - He Huang
- Department of CardiologySir Run Run Shaw Hospital affiliated with Zhejiang University School of MedicineHangzhouChina
| | - Hongliang Cong
- Department of CardiologyTianjin Chest Hospital, Tianjin UniversityTianjinChina
| | - Xianghua Fu
- Department of CardiologyThe Second Hospital of Hebei Medical UniversityShijiazhuangHebeiChina
| | - Wei Gao
- Department of CardiologyPeking University Third HospitalBeijingChina
| | - Yuejin Yang
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiantao Song
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Meilin Liu
- Department of GeriatricsPeking University First HospitalBeijingChina
| | - Zuyi Yuan
- Department of CardiologyThe First Affiliated Hospital of Xian Jiaotong UniversityXianChina
| | - Bo Zhang
- Department of CardiologyFirst Affiliated Hospital, Dalian Medical UniversityDalianLiaoningChina
| | - Zhaohui Wang
- Department of CardiologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yan Wang
- Department of CardiologyXiamen Cardiovascular Hospital, Xiamen UniversityXiamenChina
| | - Yundai Chen
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China; for the Basic Research Group, Atherosclerosis and Coronary Heart Disease Group, Interventional Cardiology Group, and Women's Heart Health Group of the Chinese Society of Cardiology
| | - Cheng Zhang
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yun Zhang
- The National Key Laboratory for Innovation and Transformation of Luobing TheoryThe Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical ScienceDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina
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Lu R, Lu M, He S, Lu J, Liao Y, Cui T, Wang M. Case report: Takotsubo syndrome following percutaneous coronary intervention. J Cardiothorac Surg 2023; 18:335. [PMID: 37974263 PMCID: PMC10655480 DOI: 10.1186/s13019-023-02412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS), which is frequently secondary to severe emotional (fear, anxiety, etc.) or physical stress, is an acute reversible heart failure syndrome characterized by temporary left ventricular regional systolic dysfunction. Nevertheless, TTS after percutaneous coronary intervention (PCI) is rare, and its clinical characteristics are easily confused with complications after PCI. CASE PRESENTATION This article reports a case of TTS induced by psychological and physical pressure after successful PCI in our institution. The patient had symptoms comparable to complications after PCI, including V1-V5 ST segment elevation and T wave changes of electrocardiogram (ECG) and troponin elevation. Coronary angiogram, left ventricle opacification (LVO), and cardiac magnetic resonance (CMR) were performed to exclude postoperative complications. Diagnosis of TTS was eventually achieved. CONCLUSION We cannot dismiss the risk of TTS in patients who have unexplained V1-V5 ST segment elevation and T wave changes of ECG and troponin elevation following successful PCI. Meanwhile, medical personnel should provide mental, cultural, and emotional services to patients in addition to essential diagnostic and treatment technical services during the perioperative period.
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Affiliation(s)
- Rui Lu
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Mingjun Lu
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Shangfei He
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Jing Lu
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yi Liao
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Tongtao Cui
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Min Wang
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China.
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González-Jasso JG, Montero-Pola YL, Toledo-Salinas O, Schlie-Villa W, Muñóz-López A, García-Hernández E. [Takotsubo cardiomyopathy associated with abnormal birth of the coronary arteries]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:882-887. [PMID: 37995560 PMCID: PMC10727765 DOI: 10.5281/zenodo.10064743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 11/25/2023]
Abstract
Background Takotsubo cardiomyopathy (TM) is a form of non-ischemic cardiomyopathy. It is characterized by transient regional systolic dysfunction of the left ventricle that mimics acute myocardial infarction. The main objective of this article is to report the case of a patient with TM associated with abnormal birth of the left coronary trunk. Clinical case A 76-year-old woman with typical angina at rest, with an electrocardiogram that showed dynamic changes in the T wave and elevation of biomarkers. Coronary angiography showed epicardial coronary arteries without significant lesions and abnormal birth of the left coronary trunk from the proximal segment of the right coronary artery. The patient progressed favorably, and the transthoracic echocardiogram showed no mobility disorders 3 months after the event. Conclusions TM and abnormal birth of the coronary arteries are rare diseases whose simultaneous presentation is extraordinary. The diagnosis of both clinical entities is made by coronary angiography and echocardiogram, and their treatment is similar to that of patients with acute coronary syndrome. Abnormal birth of the left coronary trunk with retroaortic switch reaching the contralateral site has a good clinical prognosis and echocardiographic follow-up should be performed 4 weeks after the onset of the condition.
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Affiliation(s)
- Jesús Guadalupe González-Jasso
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Yuyi Lizeth Montero-Pola
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Otoniel Toledo-Salinas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Intensivos. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Werner Schlie-Villa
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alexander Muñóz-López
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ernesto García-Hernández
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Vendrov AE, Xiao H, Lozhkin A, Hayami T, Hu G, Brody MJ, Sadoshima J, Zhang YY, Runge MS, Madamanchi NR. Cardiomyocyte NOX4 regulates resident macrophage-mediated inflammation and diastolic dysfunction in stress cardiomyopathy. Redox Biol 2023; 67:102937. [PMID: 37871532 PMCID: PMC10598408 DOI: 10.1016/j.redox.2023.102937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
In acute sympathetic stress, catecholamine overload can lead to stress cardiomyopathy. We tested the hypothesis that cardiomyocyte NOX4 (NADPH oxidase 4)-dependent mitochondrial oxidative stress mediates inflammation and diastolic dysfunction in stress cardiomyopathy. Isoproterenol (ISO; 5 mg/kg) injection induced sympathetic stress in wild-type and cardiomyocyte (CM)-specific Nox4 knockout (Nox4CM-/-) mice. Wild-type mice treated with ISO showed higher CM NOX4 expression, H2O2 levels, inflammasome activation, and IL18, IL6, CCL2, and TNFα levels than Nox4CM-/- mice. Spectral flow cytometry and t-SNE analysis of cardiac cell suspensions showed significant increases in pro-inflammatory and pro-fibrotic embryonic-derived resident (CCR2-MHCIIhiCX3CR1hi) macrophages in wild-type mice 3 days after ISO treatment, whereas Nox4CM-/- mice had a higher proportion of embryonic-derived resident tissue-repair (CCR2-MHCIIloCX3CR1lo) macrophages. A significant increase in cardiac fibroblast activation and interstitial collagen deposition and a restrictive pattern of diastolic dysfunction with increased filling pressure was observed in wild-type hearts compared with Nox4CM-/- 7 days post-ISO. A selective NOX4 inhibitor, GKT137831, reduced myocardial mitochondrial ROS, macrophage infiltration, and fibrosis in ISO-injected wild-type mice, and preserved diastolic function. Our data suggest sympathetic overstimulation induces resident macrophage (CCR2-MHCII+) activation and myocardial inflammation, resulting in fibrosis and impaired diastolic function mediated by CM NOX4-dependent ROS.
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Affiliation(s)
- Aleksandr E Vendrov
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Han Xiao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China; Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Andrey Lozhkin
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Takayuki Hayami
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Guomin Hu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China; Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Matthew J Brody
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Junichi Sadoshima
- Rutgers New Jersey Medical School, Department of Cell Biology and Molecular Medicine, Rutgers Biomedical and Health Sciences, Newark, NJ, 07101, USA
| | - You-Yi Zhang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, 100191, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, China; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China; Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100191, China
| | - Marschall S Runge
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Nageswara R Madamanchi
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.
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Watanabe Y, Yoshikawa T, Isogai T, Sakata K, Yamaguchi T, Arao K, Takaoka Y, Inohara T, Imori Y, Mochizuki H, Yamamoto T, Asai K, Nagao K, Takayama M. Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network. J Cardiol 2023; 82:356-362. [PMID: 37343932 DOI: 10.1016/j.jjcc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Hypoalbuminemia is common in critically ill patients and is associated with poor outcomes. However, the relationship between serum albumin levels and clinical outcomes in patients with takotsubo syndrome remains unclear. We examined the impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome. METHODS Using the multicenter registry of the Tokyo Cardiovascular Care Unit Network between January 2017 and December 2020, we identified 631 eligible patients with takotsubo syndrome (median age, 78 years; male proportion, 22 %) and documented serum albumin levels at admission, which were used to allocate patients to hypoalbuminemia (serum albumin <3.5 g/dL) or normal albumin (serum albumin ≥3.5 g/dL) groups. Patient characteristics and in-hospital mortality were compared between the groups. RESULTS Hypoalbuminemia was detected in 200 (32 %) patients at admission. The hypoalbuminemia group was older and had a higher proportion of men and preceding physical triggers than the normal albumin group. In-hospital all-cause mortality was greater in the hypoalbuminemia group than in the normal albumin group (9.5 % vs. 1.9 %, p < 0.001). Both cardiac (3.0 % vs. 0.5 %, p = 0.015) and non-cardiac (6.5 % vs. 1.4 %, p = 0.002) mortality was greater in the hypoalbuminemia group. In multivariable logistic regression analysis, hypoalbuminemia was independently associated with increased in-hospital mortality, even after adjusting for confounders, including age, sex, and triggering events (odds ratio, 3.23; 95 % confidence interval, 1.31-7.95; p = 0.011). CONCLUSIONS In patients with takotsubo syndrome, hypoalbuminemia is a common comorbidity and is associated with a substantial risk of in-hospital death. Close monitoring and comprehensive critical care are required in these patients.
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Affiliation(s)
- Yukihiro Watanabe
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Taku Inohara
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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Molina-Lopez VH, Escabi-Mendoza J. The Critical Role of Lambda-Shaped QRS-ST-T Wave Fusion ST-Elevation in Diagnosing and Managing Takotsubo Cardiomyopathy: A Case Report and Review of Literature. Cureus 2023; 15:e49037. [PMID: 38116354 PMCID: PMC10728760 DOI: 10.7759/cureus.49037] [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] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Stress-induced cardiomyopathy, commonly known as Takotsubo cardiomyopathy (TCM), is a clinical syndrome characterized by acute and transient ventricular systolic dysfunction that often presents with chest pain and may resemble an acute coronary syndrome. This case report discusses a complex clinical scenario involving an adult female with severe depression who attempted suicide through drug overdose, subsequently developing serotonin syndrome. Her clinical presentation was further complicated by the emergence of a unique lambda-shaped triangular QRS-ST-T waveform fusion ST-elevation electrocardiographic (ECG) pattern closely mimicking an anterolateral occlusive myocardial infarction. The study delves into the clinical implications of this unique ECG pattern in TCM, providing valuable insights into diagnosing and treating such complex cases. This case underscores the importance of recognizing diverse manifestations of TCM and its potential for severe cardiovascular complications.
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Affiliation(s)
- Victor H Molina-Lopez
- Department of Cardiology, Veterans Affairs (VA) Caribbean Healthcare System, San Juan, PRI
| | - Jose Escabi-Mendoza
- Department of Cardiology, Veterans Affairs (VA) Caribbean Healthcare System, San Juan, PRI
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Sonaglioni A, Lombardo M, Grasso E, Nicolosi GL, Foti N, Lonati C, Harari S. Presumed Takotsubo syndrome is associated with high in-hospital mortality in very elderly frail females: a case series. Aging Clin Exp Res 2023; 35:2851-2856. [PMID: 37581859 DOI: 10.1007/s40520-023-02517-5] [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: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/16/2023]
Abstract
Given the aging of general population, very elderly females with Takotsubo syndrome (TTS) are not rarely encountered in clinical practice. Although coronary angiography with left ventriculography is the gold standard diagnostic tool to exclude or confirm TTS, currently, this invasive procedure is less frequently performed in older patients with several comorbidities, such as renal failure, anemia, infections, neurological disorders, malignancy, and severe frailty. In these patients, a "presumed" TTS is diagnosed on the basis of clinical presentation, electrocardiogram, cardiac biomarkers, and echocardiographic findings without coronary angiography. While, in younger patients, TTS is generally a benign condition, in very elderly females, it is associated with higher in-hospital mortality and poor prognosis. Herein, we present four cases of ultra-octogenarian females diagnosed with "presumed TTS", who did not undergo coronary angiography due to severe frailty and multiple comorbidities and who exhibited poor outcome. This could arise the question if an early more aggressive approach could have changed final results. Probably, the solution could only be a personalized decision deriving from a profound and detailed discussion of each case through a multidisciplinary team approach.
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Affiliation(s)
| | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Nicolò Foti
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
| | - Chiara Lonati
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy.
| | - Sergio Harari
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy
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Manolis AA, Manolis TA, Manolis AS. Neurohumoral Activation in Heart Failure. Int J Mol Sci 2023; 24:15472. [PMID: 37895150 PMCID: PMC10607846 DOI: 10.3390/ijms242015472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
In patients with heart failure (HF), the neuroendocrine systems of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS) and the arginine vasopressin (AVP) system, are activated to various degrees producing often-observed tachycardia and concomitant increased systemic vascular resistance. Furthermore, sustained neurohormonal activation plays a key role in the progression of HF and may be responsible for the pathogenetic mechanisms leading to the perpetuation of the pathophysiology and worsening of the HF signs and symptoms. There are biomarkers of activation of these neurohormonal pathways, such as the natriuretic peptides, catecholamine levels and neprilysin and various newer ones, which may be employed to better understand the mechanisms of HF drugs and also aid in defining the subgroups of patients who might benefit from specific therapies, irrespective of the degree of left ventricular dysfunction. These therapies are directed against these neurohumoral systems (neurohumoral antagonists) and classically comprise beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and vaptans. Recently, the RAAS blockade has been refined by the introduction of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan, which combines the RAAS inhibition and neprilysin blocking, enhancing the actions of natriuretic peptides. All these issues relating to the neurohumoral activation in HF are herein reviewed, and the underlying mechanisms are pictorially illustrated.
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Affiliation(s)
- Antonis A Manolis
- First Department of Cardiology, Evagelismos Hospital, 106 76 Athens, Greece
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital, 115 28 Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Ippokrateio University Hospital, 115 27 Athens, Greece
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Osawa T, Tajiri K, Ieda M, Ishizu T. Clinical outcomes of takotsubo syndrome in patients with cancer: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1244808. [PMID: 37840966 PMCID: PMC10570743 DOI: 10.3389/fcvm.2023.1244808] [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: 06/23/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Recent studies suggested a relationship between Takotsubo syndrome (TTS) and malignancy. However, clinical outcomes of TTS associated with cancer have not been assessed completely. This study was aimed to investigate the outcomes of patients with TTS and cancer. Methods We performed a systematic review and meta-analysis to evaluate the clinical outcomes of TTS in patients with and without malignancy. We systematically reviewed and analyzed 14 studies (189,210 patients) published in PubMed and Cochrane Library databases until December 2022. The primary outcome was all-cause mortality at the longest follow-up. Results The prevalence of current or previous malignancy in patients with TTS was 8.7% (16,461 patients). Patients with TTS and malignancy demonstrated a higher risk of mortality at the longest follow-up than those with TTS alone (odds ratio [OR], 2.41; 95% confidence interval [CI]; 1.95-2.98; P < 0.001). Moreover, cancer was significantly associated with an increased risk of in-hospital or 30-day mortality (OR 2.36; 95% CI, 1.67-3.33; P < 0.001), shock (OR 1.42; 95% CI, 1.30-1.55; P < 0.001), mechanical respiratory support (OR 1.68; 95% CI, 1.59-1.77; P < 0.001), arrhythmia (OR 1.27; 95% CI, 1.21-1.34; P < 0.001), and major adverse cardiac events (OR 1.69; 95% CI, 1.18-2.442; P < 0.001). Conclusions This study revealed significant associations between previous or active cancer and an increased risk of all-cause mortality and in-hospital adverse events in patients with TTS.
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Affiliation(s)
- Takumi Osawa
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
- Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Rathi AC, Nagtode N, Chandra V, Pathade AG, Yelne S. Critical Insights Into the Management of Postpartum Left Main Spontaneous Coronary Artery Dissection: Current Strategies and Future Directions. Cureus 2023; 15:e44622. [PMID: 37799221 PMCID: PMC10548014 DOI: 10.7759/cureus.44622] [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: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
This review article delves into the multifaceted realm of postpartum left main spontaneous coronary artery dissection (PLMSCAD), an infrequent yet critical condition affecting women during the postpartum period. Through a comprehensive exploration of its pathophysiology, clinical presentation, diagnosis, management strategies, and future directions, this review provides a holistic understanding of PLMSCAD's complexities. The article highlights challenges in diagnosis due to overlapping symptoms and underscores the significance of prompt recognition and tailored interventions. Current management strategies, encompassing medical and interventional approaches, are analysed in the context of their short-term and long-term impact on patient outcomes. Ethical considerations and the role of patient education and support networks are explored, shedding light on the broader psychosocial dimensions of PLMSCAD management. As emerging research reveals insights into genetic influences, hormonal dynamics, and the prognosis of affected individuals, this review emphasises the necessity of collaborative research endeavours and data sharing to enhance our understanding and guide future strategies. Ultimately, this review underscores the urgency of addressing the unique needs of women experiencing PLMSCAD, urging ongoing research, multidisciplinary collaboration, and a patient-centred approach to optimise maternal health outcomes and well-being.
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Affiliation(s)
- Arya C Rathi
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhilesh Nagtode
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaibhav Chandra
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aniket G Pathade
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Repasos E, Kondylis M, Petropoulos I, Konstantinou G, Briasoulis A, Kanakakis I. Recurrent Takotsubo Cardiomyopathy Precipitated by Inhaled b2 Adrenergic Receptor Agonists. Am J Ther 2023; 30:e473-e475. [PMID: 37713700 DOI: 10.1097/mjt.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Evangelos Repasos
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Marios Kondylis
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Georgios Konstantinou
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
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Munoz KJ, Feig CL, Frandsen EL. Takotsubo cardiomyopathy in a 4-year-old female with pneumococcal meningitis. Cardiol Young 2023; 33:1722-1725. [PMID: 36918289 DOI: 10.1017/s1047951123000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
A previously healthy 4-year-old female presented in cardiogenic shock with pneumococcal meningitis. Findings on echocardiogram raised suspicion for takotsubo cardiomyopathy. With supportive care, left ventricular systolic function normalised. Findings on cardiac imaging helped determine the aetiology and avoid further invasive studies or unnecessary treatment.
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Affiliation(s)
- Kevin J Munoz
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Cheyenne L Feig
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Erik L Frandsen
- Department of Pediatric Cardiology, Loma Linda Children's Hospital, Loma Linda, CA, USA
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43
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Standifird C, Kaisler S, Gottula AL, Lauria MJ, Dean JT. Takotsubo Cardiomyopathy Syndrome in Critical Care Transport: A Case and Critical Review. Air Med J 2023; 42:372-376. [PMID: 37716811 DOI: 10.1016/j.amj.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 09/18/2023]
Abstract
Takotsubo cardiomyopathy syndrome, or simply takotsubo syndrome (TTS), is a form of stress cardiomyopathy thought to be caused by excess catecholamines in association with physical or emotional stress. Providers should maintain a high index of suspicion for TTS in patients with symptoms of acute coronary syndrome, acute decompensated heart failure, substernal chest pain, or dyspnea. However, TTS is a diagnosis of exclusion, and patients should initially be evaluated and treated for other causes, such as acute myocardial infarction. Critical care transport crews may encounter patients with TTS during their primary presentation, before diagnosis, or after the formal diagnosis is made in the catheterization laboratory. Therefore, crews should be familiar with unique aspects of the pathophysiology, diagnosis, and management of TTS. This article presents a case and provides a critical review of TTS for critical care transport clinicians.
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Affiliation(s)
- Colin Standifird
- Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV; OptimuMedicine, Las Vegas, NV.
| | - Sean Kaisler
- University of New Mexico School of Medicine, Albuquerque, NM; 306th Rescue Squadron, United States Air Force, Davis-Monthan AFB, Tucson, AZ
| | - Adam L Gottula
- Department of Emergency Medicine and Anesthesiology, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Michael J Lauria
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Lifeguard Air Emergency Services, Albuquerque, NM
| | - James T Dean
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
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44
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Kuley B, Webb JJ. Stress Cardiomyopathy Following Thoracostomy Tube Placement and Hemothorax Drainage: A Case Report. Cureus 2023; 15:e45733. [PMID: 37868484 PMCID: PMC10590169 DOI: 10.7759/cureus.45733] [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] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Stress cardiomyopathy (SCM) is a clinical phenomenon presenting symptoms suggestive of acute coronary syndrome and defined by acute, but transient, electrocardiogram (ECG) changes and left ventricular wall motion abnormalities. However, no obstructive coronary lesion is identified on catheterization, and pathognomic echocardiogram findings are typically encountered. Multiple causes have been posited in the literature (e.g., severe stress, anxiety, pain, comorbid illness, trauma). We present the case of a 46-year-old female who presented to the emergency department (ED) for delayed left-sided hemothorax (six weeks following a high-speed motor vehicle collision) and developed an acute SCM following large-bore chest tube placement. To our knowledge, no prior cases have been reported immediately following thoracostomy tube placement and hemothorax drainage in the ED setting. We explore possible mechanistic explanations related to our case, which adds to the existing literature on the subject.
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Affiliation(s)
- Brandon Kuley
- Emergency Medicine, LewisGale Medical Center, Salem, USA
| | - Jeremy J Webb
- Emergency Medicine, LewisGale Medical Center, Salem, USA
- Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
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45
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Vogel B, Tycinska A, Sambola A. Cardiogenic shock in women - A review and call to action. Int J Cardiol 2023; 386:98-103. [PMID: 37211458 DOI: 10.1016/j.ijcard.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Antonia Sambola
- Acute Cardiac Care Unit, Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
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46
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Martins C, Mateus RM, Cunha D, Gomes R. Percutaneous left ventricular assistance in cardiogenic shock due to Takotsubo cardiomyopathy secondary to status epilepticus. BMJ Case Rep 2023; 16:e254125. [PMID: 37558277 PMCID: PMC10414084 DOI: 10.1136/bcr-2022-254125] [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] [Indexed: 08/11/2023] Open
Abstract
Takotsubo syndrome is an acute reversible cardiomyopathy with left ventricular dysfunction and a clinical presentation similar to an acute coronary syndrome. Emotional or physical triggers can cause it, including neurological conditions such as seizures. We describe a case of a woman in her 50s with Takotsubo syndrome secondary to status epilepticus, presenting with cardiac arrest and cardiogenic shock. We excluded acute coronary syndrome with coronary angiography. Despite inotropic support, she remained haemodynamically unstable and a percutaneous left ventricular assistance with an Impella CP catheter was initiated. This resulted in a quick weaning of haemodynamic support and recovery of left ventricle systolic function in 2 weeks. This case illustrates the importance of a high index of suspicion to make this diagnosis and link it to neurological triggers, as well as to consider mechanical circulatory support in managing cardiogenic shock due to this cardiomyopathy.
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Affiliation(s)
| | | | - Diogo Cunha
- Cardiology, Garcia de Orta Hospital, Almada, Portugal
| | - Rui Gomes
- Intensive Care Unit, Garcia de Orta Hospital, Almada, Portugal
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47
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Arao K, Yoshikawa T, Isogai T, Imori Y, Mochizuki H, Sakata K, Takaoka Y, Yamaguchi T, Nagao K, Yamamoto T, Takayama M. A study of takotsubo syndrome over 9 years at the Tokyo Cardiovascular Care Unit Network Registry. J Cardiol 2023; 82:93-99. [PMID: 36640906 DOI: 10.1016/j.jjcc.2022.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/04/2022] [Accepted: 12/17/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute cardiovascular disease with clinical manifestations similar to those of acute myocardial infarction (AMI), and TTS sometimes occurs just after catastrophes. Large-scale studies of TTS in Japan are scarce, so we examined data over 9 years from Tokyo metropolitan acute cardiovascular care hospital network registry. METHODS A total of 1626 patients were diagnosed with TTS between 2010 and 2018 at Tokyo Cardiovascular Care Unit Network facilities, and data from all these patients were analyzed. We investigated annual and monthly captured incidence of TTS, temporal trend of the captured incidence proportion of TTS versus AMI, the occurrence of TTS on the day of the great earthquake, and we elucidated the prognostic factors for in-hospital death. RESULTS The annual incidence proportion of TTS versus AMI increased from 2.3 % to 4.5 % (p < 0.001) over 9 years. The mean TTS patient age was 74.4 years: the peak incidence of TTS was at 80 to 84 years of age for both male and female; females accounted for 78.5 % of patients. The monthly variation of the incidence of TTS was found (p = 0.009). In 2011, a total of 137 cases of TTS occurred, with as many as 6 occurring on March 11, the day of the Great East Japan Earthquake. There was a definable trigger for TTS in 64 % (physical: 36 %; emotional: 27 %; others: 2 %). All-cause in-hospital mortality was 5.3 % and was higher in males than in females (10.3 % vs 3.9 %; p < 0.001). Non-cardiac causes accounted for 62 % of in-hospital mortality. Factors at presentation that were associated with in-hospital all-cause mortality were male sex, low body mass index, and a high C-reactive protein level. CONCLUSIONS This study elucidated the clinical features, in-hospital outcomes, and their attributed factors in patients with TTS in real-world clinical practice in Japan.
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Affiliation(s)
- Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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48
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Reza RR, Parajuli A, Padullaparthi T, Aloori S, Baddam A, Parajuli A, Karnati SS, Nasir H. Takotsubo Cardiomyopathy Following COVID-19 Vaccine Booster Dose: A Case Report. Cureus 2023; 15:e43295. [PMID: 37692656 PMCID: PMC10492645 DOI: 10.7759/cureus.43295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Although the efficacy and safety of the coronavirus disease 2019 (COVID-19) vaccine have been established, side effects and adverse events related to the COVID-19 vaccine are still coming out. COVID-19 vaccine also has the potential to cause acute and long-term cardiovascular effects, which include myocarditis, pericarditis, myopericarditis, myocardial infarction, pulmonary embolism, thrombotic thrombocytopenia, and pulmonary hemorrhage. Although uncommon, takotsubo cardiomyopathy (TCM) has also been reported following COVID-19 vaccination. We report a case of TCM following the COVID-19 vaccine in a 59-year-old female who presented with intermittent chest pain and dyspnea following the COVID-19 vaccine booster dose. She had no identifiable triggers for TCM, no risk factors for cardiovascular disease, and normal cardiac enzyme levels, ruling out other causes of cardiac dysfunction. The diagnosis of TCM was supported by imaging findings and the absence of obstructive or thrombotic lesions on angiography.
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Affiliation(s)
- Rezaur Rahman Reza
- Internal Medicine, Jalalabad Ragib Rabeya Medical College, Victorville, USA
| | - Aalok Parajuli
- Medicine and Surgery, Prime Health Care/Desert Valley Hospital, Victorville, USA
| | | | - Swetha Aloori
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | - Anusha Baddam
- Internal Medicine, Malla Reddy Medical College for Women, Hyderabad, IND
| | - Aakriti Parajuli
- Epidemiology and Biostatistics, Benedictine University, Chicago, USA
| | | | - Hira Nasir
- Internal Medicine, Mayo Hospital, Lahore, PAK
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49
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Lampert J, Vaid A, Whang W, Koruth J, Miller MA, Langan MN, Musikantow D, Turagam M, Maan A, Kawamura I, Dukkipati S, Nadkarni GN, Reddy VY. A Novel ECG-Based Deep Learning Algorithm to Predict Cardiomyopathy in Patients With Premature Ventricular Complexes. JACC Clin Electrophysiol 2023; 9:1437-1451. [PMID: 37480862 DOI: 10.1016/j.jacep.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Premature ventricular complexes (PVCs) are prevalent and, although often benign, they may lead to PVC-induced cardiomyopathy. We created a deep-learning algorithm to predict left ventricular ejection fraction (LVEF) reduction in patients with PVCs from a 12-lead electrocardiogram (ECG). OBJECTIVES This study aims to assess a deep-learning model to predict cardiomyopathy among patients with PVCs. METHODS We used electronic medical records from 5 hospitals and identified ECGs from adults with documented PVCs. Internal training and testing were performed at one hospital. External validation was performed with the others. The primary outcome was first diagnosis of LVEF ≤40% within 6 months. The dataset included 383,514 ECGs, of which 14,241 remained for analysis. We analyzed area under the receiver operating curves and explainability plots for representative patients, algorithm prediction, PVC burden, and demographics in a multivariable Cox model to assess independent predictors for cardiomyopathy. RESULTS Among the 14,241-patient cohort (age 67.6 ± 14.8 years; female 43.8%; White 29.5%, Black 8.6%, Hispanic 6.5%, Asian 2.2%), 22.9% experienced reductions in LVEF to ≤40% within 6 months. The model predicted reductions in LVEF to ≤40% with area under the receiver operating curve of 0.79 (95% CI: 0.77-0.81). The gradient weighted class activation map explainability framework highlighted the sinus rhythm QRS complex-ST segment. In patients who underwent successful PVC ablation there was a post-ablation improvement in LVEF with resolution of cardiomyopathy in most (89%) patients. CONCLUSIONS Deep-learning on the 12-lead ECG alone can accurately predict new-onset cardiomyopathy in patients with PVCs independent of PVC burden. Model prediction performed well across sex and race, relying on the QRS complex/ST-segment in sinus rhythm, not PVC morphology.
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Affiliation(s)
- Joshua Lampert
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Akhil Vaid
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Whang
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie-Noelle Langan
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Musikantow
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abhishek Maan
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Division of Data Driven and Digital Medicine (D3M), The Charles Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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van Weperen VYH, Ripplinger CM, Vaseghi M. Autonomic control of ventricular function in health and disease: current state of the art. Clin Auton Res 2023; 33:491-517. [PMID: 37166736 PMCID: PMC10173946 DOI: 10.1007/s10286-023-00948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. METHODS Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. RESULTS A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. CONCLUSIONS Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
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Affiliation(s)
- Valerie Y H van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | | | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrythmia Center, University of California, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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