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Iqbal MK, Ambreen A, Mujahid M, Zarlashat Y, Abid M, Yasin A, Ullah MN, Shahzad R, Harlina PW, Khan SU, Alissa M, Algopishi UB, Almubarak HA. Cardiomegaly: Navigating the uncharted territories of heart failure - A multimodal radiological journey through advanced imaging, pathophysiological landscapes, and innovative therapeutic frontiers. Curr Probl Cardiol 2024; 49:102748. [PMID: 39009253 DOI: 10.1016/j.cpcardiol.2024.102748] [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: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
Cardiomegaly is among the disorders categorized by a structural enlargement of the heart by any of the situations including pregnancy, resulting in damage to heart muscles and causing trouble in normal heart functioning. Cardiomegaly can be defined in terms of dilatation with an enlarged heart and decreased left or biventricular contraction. The genetic origin of cardiomegaly is becoming more evident due to extensive genomic research opening up new avenues to ensure the use of precision medicine. Cardiomegaly is usually assessed by using an array of radiological modalities, including computed tomography (CT) scans, chest X-rays, and MRIs. These imaging techniques have provided an important opportunity for the physiology and anatomy of the heart. This review aims to highlight the complexity of cardiomegaly, highlighting the contribution of both ecological and genetic variables to its progression. Moreover, we further highlight the worth of precise clinical diagnosis, which comprises blood biomarkers and electrocardiograms (EKG ECG), demonstrating the significance of distinguishing between numerous basic causes. Finally, the analysis highlights the extensive variation of treatment lines, such as lifestyle modifications, prescription drugs, surgery, and implantable devices, although highlighting the critical need for individualized and personalized care.
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Affiliation(s)
- Muhammad Khalid Iqbal
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, Dalian Medical University Liaoning Provence China; Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Alia Ambreen
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Muhammad Mujahid
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Yusra Zarlashat
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Muhammad Abid
- Academy of Integrative Medicine, Dalian Medical University, Dalian 116044, China
| | - Ayesha Yasin
- Department of Pathology and Forensic Medicine, Dalian Medical University Liaoning Provence, China
| | | | - Raheel Shahzad
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), KST-Cibinong, JI Raya Bogor KM46, Cibinong 16911, Indonesia
| | - Putri Widyanti Harlina
- Department of Food Industrial Technology, Faculty of Agro-Industrial Technology, Universitas Padjadjaran, 45363 Bandung, Indonesia
| | - Shahid Ullah Khan
- Integrative Science Center of Germplasm Creation in Western China (CHONGQING) Science City and Southwest University, College of Agronomy and Biotechnology, Southwest University, Chongqing, 400715, China; Women Medical and Dental College, Khyber Medical University, Peshawar, KPK, 22020, Pakistan.
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | - Hassan Ali Almubarak
- Division of Radiology, Department of Medicine, College of Medicine and Surgery, King Khalid University, Abha, Saudi Arabia
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Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat Rev Cardiol 2024; 21:603-616. [PMID: 38698183 DOI: 10.1038/s41569-024-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Diagnostic Imaging, Emory University School of Medicine, Atlanta, GA, USA
- Veterans Administration Medical Center, Decatur, GA, USA
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Rallidis LS, Papathanasiou KA, Kosmas N, Iordanidis D, Rallidis SL, Simitsis P. Is premorbid stress assessed by hair cortisol concentration linked to Takotsubo syndrome? Results from a pilot study. Int J Cardiol 2024; 410:132241. [PMID: 38844095 DOI: 10.1016/j.ijcard.2024.132241] [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: 04/14/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION The pathophysiology of Takotsubo syndrome (TTS) is not completely understood and the role of chronic stress is among the main mechanistic links. The aim of this study was to explore whether accumulating hair cortisol concentration (HCC), a novel biomarker of chronic stress, is associated with the occurrence of TTS. METHODS A consecutive series of 18 TTS patients and 36 age and sex matched healthy controls were included in our analysis. Hair samples were collected from participants'' vertex. The proximal 2.5 cm of hair was cut in equal parts of 0.5 cm, reflecting mean cortisol levels in time intervals of 0-15, 15-30, 30-45, 45-60 and 60-75 days prior to hair collection. RESULTS HCC was higher in TTS group compared to controls at any time point and increased over time starting from 75 days prior to the event. The rate of HCC increase was significantly higher in TTS patients versus controls (beta of interaction = 0.48; 95%CI: 0.36-0.60; p < 0.001). CONCLUSIONS The steadily increasing trend of HCC in TTS patients suggests that the additive effect of multiple stressful events over several weeks prior TTS onset may disrupt cortisol homeostasis and play a role in TTS pathophysiology.
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Affiliation(s)
- Loukianos S Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece.
| | - Konstantinos A Papathanasiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Nikolaos Kosmas
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Dimitrios Iordanidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | | | - Panagiotis Simitsis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
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Carbone A, Flacco ME, Manzoli L, Lamberti N, Pigazzani F, Rega S, Migliarino S, Ferrara F, Citro R, Manfredini R, Bossone E. Chronobiological variation in takotsubo syndrome: an updated systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102804. [PMID: 39163922 DOI: 10.1016/j.cpcardiol.2024.102804] [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: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/22/2024]
Abstract
Takotsubo syndrome (TTS) might exhibit particular chronobiological patterns in its onset, characterized by variations according to time of the day, day of the week, and month of the year. The aim of this study was to fully explore the temporal patterns (circadian, weekly and seasonal) in the onset of TTS. A systematic review and meta-analysis of literature were conducted for studies (2006-2024) reporting the temporal patterns (circadian, weekly and/or seasonal) in the onset of TTS. Among the 4257 studies retrieved, 20 (including 64,567 subjects) fulfilled all eligibility criteria. Data were aggregated used random effects model as pooled risk ratio and the attributable risk (AR). The proportion analysis (including 8 studies; n=853) showed a decreasing pattern of the pooled rates of TTS shifting from the morning to the night (pooled TTS rates: 34.0%; 32.1%; 21.7%; 12.7% in the morning, afternoon, evening and night, respectively). The same pattern was observed stratifying by type of preceding stressful factor or event, considering physical stressors (pooled rates in the morning and night: 37.6% and 9.8%, respectively), and also in case no event could be identified. The pooled rates of TTS onset peaked on Monday and Tuesday (17.3% and 18.4% respectively), then declined during the week, reaching the lowest rates on Friday and Saturday (10.6% and 10.8%, respectively), with no sex differences. TTS onset reached the highest values on summer, and the lowest in winter (27.9% versus 21.7% in summer and winter, respectively). The TTS morning peak based analyses (∼33% of all the registered events) account for a RR of 1.46 (95% CI: 1.38-1.54), the week-based for a RR of 1.26 (1.16-1.35), the season-based for a RR of 1.04 (1.04-1.05). TTS onset exhibits specific chronobiological patterns, characterized by a peak during the morning hours, and on Monday and Tuesday. Differing from other cardiovascular emergencies TTS was more frequent during summer. Further studies are needed to fully understand the underlying pathophysiological mechanisms in order to tailor relative management and preventive strategies.
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Affiliation(s)
- Andreina Carbone
- Department of Public Health, University of Naples "Federico II", Naples, Italy; Unit of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Elena Flacco
- Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Filippo Pigazzani
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, UK
| | - Salvatore Rega
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | | | | | - Rodolfo Citro
- Clinical Cardiology Unit Medicine and Health Science "V. Tiberio" Department, University of Molise Responsible Research Hospital, Campobasso, Italy
| | - Roberto Manfredini
- Clinical Medicine Unit, Department of Medical Sciences, University of Ferrara, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples "Federico II", Naples, Italy.
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La Vecchia G, Del Buono MG, Sanna T, Capecchi PL, Lazzerini PE, Golino M, Kron J, Rodriguez-Miguelez P, Pelargonio G, Abbate A. Life-Threatening Arrhythmias in Patients With Takotsubo Syndrome: Insights Into Pathophysiology and Treatment Innovations. JACC Clin Electrophysiol 2024; 10:1943-1952. [PMID: 38842970 DOI: 10.1016/j.jacep.2024.03.034] [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: 02/22/2024] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 08/30/2024]
Abstract
Takotsubo syndrome (TTS) is a reversible form of acute myocardial injury due to a neurocardiogenic mechanism associated with a relevant risk for life-threatening ventricular arrhythmias, occurring in up to 25% of all patients and including both ventricular arrhythmias (especially) in the context of QT prolongation and atrial tachy- or bradyarrhythmias. The pathogenetic mechanisms of TTS-related arrhythmic complications are not completely understood, and there are no randomized clinical trials addressing the pharmacologic and nonpharmacologic management in this specific setting. In this narrative review, the authors provide an overview of the pathogenesis and the therapeutic management of arrhythmic complications in patients with TTS, along with the future perspectives and the remaining knowledge gaps in this field.
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Affiliation(s)
- Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Operative Unit of Diagnostic Interventional Cardiology, Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Division of Internal Medicine, Electroimmunology Unit, University Hospital "Le Scotte," Siena, Italy
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Division of Internal Medicine, Electroimmunology Unit, University Hospital "Le Scotte," Siena, Italy
| | - Michele Golino
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Robert M. Berne Cardiovascular Research Center and Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jordana Kron
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gemma Pelargonio
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center and Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA.
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Thuan PQ, Han TQ, Chuong PTV, Vinh BDA, Dinh NH. Takotsubo syndrome after concomitant surgical ablation for the treatment of atrial fibrillation in patients undergoing minimally invasive mitral valve surgery: A clinical case and review. Int J Surg Case Rep 2024; 121:109960. [PMID: 38971034 PMCID: PMC11269916 DOI: 10.1016/j.ijscr.2024.109960] [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: 05/12/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Takotsubo syndrome (TTS) is a reversible form of acute heart failure often triggered by physical or emotional stressors. Minimally invasive mitral valve surgery (MIMVS) has become a prevalent approach for treating mitral valve pathologies, yet its association with TTS remains underexplored. CASE PRESENTATION We present the case of a female patient undergoing MIMVS with concomitant Maze ablation, who developed TTS postoperatively. Despite a normal coronary angiogram, transient coronary spasm due to an imbalance in autonomic nervous activity was considered. The patient exhibited preoperative risk factors including sequelae of cerebral infarction. CLINICAL DISCUSSION Female patients undergoing MIMVS with preoperative risk factors such as cerebral infarction sequelae may be at increased risk of developing TTS postoperatively. CONCLUSION The InterTAK Diagnostic score, in conjunction with the International Expert Consensus Document on Takotsubo Syndrome, aids in promptly diagnosing TTS and differentiating it from acute coronary syndrome. Further research is warranted to elucidate the relationship between MIMVS and TTS.
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Affiliation(s)
- Phan Quang Thuan
- Department of Adult Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Tran Quoc Han
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Pham Tran Viet Chuong
- Department of Adult Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Bui Duc An Vinh
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Hoang Dinh
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam; Department of Adult Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Viet Nam.
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Rocha LG, Costa G, Gonçalves L. "Shark Fin" electrocardiogram pattern in Takotsubo cardiomyopathy. Intern Emerg Med 2024; 19:1497-1500. [PMID: 38558288 DOI: 10.1007/s11739-023-03525-z] [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: 09/01/2023] [Accepted: 12/27/2023] [Indexed: 04/04/2024]
Affiliation(s)
- Luísa Gomes Rocha
- Serviço de Cardiologia, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Gonçalo Costa
- Serviço de Cardiologia, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Hospitais da Universidade de Coimbra-Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
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Kato K, Di Vece D, Kitagawa M, Yamamoto K, Aoki S, Goto H, Kitahara H, Kobayashi Y, Templin C. Cardiogenic shock in takotsubo syndrome: etiology and treatment. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01031-3. [PMID: 39039401 DOI: 10.1007/s12928-024-01031-3] [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: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024]
Abstract
Takotsubo syndrome (TTS) can mimic acute coronary syndrome despite being a distinct disease. While typically benign, TTS can lead to serious complications like cardiogenic shock. Cardiogenic shock occurs in 1-20% of TTS cases. Various mechanisms can cause shock, including pump failure, right ventricular involvement, left ventricular outflow tract obstruction, and acute mitral regurgitation. Because treatment depends on the mechanism, early identification of the mechanism developing cardiogenic shock is essential for optimal treatment and improved outcomes in TTS patients with cardiogenic shock. This review summarizes current knowledge on causes and treatment of cardiogenic shock in patients with TTS.
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Affiliation(s)
- Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Davide Di Vece
- Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Mari Kitagawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kayo Yamamoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Shuhei Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Christian Templin
- Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
- Swiss Cardiovascular Clinic, Private Hospital Bethanien, Zurich, Switzerland
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Ebong IA, Quesada O, Fonkoue IT, Mattina D, Sullivan S, Oliveira GMMD, Spikes T, Sharma J, Commodore Y, Ogunniyi MO, Aggarwal NR, Vaccarino V. The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:298-314. [PMID: 38986672 PMCID: PMC11328148 DOI: 10.1016/j.jacc.2024.05.016] [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: 03/05/2024] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 07/12/2024]
Abstract
Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.
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Affiliation(s)
- Imo A Ebong
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California, USA.
| | - Odayme Quesada
- Women's Heart Center, Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; Carl and Edyth Lindner Center for Research and Education, Christ Hospital, Cincinnati, Ohio, USA
| | - Ida T Fonkoue
- Divisions of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Deirdre Mattina
- Division of Regional Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samaah Sullivan
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center-Houston, Houston, Texas, USA
| | | | - Telisa Spikes
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jyoti Sharma
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Yvonne Commodore
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Pillitteri M, Brogi E, Piagnani C, Bozzetti G, Forfori F. Perioperative management of Takotsubo cardiomyopathy: an overview. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:45. [PMID: 39010210 PMCID: PMC11247845 DOI: 10.1186/s44158-024-00178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.
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Affiliation(s)
- Marta Pillitteri
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Etrusca Brogi
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Chiara Piagnani
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Giuseppe Bozzetti
- Department of Anaesthesia, Peri Operative Medicine and Critical Care, NHS Golden Jubilee, Glasgow, UK
| | - Francesco Forfori
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
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Gudmundsson T, Redfors B, Råmunddal T, Angerås O, Petursson P, Rawshani A, Hagström H, Alfredsson J, Ekenbäck C, Henareh L, Skoglund K, Ljungman C, Mohammad M, Jernberg T, Fröbert O, Erlinge D, Omerovic E. Importance of hospital and clinical factors for early mortality in Takotsubo syndrome: Insights from the Swedish Coronary Angiography and Angioplasty Registry. BMC Cardiovasc Disord 2024; 24:359. [PMID: 39004698 PMCID: PMC11247782 DOI: 10.1186/s12872-024-04023-6] [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: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute heart failure syndrome with symptoms similar to acute myocardial infarction. TTS is often triggered by acute emotional or physical stress and is a significant cause of morbidity and mortality. Predictors of mortality in patients with TS are not well understood, and there is a need to identify high-risk patients and tailor treatment accordingly. This study aimed to assess the importance of various clinical factors in predicting 30-day mortality in TTS patients using a machine learning algorithm. METHODS We analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients with TTS in Sweden between 2015 and 2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality in TTS patients. RESULTS Of 3,180 patients hospitalized with TTS, 76.0% were women. The median age was 71.0 years (interquartile range 62-77). The crude all-cause mortality rate was 3.2% at 30 days. Machine learning algorithms by gradient boosting identified treating hospitals as the most important predictor of 30-day mortality. This factor was followed in significance by the clinical indication for angiography, creatinine level, Killip class, and age. Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia and smoking status. CONCLUSIONS Using machine learning with gradient boosting, we analyzed all Swedish patients diagnosed with TTS over seven years and found that the treating hospital was the most significant predictor of 30-day mortality.
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Affiliation(s)
- Thorsteinn Gudmundsson
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Björn Redfors
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Oskar Angerås
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Petur Petursson
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Araz Rawshani
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Henrik Hagström
- Department of Cardiology, Umeå University Hospital, Umeå, Sweden
| | | | - Christina Ekenbäck
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Skoglund
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Charlotta Ljungman
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden
| | - Moman Mohammad
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Tomas Jernberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, Gothenburg, 41345, Sweden.
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12
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Yang Y, Jiang S, Mu Y, Liu C, Han Y, Jiang J, Wang Y. Berberine prevents against myocardial injury induced by acute β-adrenergic overactivation in rats. J Appl Toxicol 2024. [PMID: 38981847 DOI: 10.1002/jat.4659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/23/2024] [Accepted: 06/06/2024] [Indexed: 07/11/2024]
Abstract
The overactivation of β-adrenergic receptors (β-ARs) can result in acute myocardial ischemic injury, culminating in myocardial necrosis. Berberine (BBR) has exhibited promising potential for prevention and treatment in various heart diseases. However, its specific role in mitigating myocardial injury induced by acute β-AR overactivation remains unexplored. This study aimed to investigate the effects and underlying mechanisms of BBR pretreatment in a rat model of acute β-AR overactivation induced by a single dose of the nonselective β-adrenergic agonist isoprenaline (ISO). Rats were pretreated with saline or BBR (100 mg/kg/day) via gavage for 14 consecutive days, followed by a subcutaneous injection of ISO or saline on the 14th day. The findings indicated that BBR pretreatment significantly attenuated myocardial injury in ISO-stimulated rats, as evidenced by reduced pathological inflammatory infiltration, necrosis, and serum markers of myocardial damage. Additionally, BBR decreased oxidative stress and inflammation in the system and heart. Furthermore, BBR pretreatment enhanced myocardial ATP levels, improved mitochondrial dysfunction through increased Drp1 phosphorylation, and augmented myocardial autophagy. In a CoCl2-induced H9c2 cell hypoxic injury model, BBR pretreatment mitigated cellular injury, apoptosis, and oxidative stress while upregulating Drp1 and autophagy-associated proteins. Mechanistically, BBR pretreatment activated AKT, AMPK, and LKB1 both in vivo and in vitro, implicating the involvement of the AKT and LKB1/AMPK signaling pathways in its cardioprotective effects. Our study demonstrated the protective effects of BBR against myocardial injury induced by acute β-AR overactivation in rats, highlighting the potential of BBR as a preventive agent for myocardial injury associated with β-adrenergic overactivation.
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Affiliation(s)
- Yalin Yang
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Jiang
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Mu
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chilu Liu
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanxing Han
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiandong Jiang
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhong Wang
- State Key Laboratory of Bioactive Substances and Function of Natural Medicine, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Naryzhnaya NV, Logvinov SV, Kurbatov BK, Derkachev IA, Mustafina LR, Gorbunov AS, Sirotina MA, Kilin M, Gusakova SV, Maslov LN. The β 2-adrenergic receptor agonist formoterol attenuates necrosis and apoptosis in the rat myocardium under experimental stress-induced cardiac injury. Fundam Clin Pharmacol 2024. [PMID: 38956972 DOI: 10.1111/fcp.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Currently, there is no effective therapy for takotsubo syndrome (stress-induced cardiac injury in humans) in the clinics. It has previously been shown that β2-adrenergic receptor (β2-AR) agonist formoterol reduces cardiomyocyte injury in experimental takotsubo syndrome. OBJECTIVES The aim of this study was to investigate whether formoterol prevents apoptosis and necrosis of cardiomyocytes and endothelial cells in stress-induced cardiomyopathy. METHODS Stress-induced cardiac injury was induced by immobilization of rats for 2, 6, and 24 hours. RESULTS The myocardium of stressed rats showed a reduction in contractility and histological manifestations of cardiomyocyte damage: karyopyknosis, perinuclear edema of cardiomyocytes and endothelial cells, and microcirculation disturbances augmented with extended exposure to stress. In addition, apoptosis of endothelial cells was detected 6 hours after the onset of stress and peaked at 24 hours. Apoptosis of cardiomyocytes significantly gained only after 24 hours of stress exposure. These morphological alterations were associated with increased levels of serum creatine kinase-MB, syndecan-1, and thrombomodulin after 24 hours of stress. Administration of β2-AR agonist formoterol (50 μg/kg) four times during 24-hour stress exposure led to the improvement in myocardial inotropy, decrease in the severity of histological signatures, reduction in the number of TUNEL-positive cardiomyocytes, serum creatine kinase-MB, syndecan-1, and thrombomodulin levels. CONCLUSION Present data suggest that apoptosis and necrosis of cardiomyocytes and necrosis of endothelial cells in stress-induced cardiac injury can be mitigated by activation of the β2-AR. However, formoterol did not eliminate completely cardiomyocyte apoptosis, histological alterations, or endothelium injury markers under stress.
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Affiliation(s)
- Natalia V Naryzhnaya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
| | - Sergey V Logvinov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
- Siberian State Medical University, 2, Moskovsky tract, Tomsk, 634050, Russian Federation
| | - Boris K Kurbatov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
| | - Ivan A Derkachev
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
| | - Liliia R Mustafina
- Siberian State Medical University, 2, Moskovsky tract, Tomsk, 634050, Russian Federation
| | - Aleksandr S Gorbunov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
| | - Maria A Sirotina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
| | - Mikhail Kilin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
| | - Svetlana V Gusakova
- Siberian State Medical University, 2, Moskovsky tract, Tomsk, 634050, Russian Federation
| | - Leonid N Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia, 111a, Kievskaya str., Tomsk, 634012, Russian Federation
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Riha I, Salameh A, Hoschke A, Raffort C, Koedel J, Rassler B. Hypoxia-Induced Pulmonary Injury-Adrenergic Blockade Attenuates Nitrosative Stress, and Proinflammatory Cytokines but Not Pulmonary Edema. J Cardiovasc Dev Dis 2024; 11:195. [PMID: 39057617 PMCID: PMC11277000 DOI: 10.3390/jcdd11070195] [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: 05/17/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Hypoxia can induce pulmonary edema (PE) and inflammation. Furthermore, hypoxia depresses left ventricular (LV) inotropy despite sympathetic activation. To study the role of hypoxic sympathetic activation, we investigated the effects of hypoxia with and without adrenergic blockade (AB) on cardiovascular dysfunction and lung injury, i.e., pulmonary edema, congestion, inflammation, and nitrosative stress. Eighty-six female rats were exposed for 72 h to normoxia or normobaric hypoxia and received infusions with NaCl, prazosin, propranolol, or prazosin-propranolol combination. We evaluated hemodynamic function and performed histological and immunohistochemical analyses of the lung. Hypoxia significantly depressed LV but not right ventricular (RV) inotropic and lusitropic functions. AB significantly decreased LV function in both normoxia and hypoxia. AB effects on RV were weaker. Hypoxic rats showed signs of moderate PE and inflammation. This was accompanied by elevated levels of tumor necrosis factor α (TNFα) and nitrotyrosine, a marker of nitrosative stress in the lungs. In hypoxia, all types of AB markedly reduced both TNFα and nitrotyrosine. However, AB did not attenuate PE. The results suggest that hypoxia-induced sympathetic activation contributes to inflammation and nitrosative stress in the lungs but not to PE. We suggest that AB in hypoxia aggravates hypoxia-induced inotropic LV dysfunction and backlog into the pulmonary circulation, thus promoting PE.
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Affiliation(s)
- Isabel Riha
- Carl-Ludwig-Institute of Physiology, University of Leipzig, 04103 Leipzig, Germany; (I.R.); (A.H.)
| | - Aida Salameh
- Department of Pediatric Cardiology, Heart Centre, University of Leipzig, 04289 Leipzig, Germany; (A.S.); (C.R.)
| | - Annekathrin Hoschke
- Carl-Ludwig-Institute of Physiology, University of Leipzig, 04103 Leipzig, Germany; (I.R.); (A.H.)
| | - Coralie Raffort
- Department of Pediatric Cardiology, Heart Centre, University of Leipzig, 04289 Leipzig, Germany; (A.S.); (C.R.)
| | - Julia Koedel
- Institute of Pathology, University of Leipzig, 04103 Leipzig, Germany;
| | - Beate Rassler
- Carl-Ludwig-Institute of Physiology, University of Leipzig, 04103 Leipzig, Germany; (I.R.); (A.H.)
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15
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Shetrit A, Freund O, Banai A, Amar Shamir R, Avivi I, Zornitzki L, Ben-Shoshan J, Szekely Y, Arbel Y, Bazan S, Halkin A, Banai S, Konigstein M. Coronary microvascular dysfunction in patients with Takotsubo syndrome. Heart Lung 2024; 68:46-51. [PMID: 38909428 DOI: 10.1016/j.hrtlng.2024.06.007] [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: 04/10/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND The pathophysiology of Takotsubo syndrome (TTS) remains incompletely understood. While coronary microvascular dysfunction (CMD) is a potential pathophysiologic mechanism, evidence is limited. OBJECTIVES We sought to evaluate CMD in patients with TTS. METHODS Consecutive patients diagnosed with TTS were included and underwent coronary angiography with invasive microvascular function evaluation, including fractional flow reserve, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistive Reserve Ratio (RRR). Patients had an echocardiography evaluation during their index admission and at approximately 6 weeks. RESULTS Thirty patients were included (mean age 74 ±9, 90 % female). Twenty-five patients (83 %) had at least one abnormal coronary microvascular function parameter. Abnormal parameters included CFR<2.5 in 20 patients (67 %), IMR>25 in 18 patients (60 %), and RRR<3.5 in 25 (83 %). Longer time from symptoms to angiography correlated with a higher CFR (r = 0.51, P<0.01), and had an area under the receiver operating characteristic curve of 0.793 (95 % CI 0.60-0.98) for pathologic CFR. Patients with emotional trigger had a lower rate of pathologic IMR compared with non-emotional trigger (36 % vs 81 %, p = 0.01). Follow up echocardiography performed at a median of 1.5 months (IQR 1.15-6) showed an improvement in left ventricular ejection fraction for all patients (from mean of 40 % to 57 %). CONCLUSION CMD was present in most patients with TTS. The role of microvascular function in TTS may vary according to the clinical presentation and RRR may be more sensitive for the diagnosis of CMD in TTS.
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Affiliation(s)
- Aviel Shetrit
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Ophir Freund
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel.
| | - Ariel Banai
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Reut Amar Shamir
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Ido Avivi
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Lior Zornitzki
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Jeremy Ben-Shoshan
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Yishay Szekely
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Yaron Arbel
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Shmuel Bazan
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Amir Halkin
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Shmuel Banai
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
| | - Maayan Konigstein
- Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel
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16
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Paratz ED, Sprott T, Preitner C, Anbalagan G, Manderson K, Hochberg T. Navigating Coronary Artery Disease in Aviation Cardiology in Australia and New Zealand. Heart Lung Circ 2024:S1443-9506(24)00618-8. [PMID: 38871530 DOI: 10.1016/j.hlc.2024.05.004] [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: 02/08/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Cardiologists will commonly assess patients who hold an aviation medical certificate and require unique assessments and communications with national civil aviation authorities (in Australia, the Civil Aviation Safety Authority [CASA] and in New Zealand, the Civil Aviation Authority of New Zealand [CAA NZ]). Cardiac conditions are the most common reason for disqualification from holding an aviation licence, and coronary artery disease is considered a high-risk condition for pilot incapacitation. AIM To provide a contemporary update on the aeromedical approach to the evaluation, detection, and management of coronary artery disease in an Australasian context. METHODS A narrative view of current and historical practice in the area of aeromedical evaluation of coronary disease was undertaken. RESULTS This review highlights the aeromedical approach to risk stratification and specific challenges of the aviation environment for patients with coronary artery disease. Scenarios of coronary artery disease screening, common and rare acute coronary syndromes, and the assessment of established coronary artery disease are examined in detail. Suggestions to facilitate communications between specialists and CASA or CAA NZ to facilitate patient re-certification are also provided. CONCLUSION Patients who are pilots have unique requirements in terms of their coronary assessment, management, and follow-up to maintain eligibility to fly. It is important for cardiologists to be aware of relevant occupational requirements to provide optimal care to their patients.
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Affiliation(s)
- Elizabeth D Paratz
- St Vincent's Institute of Medical Research, Fitzroy, Vic, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Vic, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.
| | - Timothy Sprott
- Civil Aviation Authority of New Zealand, Wellington, New Zealand
| | - Claude Preitner
- Civil Aviation Authority of New Zealand, Wellington, New Zealand
| | - Ganesh Anbalagan
- Civil Aviation Safety Authority, Aviation House, Phillip, ACT, Australia
| | - Kate Manderson
- Civil Aviation Safety Authority, Aviation House, Phillip, ACT, Australia
| | - Tony Hochberg
- Civil Aviation Safety Authority, Aviation House, Phillip, ACT, Australia
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17
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Petursson P, Oštarijaš E, Redfors B, Råmunddal T, Angerås O, Völz S, Rawshani A, Hambraeus K, Koul S, Alfredsson J, Hagström H, Loghman H, Hofmann R, Fröbert O, Jernberg T, James S, Erlinge D, Omerovic E. Effects of pharmacological interventions on mortality in patients with Takotsubo syndrome: a report from the SWEDEHEART registry. ESC Heart Fail 2024; 11:1720-1729. [PMID: 38454651 PMCID: PMC11098647 DOI: 10.1002/ehf2.14713] [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: 09/11/2023] [Revised: 12/17/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
AIMS Takotsubo syndrome (TS) is a heart condition mimicking acute myocardial infarction. TS is characterized by a sudden weakening of the heart muscle, usually triggered by physical or emotional stress. In this study, we aimed to investigate the effect of pharmacological interventions on short- and long-term mortality in patients with TS. METHODS AND RESULTS We analysed data from the SWEDEHEART (the Swedish Web System for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry, which included patients who underwent coronary angiography between 2009 and 2016. In total, we identified 1724 patients with TS among 228 263 individuals in the registry. The average age was 66 ± 14 years, and 77% were female. Nearly half of the TS patients (49.4%) presented with non-ST-elevation acute coronary syndrome, and a quarter (25.9%) presented with ST-elevation myocardial infarction. Most patients (79.1%) had non-obstructive coronary artery disease on angiography, while 11.7% had a single-vessel disease and 9.2% had a multivessel disease. All patients received at least one pharmacological intervention; most of them used beta-blockers (77.8% orally and 8.3% intravenously) or antiplatelet agents [aspirin (66.7%) and P2Y12 inhibitors (43.6%)]. According to the Kaplan-Meier estimator, the probability of all-cause mortality was 2.5% after 30 days and 16.6% after 6 years. The median follow-up time was 877 days. Intravenous use of inotropes and diuretics was associated with increased 30 day mortality in TS [hazard ratio (HR) = 9.92 (P < 0.001) and HR = 3.22 (P = 0.001), respectively], while angiotensin-converting enzyme inhibitors and statins were associated with decreased long-term mortality [HR = 0.60 (P = 0.025) and HR = 0.62 (P = 0.040), respectively]. Unfractionated and low-molecular-weight heparins were associated with reduced 30 day mortality [HR = 0.63 (P = 0.01)]. Angiotensin receptor blockers, oral anticoagulants, P2Y12 antagonists, aspirin, and beta-blockers did not statistically correlate with mortality. CONCLUSIONS Our findings suggest that some medications commonly used to treat TS are associated with higher mortality, while others have lower mortality. These results could inform clinical decision-making and improve patient outcomes in TS. Further research is warranted to validate these findings and to identify optimal pharmacological interventions for patients with TS.
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Affiliation(s)
- Petur Petursson
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | | | - Björn Redfors
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Truls Råmunddal
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Oskar Angerås
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Sebastian Völz
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Araz Rawshani
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
| | | | - Sasha Koul
- Department of CardiologySkåne University HospitalLundSweden
| | - Joakim Alfredsson
- Department of CardiologyLinköping University HospitalLinköpingSweden
| | | | - Henareh Loghman
- Department of CardiologyKarolinska University HospitalStockholmSweden
| | - Robin Hofmann
- Department of CardiologySödra HospitalStockholmSweden
| | - Ole Fröbert
- Department of CardiologyÖrebro University HospitalÖrebroSweden
| | - Tomas Jernberg
- Department of CardiologyDanderyd University HospitalStockholmSweden
| | - Stefan James
- Department of CardiologyUppsala University HospitalUppsalaSweden
| | - David Erlinge
- Department of CardiologySkåne University HospitalLundSweden
| | - Elmir Omerovic
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska Academy at University of GothenburgGothenburgSweden
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18
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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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Kezuka D, Haruyama A, Suzuki E, Sakuma K. A case of reinitiation of modified electroconvulsive therapy 2 weeks after modified electroconvulsive therapy-induced Takotsubo cardiomyopathy in a male patient with major depressive disorder. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e221. [PMID: 38919546 PMCID: PMC11199058 DOI: 10.1002/pcn5.221] [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: 03/06/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
Background Takotsubo cardiomyopathy (TCM) is a left ventricular dysfunction resembling acute coronary syndrome. Its prognosis is generally favorable; however, a subset of patients may present with severe complications. TCM is a rare side-effect of modified electroconvulsive therapy (ECT); it has been reported in 22 female and two male patients. Eight cases of ECT reinitiation after TCM have been reported (all females), with the shortest duration being 3 weeks. Case Presentation We report the case of a 61-year-old man with a history of major depressive disorder and no history of heart disease or previous ECT treatment. Antidepressants had been ineffective, and ECT was indicated. After the third ECT session, the patient complained of chest pain and shortness of breath. Electrocardiography revealed ST elevation, and catheter angiography was used to diagnose TCM. The patient had mild heart failure but remained stable. Recognizing that ECT was effective, the patient asked for it to be reinitiated. We confirmed that the cardiac function had been normalized, applied a bisoprolol fumarate patch as a preventive measure, and reinitiated ECT 14 days after the onset of TCM. ECT was performed five times, with no recurrence of TCM and a marked improvement in depression. Conclusion We describe a male patient with major depressive disorder who underwent reinitiation of ECT 2 weeks after ECT-induced TCM. Therefore, TCM should be recognized as a side-effect of ECT, even in men. Moreover, depending on whether the patient's condition is stable, ECT can be successfully performed in patients with TCM.
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Affiliation(s)
- Dai Kezuka
- Department of Comprehensive Psychosomatic MedicineAsaka HospitalKoriyamaJapan
- Division of PsychiatryTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Akiko Haruyama
- Department of Internal MedicineAsaka HospitalKoriyamaJapan
- Department of Cardiovascular MedicineDokkyo Medical University HospitalMibuTochigiJapan
| | - Eiji Suzuki
- Division of PsychiatryTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Kei Sakuma
- Department of Comprehensive Psychosomatic MedicineAsaka HospitalKoriyamaJapan
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20
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Grant E, Sanghavi M. Ischemic Heart Disease in Women. Med Clin North Am 2024; 108:567-579. [PMID: 38548464 DOI: 10.1016/j.mcna.2023.11.001] [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: 04/02/2024]
Abstract
This review synthesizes the current understanding of ischemic heart disease in women, briefly discussing differences in risk factors, presentation, and treatment. We have underscored the unique clinical phenotype of IHD in women with a higher prevalence of ischemia with non-obstructive coronary arteries. Further research is needed to elucidate the complexities of ischemic heart disease in women, understand the discordance between ischemic burden and clinical symptoms, and optimize treatment strategies.
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Affiliation(s)
- Eleonore Grant
- Department of Internal Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Monika Sanghavi
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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21
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Lucà F, Pavan D, Gulizia MM, Manes MT, Abrignani MG, Benedetto FA, Bisceglia I, Brigido S, Caldarola P, Calvanese R, Canale ML, Caretta G, Ceravolo R, Chieffo A, Chimenti C, Cornara S, Cutolo A, Di Fusco SA, Di Matteo I, Di Nora C, Fattirolli F, Favilli S, Francese GM, Gelsomino S, Geraci G, Giubilato S, Ingianni N, Iorio A, Lanni F, Montalto A, Nardi F, Navazio A, Nesti M, Parrini I, Pilleri A, Pozzi A, Rao CM, Riccio C, Rossini R, Scicchitano P, Valente S, Zuccalà G, Gabrielli D, Grimaldi M, Colivicchi F, Oliva F. Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'. Eur Heart J Suppl 2024; 26:ii264-ii293. [PMID: 38784671 PMCID: PMC11110461 DOI: 10.1093/eurheartjsupp/suae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
It has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women's diseases.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano GOM, Reggio Calabria, Via Melacriono, 1, 89129 Reggio, Calabria, Italy
| | - Daniela Pavan
- Cardio-Cerebro-Rehabilitation Department, Azienda Sanitaria Friuli Occidentale, (AS FO) Via della Vecchia Ceramica, 1, Pordenone 33170, Italy
| | - Michele Massimo Gulizia
- Cardiology Unit, Cardiology Spoke Cetraro-Paola, San Franceco di paola Hospital, 87027 Paola, CS, Italy
| | - Maria Teresa Manes
- Cardiology Unit, Cardiology Spoke Cetraro-Paola, San Franceco di paola Hospital, 87027 Paola, CS, Italy
| | | | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano GOM, Reggio Calabria, Via Melacriono, 1, 89129 Reggio, Calabria, Italy
| | - Irma Bisceglia
- Cardio-Thoraco-Vascular Department, San Camillo Forlanini Hospital, 00152 Roma, Italy
| | - Silvana Brigido
- Cardiology Clinics, ‘F.’ Hospital Jaia’, 70014 Conversano, BA, Italy
| | | | | | | | - Giorgio Caretta
- Cardiology Unit, Sant’Andrea Hospital, 19100 La Spezia, SP, Italy
| | - Roberto Ceravolo
- Cardiology Division, Giovanni Paolo II Hospial, 88046 Lamezia Terme, CZ, Italy
| | - Alaide Chieffo
- Interventional Cardiology, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy
| | - Stefano Cornara
- Levante Cardiology, San Paolo Hospital, Savona, 17100 Savona, SV, Italy
| | - Ada Cutolo
- Cardiolog Unit, Ospedale dell’Angelo, 30172 Mestre, Italy
| | | | - Irene Di Matteo
- Cardiology Unit, Cariovascular Department, ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Concetta Di Nora
- Cardiac Surgery Unit, Santa Maria della Misericordia Hospital, 33100 Udine, UD, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, Florence University, 50121 Firenze, Italy
| | - Silvia Favilli
- Pediatric and Transition Cardiology Unit, Meyer University Hospital, 50139 Florence, Italy
| | - Giuseppina Maura Francese
- Cardiology Unit, Cardiology Spoke Cetraro-Paola, San Franceco di paola Hospital, 87027 Paola, CS, Italy
| | - Sandro Gelsomino
- Pediatric and Transition Cardiology Unit, Meyer University Hospital, 50139 Florence, Italy
| | - Giovanna Geraci
- Cardiology Unit, Sant'Antonio Abate di Erice, 91016 Erice, Trapani, Italy
| | | | | | - Annamaria Iorio
- Cardiology Unity 1, Cardiology 1, Cardiovascular Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Francesca Lanni
- Cardiology Unity, San Giuseppe Moscati Hospital, 83100 Avellino, Italy
| | - Andrea Montalto
- Cardiac Surgery Unit, San Camillo Forlanini Hospital, 00152 Roma, Italy
| | - Federico Nardi
- Dipartimento di Cardiologia, Ospedale Santo Spirito, Casale Monferrato, Italy
| | | | - Martina Nesti
- Cardiology Unity, San Donato Hospital, 52100 Arezzo, Italy
| | - Iris Parrini
- Cardiology Unity, Umberto I Di Torino Hospital, 10128 Torino, Italy
| | - Annarita Pilleri
- Federico Nardi, Cardiology Unit, Casale Monferrato Hospital, 15033 Casale Monferrato (AL), Italy
| | - Andrea Pozzi
- Cardiology Unity 1, Cardiology 1, Cardiovascular Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano GOM, Reggio Calabria, Via Melacriono, 1, 89129 Reggio, Calabria, Italy
| | - Carmine Riccio
- Post-Acute Patient Follow-up Unit, Cardio-Vascular Department, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | | | | | - Serafina Valente
- Clinical-Surgical Cardiology, A.O.U. Siena, Santa Maria alle Scotte Hospital, 53100 Siena, Italy
| | - Giuseppe Zuccalà
- Department of Geriatrics, Center for Aging Medicine, Catholic University of the Sacred Heart and IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy
| | - Domenico Gabrielli
- Dipartimento Cardio-Toraco-Vascolare, U.O.C. Cardiologia, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, 50121 Firenze, Italy
| | - Massimo Grimaldi
- Cardiology Division, Coronary Intensive Care Unit, Miulli Hospital, 70021 Acquaviva delle Fonti, Italy
| | | | - Fabrizio Oliva
- Cardiology Unit, Cariovascular Department, ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
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22
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Elkattawy O, Sames A, Kunamneni S, Sutariya R, Ismail M, Mohamed O, Lee TJ, Javed J, Elkattawy S, Hossain A, Shamoon F. Pulmonary Embolism in Patients Admitted With Takotsubo Cardiomyopathy: Prevalence and Associated In-Hospital Adverse Events. Cureus 2024; 16:e59268. [PMID: 38813344 PMCID: PMC11135138 DOI: 10.7759/cureus.59268] [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: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) is a poorly understood condition typically characterized by abnormal left ventricular wall motion without causative coronary artery disease and typically presents in post-menopausal women after the experience of a physical or emotional stressor. The pathophysiology of TCM is complex and multifactorial, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically, pulmonary embolism (PE), which is understudied in its relation to TCM. The purpose of this study was to characterize and evaluate the real-world prevalence and outcomes of PE in TCM. Methods Data were derived from the National Inpatient Sample database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with TCM with and without PE. Outcomes for TCM patients with PE and predictors of mortality in TCM were also analyzed. Results PE developed in 788 of 40,120 patients with TCM (1.96%). After multivariate adjustment, PE was found to be independently associated with intracardiac thrombus (adjusted odds ratio (aOR) 2.067; 95% confidence interval (CI): 1.198-3.566; p = 0.009) and right heart catheterization (RHC) (aOR: 1.971; 95% CI: 1.160-3.350; p = 0.012). Mortality in patients with TCM was associated with, among other factors, age in years at admission (aOR: 1.104; 95% CI: 1.010-1.017; p = 0.001), African American race (aOR: 1.191; 95% CI: 1.020-1.391; p = 0.027), Asian or Pacific Islander race (aOR: 1.637; 95% CI: 1.283-2.090; p = 0.001), coagulopathy (aOR: 3.393; 95% CI: 2.889-2.986; p = 0.001), liver disease (aOR: 1.446; 95% CI: 1.147-1.824; p = 0.002), atrial fibrillation (aOR: 1.460; 95% CI: 1.320-1.615; p = 0.001), and pulmonary embolism (aOR: 2.217; 95% CI: 1.781-2.760; p = 0.001). Conclusion In a large cohort of patients admitted with TCM, we found the prevalence of PE to be 1.96%. PE, along with comorbidities such as coagulopathy and atrial fibrillation, was found to be a significant predictor of mortality in this patient cohort.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Antonia Sames
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sruthi Kunamneni
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Riya Sutariya
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Mohamed Ismail
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Mohamed
- Medicine, Saint Barnabas Medical Center, Livingston, USA
| | - Thomas J Lee
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Jahanzeb Javed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Afif Hossain
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Fayez Shamoon
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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23
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Arteaga I, Iglesias G, Mesa A, Cánovas M, Avilés M. [Takotsubo syndrome: About a case]. Semergen 2024; 50:102085. [PMID: 37983989 DOI: 10.1016/j.semerg.2023.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 11/22/2023]
Affiliation(s)
- I Arteaga
- Centro de Atención Primaria Palaudàries, Lliçà d'Amunt, Barcelona, España.
| | - G Iglesias
- Centro de Atención Primaria Vall del Tenes, Llicà d'Amunt, Barcelona, España
| | - A Mesa
- Centro de Atención Primaria Palaudàries, Lliçà d'Amunt, Barcelona, España
| | - M Cánovas
- Centro de Atención Primaria Bigues i Riells, Bigues i Riells, Barcelona, España
| | - M Avilés
- Centro de Atención Primaria Palaudàries, Lliçà d'Amunt, Barcelona, España
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24
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Manhaeghe L, Goethals AM, Van Aerde N, Frederiks P, Sinnaeve P, Janssens S, Willems R. Pheochromocytoma leading to Takotsubo and Ogilvie syndrome, a pathophysiological triad. Acta Cardiol 2024; 79:109-113. [PMID: 37823390 DOI: 10.1080/00015385.2023.2268438] [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: 04/05/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
Takotsubo syndrome (TTS) is a transient left ventricle dysfunction usually caused by a stressful trigger (emotional or physical). We report the case of a 77 year-old female patient who presented with TTS caused by a pheochromocytoma, a catecholamine-producing neuroendocrine tumour. Diagnosis was facilitated by acute kidney injury prompting renal ultrasound, recurrence of TTS and symptoms of episodic palpitations, profuse sweating and labile blood pressure. Furthermore, during her hospitalisation the patient also developed an Ogilvie syndrome, an acute colonic pseudo-obstruction, due to the catecholamine-excess. Treatment consisted of betablocker and angiotensin-converting enzyme inhibitor for TTS, neostigmine for Ogilvie syndrome, in combination with alpha-blocker and surgical removal of the tumour after recuperation of left ventricular function and colonic pseudo-obstruction. To our knowledge, this is the first case report of the pathophysiological triad of pheochromocytoma leading to Takotsubo and Ogilvie syndrome in a single patient.
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Affiliation(s)
- Lynn Manhaeghe
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Nathalie Van Aerde
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pascal Frederiks
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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25
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Almeida AG, Grapsa J, Gimelli A, Bucciarelli-Ducci C, Gerber B, Ajmone-Marsan N, Bernard A, Donal E, Dweck MR, Haugaa KH, Hristova K, Maceira A, Mandoli GE, Mulvagh S, Morrone D, Plonska-Gosciniak E, Sade LE, Shivalkar B, Schulz-Menger J, Shaw L, Sitges M, von Kemp B, Pinto FJ, Edvardsen T, Petersen SE, Cosyns B. Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:e116-e136. [PMID: 38198766 DOI: 10.1093/ehjci/jeae013] [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: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Cardiovascular diseases (CVD) represent an important cause of mortality and morbidity in women. It is now recognized that there are sex differences regarding the prevalence and the clinical significance of the traditional cardiovascular (CV) risk factors as well as the pathology underlying a range of CVDs. Unfortunately, women have been under-represented in most CVD imaging studies and trials regarding diagnosis, prognosis, and therapeutics. There is therefore a clear need for further investigation of how CVD affects women along their life span. Multimodality CV imaging plays a key role in the diagnosis of CVD in women as well as in prognosis, decision-making, and monitoring of therapeutics and interventions. However, multimodality imaging in women requires specific consideration given the differences in CVD between the sexes. These differences relate to physiological changes that only women experience (e.g. pregnancy and menopause) as well as variation in the underlying pathophysiology of CVD and also differences in the prevalence of certain conditions such as connective tissue disorders, Takotsubo, and spontaneous coronary artery dissection, which are all more common in women. This scientific statement on CV multimodality in women, an initiative of the European Association of Cardiovascular Imaging of the European Society of Cardiology, reviews the role of multimodality CV imaging in the diagnosis, management, and risk stratification of CVD, as well as highlights important gaps in our knowledge that require further investigation.
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Affiliation(s)
- Ana G Almeida
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Julia Grapsa
- Cardiology Department, Guys and St Thomas NHS Trust, London, UK
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, UCLouvain, Brussels, Belgium
- Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Nina Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Bernard
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
- Service de Cardiologie, CHRU de Tours, Tours, France
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI-UMR 1099, University of Rennes, Rennes, France
| | - Marc R Dweck
- Centre for Cardiovascular Science, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Krassimira Hristova
- Center for Cardiovascular Diseases, Faculty of Medicine, Sofia University, Sofia, Bulgaria
| | - Alicia Maceira
- Ascires Biomedical Group, Valencia, Spain
- Department of Medicine, Health Sciences School, UCH-CEU University, Valencia, Spain
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Doralisa Morrone
- Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leyla Elif Sade
- Cardiology Department, University of Baskent, Ankara, Turkey
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jeanette Schulz-Menger
- Charité ECRC Medical Faculty of the Humboldt University Berlin and Helios-Clinics, Berlin, Germany
- DZHK, Partner site Berlin, Berlin, Germany
| | - Leslee Shaw
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERCV, Barcelona, Spain
| | - Berlinde von Kemp
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
| | - Fausto J Pinto
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
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26
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Cakan F, Say MA, Adar A. Intraoperative Takotsubo Cardiomyopathy: A Case Report. J Perianesth Nurs 2024:S1089-9472(23)01103-6. [PMID: 38520468 DOI: 10.1016/j.jopan.2023.12.014] [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: 08/15/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 03/25/2024]
Abstract
Takotsubo cardiomyopathy (TTC) is a rare condition associated with transient akinesia of apical segments and hyperkinesia of basal segments of the heart. Although several mechanisms have been proposed to cause direct and indirect myocardial damage owing to catecholamine excess, the underlying pathophysiology remains unknown. An 18-year-old female was referred to our otorhinolaryngology outpatient clinic for a septorhinoplasty. Apart from the fear of surgery, the patient had no other health issues. After the administration of local anesthesia (lidocaine and epinephrine mix), tachycardia storms occurred and soon ended with cardiac collapse. Further evaluation revealed TTC. TTC should be considered, especially in cases of treatment-resistant hemodynamic problems after cardiac resuscitation, and nurses can play a crucial role during the preanesthetic period in helping the patient cope with the stress factors related to the upcoming surgery.
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Affiliation(s)
- Fahri Cakan
- Cerkezkoy State Hospital, Department of Cardiology, Tekirdag, Turkiye.
| | - Mehmet A Say
- Cerkezkoy State Hospital, Department of Ear-Nose-Throat, Tekirdag, Turkiye
| | - Adem Adar
- Baskent University Alanya Application And Research Hospital, Department of Cardiology, Antalya, Turkiye
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27
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Li S, Yang S, Zhou S, Zhang S, Li X, Zhang H, Ren P, Liu Y, Liu Y, Chen Y. Is Takotsubo syndrome induced by patent ductus arteriosus occlusion? BMC Cardiovasc Disord 2024; 24:135. [PMID: 38431545 PMCID: PMC10908159 DOI: 10.1186/s12872-024-03788-0] [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: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024] Open
Abstract
Takotsubo syndrome (TTS), commonly referred to as "broken heart syndrome," is a distinctive form of acute and reversible heart failure that primarily affects young to middle-aged individuals, particularly women. While emotional or physical stressors often trigger TTS, rare cases have been linked to interventional procedures for congenital heart disease (CHD). Despite its recognition, the exact causes of TTS remain elusive. Research indicates that dysregulation in autonomic nerve function, involving sympathetic and parasympathetic activities, plays a pivotal role. Genetic factors, hormonal influences like estrogen, and inflammatory processes also contribute, unveiling potential gender-specific differences in its occurrence. Understanding these multifaceted aspects of TTS is crucial for refining clinical approaches and therapies. Continued research efforts will not only deepen our understanding of this syndrome but also pave the way for more targeted and effective diagnostic and treatment strategies. In this report, we conduct an in-depth analysis of a case involving a TTS patient, examining the illness progression and treatment procedures. The aim of this analysis is to enhance the understanding of TTS among primary care physicians. By delving into this case, we aspire to prevent misdiagnosis of typical TTS cases that patients may present, thereby ensuring a more accurate diagnosis and appropriate treatment.
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Affiliation(s)
- Shuhao Li
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Senyan Yang
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Shujing Zhou
- Faculty of Medicine, University of Debrecen, 4032, Debrecen, Hungary
| | - Shuang Zhang
- MianYang Central Hospital, Sichuan Province, People's Republic of China
| | - Xueying Li
- Second People's Hospital of Ya'an City, Sichuan Province, People's Republic of China
| | - Haibo Zhang
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Ping Ren
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Yanwu Liu
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Ying Liu
- Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, People's Republic of China.
| | - Yuanguo Chen
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China.
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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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Maayah M, Grubman S, Allen S, Ye Z, Park DY, Vemmou E, Gokhan I, Sun WW, Possick S, Kwan JM, Gandhi PU, Hu JR. Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing. Diagnostics (Basel) 2024; 14:503. [PMID: 38472975 DOI: 10.3390/diagnostics14050503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Cardiac troponin (Tn) plays a central role in the evaluation of patients with angina presenting with acute coronary syndrome. The advent of high-sensitivity assays has improved the analytic sensitivity and precision of serum Tn measurement, but this advancement has come at the cost of poorer specificity. The role of clinical judgment is of heightened importance because, more so than ever, the interpretation of serum Tn elevation hinges on the careful integration of findings from electrocardiographic, echocardiographic, physical exam, interview, and other imaging and laboratory data to formulate a weighted differential diagnosis. A thorough understanding of the epidemiology, mechanisms, and prognostic implications of Tn elevations in each cardiac and non-cardiac etiology allows the clinician to better distinguish between presentations of myocardial ischemia and myocardial injury-an important discernment to make, as the treatment of acute coronary syndrome is vastly different from the workup and management of myocardial injury and should be directed at the underlying cause.
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Affiliation(s)
- Marah Maayah
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Scott Grubman
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Stephanie Allen
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Zachary Ye
- Department of Internal Medicine, Temple University Medical Center, Philadelphia, PA 19140, USA
| | - Dae Yong Park
- Department of Internal Medicine, Cook County Hospital, Chicago, IL 60612, USA
| | - Evangelia Vemmou
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Ilhan Gokhan
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Wendy W Sun
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Stephen Possick
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Jennifer M Kwan
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Parul U Gandhi
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
- Department of Cardiology, Veterans Affairs Connecticut Health Care System, West Haven, CT 06516, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520, USA
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Mousavi RA, Schober A, Kronberger C, Han E, Litschauer B, Pichler G, Badr Eslam R. Effects of cardiovascular risk factors and pre-existing diseases on the short-term outcome of Takotsubo syndrome. Wien Klin Wochenschr 2024:10.1007/s00508-024-02326-4. [PMID: 38319434 DOI: 10.1007/s00508-024-02326-4] [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: 10/05/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The effects of cardiovascular risk factors (CVRF) on the development of most acute cardiac conditions are well established; however, little is known about the frequency and effects of CVRF in Takotsubo syndrome (TTS) patients. OBJECTIVE The aim of our study was to compare the frequency of CVRF and pre-existing diseases (PD) of TTS patients to ST-elevation myocardial infarction (STEMI) patients and analyze their effects on short-term outcome. METHODS We analyzed the frequency of CVRF (hypertension, hyperlipidemia, type II diabetes mellitus, smoking, chronic kidney disease, family history) as well as somatic and psychiatric PD at admission in TTS patients and compared them with STEMI patients. Their effect on short-term outcome was calculated using a combined endpoint of cardiogenic shock, cardiopulmonary resuscitation, mechanical ventilation, and/or in-hospital death. RESULTS In total, 150 TTS and 155 STEMI patients were included in our study. We observed a higher frequency of psychiatric (30% vs. 7%, p < 0.001), neurological (5% vs. 0%, p = 0.01), and pulmonary (18% vs. 5%, p < 0.001) PD in TTS patients as compared to STEMI patients. There were less smokers (47% vs. 61%, p = 0.03) and patients with hyperlipidemia (24% vs. 51%, p < 0.001) in the TTS cohort than in the STEMI cohort. None of the CVRF or PD behaved as an independent predictor for adverse short-term outcome in TTS patients. CONCLUSION Psychiatric, neurological, and pulmonary pre-existing diseases are more common in TTS than in STEMI patients. Interestingly, PD and CVRF do not seem to have any impact on the short-term outcome of TTS patients.
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Affiliation(s)
- Roya Anahita Mousavi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | - Andreas Schober
- Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
- Department of Cardiology, Clinic Floridsdorf, Vienna, Austria
| | | | - Emilie Han
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Gernot Pichler
- Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
- Department of Cardiology, Clinic Floridsdorf, Vienna, Austria
| | - Roza Badr Eslam
- Department of Cardiology, Medical University of Vienna, Vienna, Austria.
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Culerrier J, Terrier B, Groh M, Lopez-Sublet M, Marie BDS, Falgarone G, Lidove O, Mercie P, Mouthon L, Meune C, Dhote R. Takotsubo syndrome occurring in systemic diseases: A French multicenter retrospective case-control study and literature review. Autoimmun Rev 2024; 23:103483. [PMID: 38016574 DOI: 10.1016/j.autrev.2023.103483] [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: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Describe the characteristics of patients presenting with TTS during the course of a broad spectrum of systemic diseases, in comparison to classic TTS. METHODS French multicenter retrospective case-control study completed by a literature review. RESULTS 19 new cases were included in the study. The literature review identified 25 previously published cases. Among the 44 patients, 41 were females, with a median age of 67 years. The main underlying systemic diseases were systemic lupus erythematosus for seven, rheumatoid arthritis for six and primary Sjögren's syndrome for five. A TTS trigger was found in 34 cases, including a systemic disease flare-up in 28. The flare-up was treated in 15 cases, mainly with corticosteroids. One patient died during the episode, unrelated to the TTS. With a median follow-up of 24 months, all patients had recovered a normal LVEF, one had presented a recurrence of TTS, and none had died of a cardiac cause. Finally, the 19 new patients were compared with 19 classic TTS. The disease characteristics were extremely similar, with no significant difference in terms of clinical, electrocardiographic, biological and echocardiographic presentation. CONCLUSION A broad spectrum of systemic diseases may rarely be accompanied by TTS, particularly during disease flare-ups. Although uncommon, TTS should be borne in mind in the presence of any cardiac symptomatology during the course of a systemic disease. Compared with classic TTS, their clinical, biological and echographic presentation is unremarkable. The prognosis for TTS appears to be good, with the consistent recovery of LVEF and no cardiac-related deaths.
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Affiliation(s)
- Julien Culerrier
- Department of Internal Medicine, Hôpital Avicenne, AP-HP, Bobigny, France.
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | | | - Benjamin De Sainte Marie
- Department of Internal Medicine, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | | | - Olivier Lidove
- Department of Internal Medicine, Hôpital de la Croix St Simon, Paris, France
| | - Patrick Mercie
- Department of Internal Medicine, Hôpital Saint-André, Bordeaux, France
| | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Christophe Meune
- Department of Cardiology, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Robin Dhote
- Department of Internal Medicine, Hôpital Avicenne, AP-HP, Bobigny, France
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Boivin-Proulx LA, Haddad K, Lombardi M, Chong AY, Escaned J, Mukherjee S, Forcillo J, Potter BJ, Coutinho T, Pacheco C. Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Artery Disease: A Contemporary Systematic Review. CJC Open 2024; 6:380-390. [PMID: 38487045 PMCID: PMC10935701 DOI: 10.1016/j.cjco.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/14/2023] [Indexed: 03/17/2024] Open
Abstract
Background Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is defined as acute myocardial infarction (AMI) with angiographically nonobstructive coronary artery disease. MINOCA represents 6% of all AMI cases and is associated with increased mortality and morbidity. However, the wide array of pathophysiological factors and causes associated with MINOCA presents a diagnostic conundrum. Therefore, we conducted a contemporary systematic review of the pathophysiology of MINOCA. Methods A comprehensive systematic review of MINOCA was carried out through the utilization of the PubMed database. All systematic reviews, meta-analyses, randomized controlled trials, and cohort studies available in English or French that reported on the pathophysiology of MINOCA published after January 1, 2013 were retained. Results Of the 600 identified records, 80 records were retained. Central to the concept of MINOCA is the definition of AMI, characterized by the presence of myocardial damage reflected by elevated cardiac biomarkers in the setting of acute myocardial ischemia. As a result, a structured approach should be adopted to thoroughly assess and address clinically overlooked obstructive coronary artery disease, and cardiac and extracardiac mechanisms of myocyte injury. Once these options have been ruled out, a diagnosis of MINOCA can be established, and the appropriate multimodal assessment can be conducted to determine its specific underlying cause (plaque disruption, epicardial coronary vasospasm, coronary microvascular dysfunction, and coronary embolism and/or spontaneous coronary dissection or supply-demand mismatch). Conclusions Integrating a suitable definition of AMI and understanding the pathophysiological mechanisms of MINOCA are crucial to ensure an effective multimodal diagnostic evaluation and the provision of adequate tailored therapies.
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Affiliation(s)
- Laurie-Anne Boivin-Proulx
- Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kevin Haddad
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Marco Lombardi
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Aun Yeong Chong
- Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Swati Mukherjee
- Department of Cardiology, Cabrini Health, Malvern, Victoria, New South Wales, Australia
| | - Jessica Forcillo
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Brian J. Potter
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | | | - Christine Pacheco
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Hôpital Pierre-Boucher, Longueuil, Quebec, Canada
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Celeski M, Nusca A, De Luca VM, Antonelli G, Cammalleri V, Melfi R, Mangiacapra F, Ricottini E, Gallo P, Cocco N, Rinaldi R, Grigioni F, Ussia GP. Takotsubo Syndrome and Coronary Artery Disease: Which Came First-The Chicken or the Egg? J Cardiovasc Dev Dis 2024; 11:39. [PMID: 38392253 PMCID: PMC10889783 DOI: 10.3390/jcdd11020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Takotsubo syndrome (TTS) is a clinical condition characterized by temporary regional wall motion anomalies and dysfunction that extend beyond a single epicardial vascular distribution. Various pathophysiological mechanisms, including inflammation, microvascular dysfunction, direct catecholamine toxicity, metabolic changes, sympathetic overdrive-mediated multi-vessel epicardial spasms, and transitory ischemia may cause the observed reversible myocardial stunning. Despite the fact that TTS usually has an acute coronary syndrome-like pattern of presentation, the absence of culprit atherosclerotic coronary artery disease is often reported at coronary angiography. However, the idea that coronary artery disease (CAD) and TTS conditions are mutually exclusive has been cast into doubt by numerous recent studies suggesting that CAD may coexist in many TTS patients, with significant clinical and prognostic repercussions. Whether the relationship between CAD and TTS is a mere coincidence or a bidirectional cause-and-effect is still up for debate, and misdiagnosis of the two disorders could lead to improper patient treatment with unfavourable outcomes. Therefore, this review seeks to provide a profound understanding of the relationship between CAD and TTS by analyzing potential common underlying pathways, addressing challenges in differential diagnosis, and discussing medical and procedural techniques to treat these conditions appropriately.
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Affiliation(s)
- Mihail Celeski
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Annunziata Nusca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valeria Maria De Luca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giorgio Antonelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valeria Cammalleri
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rosetta Melfi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Fabio Mangiacapra
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Elisabetta Ricottini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Paolo Gallo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Nino Cocco
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Raffaele Rinaldi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Zhang S, Zhao D, Yang Z, Wang F, Yang S, Wang C. Circulating mitochondria promoted endothelial cGAS-derived neuroinflammation in subfornical organ to aggravate sympathetic overdrive in heart failure mice. J Neuroinflammation 2024; 21:27. [PMID: 38243316 PMCID: PMC10799549 DOI: 10.1186/s12974-024-03013-x] [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: 08/17/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Sympathoexcitation contributes to myocardial remodeling in heart failure (HF). Increased circulating pro-inflammatory mediators directly act on the Subfornical organ (SFO), the cardiovascular autonomic center, to increase sympathetic outflow. Circulating mitochondria (C-Mito) are the novel discovered mediators for inter-organ communication. Cyclic GMP-AMP synthase (cGAS) is the pro-inflammatory sensor of damaged mitochondria. OBJECTIVES This study aimed to assess the sympathoexcitation effect of C-Mito in HF mice via promoting endothelial cGAS-derived neuroinflammation in the SFO. METHODS C-Mito were isolated from HF mice established by isoprenaline (0.0125 mg/kg) infusion via osmotic mini-pumps for 2 weeks. Structural and functional analyses of C-Mito were conducted. Pre-stained C-Mito were intravenously injected every day for 2 weeks. Specific cGAS knockdown (cGAS KD) in the SFO endothelial cells (ECs) was achieved via the administration of AAV9-TIE-shRNA (cGAS) into the SFO. The activation of cGAS in the SFO ECs was assessed. The expression of the mitochondrial redox regulator Dihydroorotate dehydrogenase (DHODH) and its interaction with cGAS were also explored. Neuroinflammation and neuronal activation in the SFO were evaluated. Sympathetic activity, myocardial remodeling, and cardiac systolic dysfunction were measured. RESULTS C-Mito were successfully isolated, which showed typical structural characteristics of mitochondria with double-membrane and inner crista. Further analysis showed impaired respiratory complexes activities of C-Mito from HF mice (C-MitoHF) accompanied by oxidative damage. C-Mito entered ECs, instead of glial cells and neurons in the SFO of HF mice. C-MitoHF increased the level of ROS and cytosolic free double-strand DNA (dsDNA), and activated cGAS in cultured brain endothelial cells. Furthermore, C-MitoHF highly expressed DHODH, which interacted with cGAS to facilitate endothelial cGAS activation. C-MitoHF aggravated endothelial inflammation, microglial/astroglial activation, and neuronal sensitization in the SFO of HF mice, which could be ameliorated by cGAS KD in the ECs of the SFO. Further analysis showed C-MitoHF failed to exacerbate sympathoexcitation and myocardial sympathetic hyperinnervation in cGAS KD HF mice. C-MitoHF promoted myocardial fibrosis and hypertrophy, and cardiac systolic dysfunction in HF mice, which could be ameliorated by cGAS KD. CONCLUSION Collectively, we demonstrated that damaged C-MitoHF highly expressed DHODH, which promoted endothelial cGAS activation in the SFO, hence aggravating the sympathoexcitation and myocardial injury in HF mice, suggesting that C-Mito might be the novel therapeutic target for sympathoexcitation in HF.
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Affiliation(s)
- Shutian Zhang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
| | - Dajun Zhao
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
| | - Zhaohua Yang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
| | - Fanshun Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
| | - Shouguo Yang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
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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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Yalta K, Palabıyık O, Gurdogan M, Yetkın E. Hyponatremia and takotsubo syndrome: a review of pathogenetic and clinical implications. Heart Fail Rev 2024; 29:27-44. [PMID: 37698728 DOI: 10.1007/s10741-023-10344-z] [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] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.
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Affiliation(s)
- Kenan Yalta
- Cardiology Department, School of Medicine, TrakyaUniversity, Balkan Yerleşkesi, 22030, Edirne, Turkey.
| | - Orkide Palabıyık
- Trakya University, Vocational Collage of Health Services, Edirne, Turkey
| | - Muhammet Gurdogan
- Cardiology Department, School of Medicine, TrakyaUniversity, Balkan Yerleşkesi, 22030, Edirne, Turkey
| | - Ertan Yetkın
- Türkiye Hastanesi, Cardiology Department, Istanbul, Turkey
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38
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Simões JLB, Braga GDC, Mittelmann TH, Bagatini MD. Current Pharmacology and Modulation of the Purinergic System in Takotsubo Syndrome Triggered by Cytokine Storm. Curr Probl Cardiol 2024; 49:102019. [PMID: 37544631 DOI: 10.1016/j.cpcardiol.2023.102019] [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: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Studies show that with the COVID-19 pandemic, the world's population went through multiple stress and anxiety factors, generating serious psychological problems, in addition, the virus also caused damage and physical stress to those contaminated. In this way, the intense emotional experiences and stressful effects on the body caused by SARS-CoV-2 are capable of triggering the excessive release of catecholamines in the body. Thus, the framework of Takotsubo Syndrome is characterized by myocardial dysfunction as a response of cardiac receptors to the spillage of such hormones in an unregulated way in the human body. The purinergic system plays a central role in this process, as it actively participates in actions responsible for the syndromic cascade, such as the stress generated by the cytokine storm triggered by the virus and the stimulation of deregulated catecholamine release. Therefore, further pharmacological studies on the role of purines in this pathology should be developed in order to avoid the evolution of the syndrome and to modulate its P1 and P2 receptors aiming at developing means of reversing or treating the Takotsubo Syndrome.
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39
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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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40
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Arunkumar S, Jegaverrapandi K. Pharmacological Triggers of Takotsubo Cardiomyopathy: An Updated Review of Evidence and Recommendations. Curr Cardiol Rev 2024; 20:50-60. [PMID: 38367261 PMCID: PMC11107468 DOI: 10.2174/011573403x273613240125072754] [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: 09/06/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Previous publications in 2011, 2016, and 2022 have presented lists of drugs associated with takotsubo cardiomyopathy (TCM). This review aims to provide updated drug lists that have been reported as potential causes of TCM. METHODS Following the same methodology employed in previous reviews, a detailed investigation was carried out in the PubMed/Medline database from June 2022 to July 2023 to identify drug-induced TCM (DITC) case reports. Various search terms related to the drug-induced transient left ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, drug-induced broken heart syndrome, drug triggered takotsubo cardiomyopathy, takotsubo cardiomyopathy, and iatrogenic takotsubo cardiomyopathy were utilized. Filters for fulltext availability, case reports, human studies, and English language were applied. Articles reporting drugs associated with TCM development were included in the analysis. RESULTS Foremost 192 case reports were initially identified, with 75 drugs meeting the inclusion criteria after a thorough review. The latest revision identified seven drugs that might lead to TCM, with four drugs (57.14%) already reported in previous reviews and three drugs (42.86%) newly identified. Consequently, the updated drug list potentially triggering TCM in 2023 comprises a sum of 75 drugs. CONCLUSION The recent 75 drugs provided additional evidence linking to TCM development. The updated list predominantly includes drugs that induce sympathetic overstimulation, although some drugs on the list have unclear associations with sympathetic nervous system activation.
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Affiliation(s)
- S. Arunkumar
- J.K.K.Nattraja College of Pharmacy, Kumarapalayam, Namakkal district, Tamilnadu, India
| | - K. Jegaverrapandi
- Department of Pharmacy Practice, J.K.K.Nattraja College of Pharmacy, Kumarapalayam, Namakkal district, Tamilnadu, India
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41
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Ong HT, Chen J. Mental stress, atheroma, myocardial ischaemia and injury: the link is inflammation. Gen Psychiatr 2023; 36:e101282. [PMID: 38155845 PMCID: PMC10753718 DOI: 10.1136/gpsych-2023-101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
Increasing observational and experimental trial data have shown that mental stress can lead to an increase in adverse clinical cardiovascular events. Mental stress affects the heart by inducing ischaemia and precipitating myocardial infarction (MI) or direct myocardial injury. Mental stress leads to systemic inflammation. Inflammation is known to cause rapid atheromatous plaque progression, instability and thrombosis-the classic type 1 MI. Inflammation can also lead to type 2 MI or myocarditis and injury. The published data linking systemic inflammation, mental stress and cardiovascular disease will be reviewed to establish the linkage between mind and heart, thereby highlighting the importance of holistically managing the patient, not only addressing separate organ systems. Finally, recent trial evidence showing the value of anti-inflammatory drugs in cardiovascular and mental conditions will be briefly considered.
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Affiliation(s)
- Hean Teik Ong
- Cardiology, HT Ong Heart Clinic, Georgetown, Penang, Malaysia
| | - Jinghong Chen
- Editorial Office of General Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Silverio A, Bossone E, Parodi G, Scudiero F, Di Maio M, Vriz O, Bellino M, Zito C, Provenza G, Iuliano G, Cristiano M, Novo G, Mauro C, Rigo F, Innelli P, Salerno-Uriarte J, Cameli M, Tremiterra G, Vecchione C, Antonini-Canterin F, Galasso G, Citro R. Arterial hypertension in patients with takotsubo syndrome: prevalence, long-term outcome, and secondary preventive strategies: a report from the Takotsubo Italian Network register. Eur J Prev Cardiol 2023; 30:1998-2005. [PMID: 37463434 DOI: 10.1093/eurjpc/zwad237] [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: 12/08/2022] [Revised: 06/18/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
AIMS The aim of this study was to investigate the long-term outcome of takotsubo syndrome (TTS) patients with and without hypertension (HT) and to evaluate the effectiveness of treatment with beta-blockers (BBs) and/or renin-angiotensin-aldosterone system inhibitors (RAASi). METHODS AND RESULTS The study population includes a register-based, multicentre cohort of consecutive patients with TTS, divided into two groups according to the history of HT. Further stratification was performed for BB/RAASi prescription at discharge. The primary outcome was the composite of all-cause death and TTS recurrence at the longest available follow-up. The propensity score weighting technique was used to account for potential confounding. In the overall population (903 patients, mean age 70 ± 11 years), HT was reported in 66% of cases. At a median 2-year follow-up, there was no difference in the risk of the primary composite outcome between patients with and without HT. The adjusted Cox regression analysis showed a significantly lower risk for the primary outcome [adjusted hazard ratio (aHR): 0.69; 95% confidence interval (CI): 0.49-0.99] in patients who received BB vs. those who did not. Renin-angiotensin-aldosterone system inhibitors treatment was not associated with the primary study outcome. The lower risk for the primary outcome with BB treatment was confirmed in patients with HT (aHR: 0.37; 95% CI: 0.24-0.56) but not in patients without (aHR: 1.83; 95% CI: 0.92-3.64; Pinteraction < 0.001). CONCLUSION In this TTS study, HT did not affect the long-term risk of adverse events but increased the probability of benefit from BB treatment after discharge. Owing to the favourable outcome impact of BB prescription in TTS patients with HT, a tailored pharmacological therapy should be considered in this cohort.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Guido Parodi
- Department of Cardiology, ASL4 Liguria, Lavagna, Italy
| | | | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, University Hospital 'Policlinico G. Martino', Messina, Italy
| | - Gennaro Provenza
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Giuseppe Iuliano
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Mario Cristiano
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Ciro Mauro
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale dell'Angelo Mestre-Venice, Venice, Italy
| | - Pasquale Innelli
- Department of Cardiovascular Imaging, San Carlo Hospital, Potenza, Italy
| | | | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuliana Tremiterra
- Healtcare Management, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Isernia, Italy
| | - Francesco Antonini-Canterin
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Motta di Livenza, Treviso, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Rodolfo Citro
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Isernia, Italy
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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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Padilla-Lopez M, Duran-Cambra A, Belmar-Cliville D, Soriano-Amores M, Arakama-Goikoetxea S, Vila-Perales M, Bragagnini W, Rodríguez-Sotelo L, Peña-Ortega P, Sánchez-Vega J, Carreras-Mora J, Sionis A. Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome. Front Cardiovasc Med 2023; 10:1286975. [PMID: 38111891 PMCID: PMC10725917 DOI: 10.3389/fcvm.2023.1286975] [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: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Takotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS. Methods A retrospective case-control study was conducted where ECGs were reviewed at three time points from symptom onset (within the first 12 h, at 48 h, and at 5-7 days) and compared between patients with typical TTS (n = 33) and those with MV-TTS (n = 27), as classified by ventriculography. Results 12-h ECG findings revealed that typical TTS featured ST-segment elevation through anterior leads V3-V6, with maximal deviation in V3 (0.98 ± 0.99 mm) and V4 (0.91 ± 0.91 mm), whereas MV-TTS featured ST-segment depression in inferior leads (-0.24 ± 0.57 mm in II, -0.30 ± 0.52 mm in III, and -0.32 ± 0.47 mm in aVF) and in precordial leads V4-V6. In 48-h ECG findings, the most significant change was T wave inversion, which was more widespread and deeper in typical TTS, with the most pronounced negative T wave depths, exceeding 3 mm, observed in leads V3-V5; in contrast, in MV-TTS, T wave inversion was evident in fewer leads and showed less depth, with the most pronounced negative T waves reaching 1 mm at most in leads I, aVL, and V2. While the QTc interval was prolonged in both groups at 48 h, this prolongation was more pronounced in typical TTS than in MV-TTS (523 ± 52 ms vs. 487 ± 66 ms; p = 0.029). In ECGs at 5-7 days, results essentially returned to baseline. Conclusion Patients with MV-TTS exhibited a distinctive pattern of ECG abnormalities, marked by ST-segment depression in inferolateral leads, less profound and less extensive T wave inversion that mostly affected leads I, aVL and V2, and attenuated QT interval prolongation compared to typical TTS.
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Affiliation(s)
- Mireia Padilla-Lopez
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Albert Duran-Cambra
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - David Belmar-Cliville
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Marc Soriano-Amores
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sabiñe Arakama-Goikoetxea
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Montserrat Vila-Perales
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Walter Bragagnini
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Laura Rodríguez-Sotelo
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Peña-Ortega
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jesús Sánchez-Vega
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Carreras-Mora
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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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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Pogran E, Zweiker D, Gargiulo L, El‐Razek AA, Lechner I, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Zirlik A, Bauer A, Metzler B, Lambert T, Steinwender C, Huber K. Takotsubo syndrome before and during the COVID-19 pandemic in Austria: a retrospective cohort study (TOSCA-19). ESC Heart Fail 2023; 10:3667-3676. [PMID: 37803874 PMCID: PMC10682936 DOI: 10.1002/ehf2.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
AIMS This study aims to investigate the prevalence of Takotsubo syndrome (TTS) as a percentage of the total number of acute coronary syndrome (ACS), including non-STE-elevation myocardial infarction and ST-elevation myocardial infarction, as well as the short-term outcome of TTS patients before and during the COVID-19 pandemic. METHODS AND RESULTS We compared patients from two different periods: (i) Period 1 (before the COVID-19 pandemic): 1 March to 30 December 2019, and (ii) Period 2 (during the COVID-19 pandemic): 1 March to 30 December 2020. The retrospective database was created from the archives of the participating hospitals or electronic hospital systems by trained medical personnel. The subjects' medical history, cardiovascular risk factors, laboratory values, echocardiography findings, and an in-hospital outcome were variables of interest. Furthermore, propensity score matching analysis was performed to evaluate the short-term prognosis in TTS and ACS patients. Altogether six Austrian centres-(i) 3rd Medical Department of Cardiology and Intensive Care Medicine, Clinic Ottakring, Vienna, Austria; (ii) 5th Medical Department of Cardiology, Clinic Favoriten, Vienna, Austria; (iii) 2nd Medical Department, Hanusch Hospital, Vienna, Austria; (iv) University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Austria; (v) Department of Cardiology, University Hospital Graz, Graz, Austria; (vi) Department of Cardiology and Intensive Medicine, Kepler University Clinic, Linz, Austria-participated in the study. During period 1, 87 (3.5%) patients out of 2482 ACS patients had TTS in all participating centres. During period 2, 71 (2.7%) patients out of 2572 ACS patients had TTS in all participating centres. Accordingly, the prevalence of TTS remained stable irrespective of potential psychologic stress during the COVID pandemic. Furthermore, the baseline characteristics of TTS patients did not change during the COVID-19 pandemic. The prevalence of in-hospital complications [cardiogenic shock (4.6% vs. 4.3%, P = 0.925), ventricle thrombus (1.1% vs. 1.4%, P = 0.885) and in-hospital bleeding (3.4% vs. 1.4%, P = 0.417)] remained stable. The all-cause in-hospital mortality of TTS patients did not change during the COVID-19 pandemic [χ2 (2) = 0.058, P = 0.810]. Moreover, a propensity score matching analysis of all-cause in-hospital mortality between matched TTS and ACS patients showed higher in-hospital mortality in ACS patients during COVID-19 pandemic (P = 0.043). CONCLUSIONS Despite the well-known increased psychologic stress during the COVID-19 pandemic, the prevalence of TTS during the COVID-19 pandemic and the short-term clinical outcome in Austria remained unimpacted.
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Affiliation(s)
- Edita Pogran
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
- Doctoral Programme Meduni ViennaMedical University of ViennaViennaAustria
| | - David Zweiker
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
| | - Laura Gargiulo
- School of MedicineSigmund Freud Private UniversityViennaAustria
| | | | - Ivan Lechner
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Ivan Vosko
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Stefan Rechberger
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Heiko Bugger
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Günter Christ
- 5th Medical Department of CardiologyClinic FavoritenViennaAustria
| | - Diana Bonderman
- 5th Medical Department of CardiologyClinic FavoritenViennaAustria
| | | | - Andreas Zirlik
- Department of CardiologyUniversity Hospital GrazGrazAustria
| | - Axel Bauer
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Bernhard Metzler
- University Clinic for Internal Medicine III‐Cardiology and AngiologyInnsbruckAustria
| | - Thomas Lambert
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Clemens Steinwender
- Department of Cardiology and Intensive Care MedicineKepler University Hospital LinzLinzAustria
| | - Kurt Huber
- 3rd Medical Department of Cardiology and Intensive Care MedicineClinic Ottakring (former Wilhelminenhospital)ViennaAustria
- School of MedicineSigmund Freud Private UniversityViennaAustria
- Ludwig Boltzmann Institute for Interventional Cardiology and RhythmologyMedical University of ViennaViennaAustria
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Theofilis P, Vlachakis PK, Mantzouranis E, Sakalidis A, Chrysohoou C, Leontsinis I, Lazaros G, Dimitriadis K, Drakopoulou M, Vordoni A, Oikonomou E, Tsioufis K, Tousoulis D. Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics. Angiology 2023:33197231218331. [PMID: 37995282 DOI: 10.1177/00033197231218331] [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] [Indexed: 11/25/2023]
Abstract
Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis K Vlachakis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Mantzouranis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Sakalidis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Chrysohoou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Leontsinis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Drakopoulou
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Vordoni
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Citro R, Bellino M, Merli E, Di Vece D, Sherrid MV. Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning? J Am Heart Assoc 2023; 12:e032028. [PMID: 37889174 PMCID: PMC10727392 DOI: 10.1161/jaha.123.032028] [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: 10/28/2023]
Abstract
Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply-demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.
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Affiliation(s)
- Rodolfo Citro
- Cardio‐Thorax‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
- Department of Vascular PhysiopathologyIRCCS NeuromedPozzilliItaly
| | - Michele Bellino
- Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | - Elisa Merli
- Department of CardiologyOspedale per gli InfermiFaenzaItaly
| | - Davide Di Vece
- Department of CardiologyUniversity Hospital ZurichZurichSwitzerland
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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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Singh T, Mishra AK, Vojjala N, John KJ, George AA, Jha A, Hadley M. Cardiovascular complications following medical termination of pregnancy: An updated review. World J Cardiol 2023; 15:518-530. [PMID: 37900907 PMCID: PMC10600792 DOI: 10.4330/wjc.v15.i10.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described. AIM To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP. METHODS We performed a literature search in PubMed, Medline, RCA, and google scholar, using the search terms "abortions" or "medical/legal termination of pregnancy" and "cardiac complications" or "cardiovascular complications". RESULTS The most common complications described in the literature following MTP were infective endocarditis (IE) (n = 16), takotsubo cardiomyopathy (TTC) (n = 7), arrhythmias (n = 5), and sudden coronary artery dissection (SCAD) (n = 4). The most common valve involved in IE was the tricuspid valve in 69% (n = 10). The most observed causative organism was group B Streptococcus in 81% (n = 12). The most common type of TTC was apical type in 57% (n = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications. CONCLUSION In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.
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Affiliation(s)
- Tejveer Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States.
| | - Nikhil Vojjala
- Department of Internal Medicine, Post-Graduation Institute of Medical Education and Research, Chandigarh 00000, India
| | - Kevin John John
- Department of Internal Medicine, Tufts Medical Center, Boston, MA 01212, United States
| | - Anu A George
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anil Jha
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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