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AlShehabi N, Hallak Y, Battistin U, Faraji H, Othman M, Alkowatli H, Butt M. Takotsubo Cardiomyopathy Complicating Diabetic Ketoacidosis, Hypothermia and Hypernatremia in a Comatose Patient. Cureus 2024; 16:e65009. [PMID: 39161482 PMCID: PMC11333144 DOI: 10.7759/cureus.65009] [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: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a transient wall motion abnormality of the left ventricular apex associated with emotional or physical stress. In the setting of diabetic ketoacidosis (DKA), it is thought to be caused by the compound effect of a catecholamine surge and the noxious effect of acidosis and ketones leading to myocardial stunning. In this report, the first of its kind in the Middle East, we describe the case of a 71-year-old comatose patient, who was being treated for DKA and hypernatremia and was incidentally diagnosed with TCM. We also review 15 case reports of DKA-induced TCM published to date in the literature, many of which had an atypical presentation and good outcomes. Furthermore, we discuss possible risk factors for TCM in our case and supporting literature. It is recommended to maintain increased vigilance and attempt early identification of such conditions in acutely ill patients to prevent life-threatening complications.
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Affiliation(s)
- Nagam AlShehabi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Yusuf Hallak
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Umberto Battistin
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Hanan Faraji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Malek Othman
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
| | - Hamza Alkowatli
- Department of Internal Medicine, HCA Florida Blake Hospital, Bradenton, USA
| | - Mehmood Butt
- Cardiology, King's College Hospital Dubai, Dubai, ARE
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Teferi AM, Paz H, Bankowski S, Rahimi M, Zaremski L. Takotsubo Cardiomyopathy in a Young Patient Presenting as Cardiac Arrest and Cardiogenic Shock. Cureus 2024; 16:e61560. [PMID: 38962651 PMCID: PMC11221618 DOI: 10.7759/cureus.61560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Takotsubo cardiomyopathy (TC) is a reversible cardiac disorder that rarely results in serious morbidity and mortality. Cardiogenic shock and cardiac arrest can occur in patients with TC. In this case report, we present the case of a 31-year-old woman with no significant comorbidities who suffered cardiac arrest due to TC and subsequent cardiogenic shock that required inotropic and vasopressor support. The patient's condition progressively improved, and her cardiac function recovered within a few weeks. This case illustrates the importance of recognizing TC as a significant cause of otherwise unexplained cardiac arrest and highlights the need for evidence-based guidelines for treating cardiogenic shock in this setting.
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Affiliation(s)
| | - Hosman Paz
- Internal Medicine, St. Barnabas Hospital (SBH) Health System, New York, USA
| | | | - Mona Rahimi
- Emergency Medicine, St. Barnabas Hospital (SBH) Health System, New York, USA
| | - Lynn Zaremski
- Cardiology, St. Barnabas Hospital (SBH) Health System, New York, USA
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Eftekharzadeh P, Patel A, Sokolova E, Rodas A, Ahmed S. Takotsubo Cardiomyopathy: A COVID-19 Complication. Cureus 2022; 14:e22803. [PMID: 35399473 PMCID: PMC8980236 DOI: 10.7759/cureus.22803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/17/2023] Open
Abstract
COVID-19 started as an unknown viral illness and has been a challenging pandemic to overcome. The virus has been associated with multiple organ involvement, including the heart. Takotsubo cardiomyopathy (TSCM), a stress cardiomyopathy, is an uncommon complication in patients diagnosed with COVID-19. The pathogenesis is historically a result of stress onto the body that leads to a catecholamine surge. However, COVID-19 may cause direct damage to the cardiac myocytes via spike protein and angiotensin-converting enzyme 2 (ACE2) receptors which can further exacerbate the stressful insult on the patient and lower the threshold for developing TSCM. In this case report, we discuss a 94-year-old female who presented with signs and symptoms of acute coronary syndrome but, upon cardiac catheterization, was found to have basal hypercontraction with apical ballooning, consistent with TSCM.
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Chiang LLW, Tsang SL, Lee JX, Gong M, Liu T, Tse G, Chang D, Lakhani I, Li KHC. Takotsubo cardiomyopathy with low ventricular ejection fraction and apical ballooning predicts mortality: a systematic review and meta-analysis. Heart Fail Rev 2020; 26:309-318. [PMID: 32895749 DOI: 10.1007/s10741-020-10018-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 12/27/2022]
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by temporary wall motion abnormality of the left ventricle. There is much debate upon the prognostic parameters. We conducted a systematic review and meta-analysis to investigate whether LVEF and the presence of apical ballooning predict long-term mortality in TCM. PubMed and Embase were searched through to October 30, 2017 without language restrictions, followed by an additional search through to February 2, 2020. Our search identified 18 studies that met the inclusion criteria, with a total of 5168 patients. Reduced LVEF as a categorical variable was associated with more than threefold increase in mortality risk in TCM patients (HR 3.10; 95% CI 1.78-5.42; P < 0.0001; I2 = 57%). Further subset analyses with the exclusion of studies consisting of patients with coronary artery disease revealed another significant relationship between LVEF and mortality (HR 3.13; 95% CI 1.392-7.031; P < 0.006; I2 = 58%). LVEF as a continuous variable was also found to be associated with increased mortality risk. However, this relationship only retained significance when computing odds ratios instead of hazard ratios (OR 0.95; 95% CI 0.93-0.98; P < 0.001; I2 = 0%). Finally, the existence of apical ballooning failed to demonstrate any link with an increased risk of mortality (HR 1.26; 95% CI 0.97-1.64; P = 0.09; I2 = 34%). LVEF and apical ballooning are both potential prognostic markers for mortality.
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Affiliation(s)
| | - Shek Long Tsang
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, China
| | - Jing Xian Lee
- Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Gary Tse
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, China
| | - Dong Chang
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ishan Lakhani
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China.
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Abstract
• Takotsubo syndrome can be triggered by various stress factors. • Echocardiography is helpful to evaluate wall motion abnormality and LV dysfunction. • ECMO extended the diagnostic window and improved tissue perfusion. • Expert diagnosis and consultation can be conducted online, greatly enhancing accuracy.
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Affiliation(s)
- Zhongzhou Su
- Jiangmen Hospital of Sun Yatsen University, Jiangmen, China
| | - Yu Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medicine Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongwen Fei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medicine Sciences, Guangzhou, China
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A Rare Case of Takotsubo Syndrome and Acute Coronary Syndrome of the Right Coronary Artery. Case Rep Cardiol 2019; 2019:9128273. [PMID: 31281681 PMCID: PMC6590605 DOI: 10.1155/2019/9128273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 05/12/2019] [Indexed: 01/16/2023] Open
Abstract
Takotsubo syndrome (TTS) is an increasingly recognized heart disease that was initially regarded as a benign condition, but since has proven to cause irreversible myocardial damage, resembling that of acute coronary syndrome (ACS). The etiology of TTS is still uncertain but may be associated with catecholamine elevations during times of emotional or physical stress. Catecholamines are also understood to have prothrombotic properties, which could lead to ACS. With these similarities, differentiating these two pathologies can be difficult, especially when TTS and ACS occur simultaneously.
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Asher E, Odeh Q, Sabbag A, Goldkorn R, Elian D, Ben Zekry S, Peled Y, Abu-Much A, Mazin I, Beigel R, Matetzky S. Differentiating Takotsubo cardiomyopathy from ST-segment elevation myocardial infarction. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918795015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Takotsubo cardiomyopathy affects between 1.7% and 2.2% of patients hospitalized with suspected acute coronary syndromes. Characterized by chest pain, electrocardiogram changes, and transient left ventricular apical wall motion abnormality, it is under-recognized and often misdiagnosed. Objectives: In order to better differentiate between St-segment myocardial infarction and Takotsubo cardiomyopathy, we developed a scoring system. Methods: Of the 82 patients enrolled with Takotsubo cardiomyopathy, 67 had ST-segment elevation on electrocardiogram and were compared with 79 ST-elevation myocardial infarction patients. A multi-variant logistic regression model was used to find factors independently associated with Takotsubo cardiomyopathy. The Platelets and Thrombosis in Sheba (PLATIS)-Takotsubo cardiomyopathy is based on a 10-point scoring system: stressful events (3), females (2), no history of diabetes mellitus (2), estimated left ventricular ejection fraction ≤ 40% on admission echo (1), positive troponin on admission (1), and no smoking (1). Patients with Takotsubo cardiomyopathy were older (66 ± 11 vs 60 ± 11 years, p < 0.001), predominantly female (90% vs 15%, p < 0.001), with a lower incidence of diabetes mellitus, dyslipidemia, and smoking. Nevertheless, in-hospital mortality was similar in both groups. Results: In a multivariate logistic regression analysis, the average Platelets and Thrombosis in Sheba-Takotsubo cardiomyopathy scoring was significantly higher in Takotsubo cardiomyopathy compared with ST-elevation myocardial infarction patients (8.35 ± 1.7 vs 3.42 ± 1.6, p < 0.001). With an overall score of ≥7, the receiver-operating characteristic curve was 0.82 with a sensitivity of 75% and a specificity of 89% (positive predictive value = 85% and negative predictive value = 80%). Conclusion: The Takotsubo cardiomyopathy scoring system is a simple, reliable tool that can assist in diagnosing and differentiating between patients with Takotsubo cardiomyopathy and those with ST-elevation myocardial infarction.
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Affiliation(s)
- Elad Asher
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Qasim Odeh
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Sabbag
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Goldkorn
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Elian
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Ben Zekry
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arsalan Abu-Much
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Mazin
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beigel
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gue YX, Bhandari SS, Ahamed M. An uncommon manifestation of shock: Takotsubo syndrome. Echo Res Pract 2017; 4:K41-K45. [PMID: 28916516 PMCID: PMC5633058 DOI: 10.1530/erp-17-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022] Open
Abstract
76-year-old female presented following an episode of collapse. She was hypotensive with the paramedics and remained refractory despite fluid resuscitation. Her initial baseline tests revealed an elevated troponin; she subsequently underwent a coronary angiogram that showed mild coronary artery disease. Left ventriculogram was performed, which showed abnormal mid-wall ballooning and severely impaired systolic function, characteristic of Takotsubo syndrome. Echocardiogram confirmed the presence of diagnosis and presence of left ventricular outflow tract obstruction with high gradient. She was initiated on medical heart failure therapy and improved. Follow-up investigations after 2 months showed complete resolution of systolic dysfunction and symptoms.
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Affiliation(s)
- Ying X Gue
- Department of Cardiology, Royal Derby Hospital, Derby Hospital NHS Foundation Trust, Derby, UK
| | - Sanjay S Bhandari
- Department of Cardiology, Royal Derby Hospital, Derby Hospital NHS Foundation Trust, Derby, UK
| | - Mubarak Ahamed
- Department of Cardiology, Royal Derby Hospital, Derby Hospital NHS Foundation Trust, Derby, UK
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DKA-Induced Takotsubo Cardiomyopathy in Patient with Known HOCM. Case Rep Crit Care 2017; 2017:4287125. [PMID: 28473928 PMCID: PMC5394412 DOI: 10.1155/2017/4287125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/09/2017] [Indexed: 12/03/2022] Open
Abstract
The first published case of Diabetic Ketoacidosis-induced Takotsubo cardiomyopathy was in 2009. Our patient is the 1st reported case of Diabetic Ketoacidosis- (DKA-) induced Takotsubo cardiomyopathy (TC) in a patient with known hypertrophic cardiomyopathy (HOCM) in the United States. In the literature, there are only two examples linking DKA to TC; however, this report focuses on the biochemical and physiological causes of TC in a patient with known HOCM and new-onset DKA. TC in previously diagnosed HOCM poses particular complications. With the above patient's baseline outflow tract obstruction due to septal hypertrophy, the acute reduction in EF due to TC resulted in transient drop in brain perfusion and, therefore, syncope.
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Balsa AM, Ferreira AR, Alves M, Guimarães J. Takotsubo Cardiomyopathy Associated with Levothyroxine Over-replacement. EUROPEAN ENDOCRINOLOGY 2017; 13:30-32. [PMID: 29632604 PMCID: PMC5813443 DOI: 10.17925/ee.2017.13.01.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/15/2017] [Indexed: 11/24/2022]
Abstract
Takotsubo cardiomyopathy (TC) is characterised by acute, transient left ventricular apical ballooning precipitated by emotional or physiologically stressful stimuli and has been previously associated with Grave’s disease based on a few clinical reports. More recently, the association with exogenous thyrotoxicosis and radioiodine-induced thyroiditis has also been described. Iatrogenic hyperthyroidism on patients on levothyroxine replacement therapy for hypothyroidism has not been reported as a cause of TC. The authors describe two female patients with TC associated with levothyroxine over-replacement. A 74-year-old and a 48-year-old female patient, medicated with levothyroxine (respectively, 2.27 μg/kg and 1.85 μg/kg) for autoimmune thyroiditis were admitted to our emergency room with precordial pain. The first had an electrocardiogram with ST-segment elevation in the anterior precordial leads, and the latter had sinus tachycardia with deep T-wave inversion and QT interval prolongation. Further investigation revealed a mild elevation of cardiac biomarker levels and severe apical hypokinesis, but no significant coronary lesions on catheterisation. The suppressed thyroid stimulating hormone (TSH) levels were verified in the cardiac intensive care unit: 0.21 and 0.07 mIU/l (0.35–5.50) respectively. Both patients showed improvement of the apical hypokinesis on the discharge echocardiogram and normalisation of cardiac biomarker levels. Levothyroxine dose was reduced. This case report focuses on the cardiovascular risks of thyrotoxicosis, emphasises the importance of correct dose adjustment on patients under levothyroxine replacement therapy and stresses that TSH should be determined in patients presenting with acute coronary syndrome and typical findings of TC.
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Affiliation(s)
- Ana Margarida Balsa
- Department of Endocrinology, Diabetes and Nutrition, Hospital Centre of Baixo Vouga, Aveiro, Portugal
| | | | - Márcia Alves
- Department of Endocrinology, Diabetes and Nutrition, Hospital Centre of Baixo Vouga, Aveiro, Portugal
| | - Joana Guimarães
- Department of Endocrinology, Diabetes and Nutrition, Hospital Centre of Baixo Vouga, Aveiro, Portugal
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Differences between Takotsubo cardiomyopathy and reverse Takotsubo cardiomyopathy associated with subarachnoid hemorrhage. IJC HEART & VASCULATURE 2016; 11:99-103. [PMID: 28616533 PMCID: PMC5441322 DOI: 10.1016/j.ijcha.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/02/2016] [Indexed: 10/29/2022]
Abstract
BACKGROUND Both Takotsubo cardiomyopathy (TTC) and reverse TTC (r-TTC) are characterized by reversible regional wall motion abnormalities of the heart unrelated to coronary artery pathology. It remains unclear whether and/or how r-TTC differs from TTC. Subarachnoid hemorrhage (SAH) is occasionally causative of TTC/r-TTC, and this study was conducted to detect possible differences between TTC and r-TTC associated with SAH. METHODS A single-center retrospective study was conducted on 328 consecutive SAH patients. They routinely underwent transthoracic echocardiography (TTE), ECG, and measurements of plasma catecholamines and other cardiac biomarkers within 24 h of admission. Demographic, echocardiographic, electrocardiographic and neurochemical profiles were compared between patients with TTC and r-TTC. The diagnosis of TTC/r-TTC was based on the revised Mayo Clinic Criteria. RESULTS Data of 21 SAH-induced TTC and 10 SAH-induced r-TTC patients admitted between January 2009 and December 2014 were analyzed. The patients with r-TTC were significantly younger than those with TTC (51.8 ± 10.9 vs. 63.5 ± 14.4 years, p = 0.04). The former exhibited significantly higher plasma epinephrine levels than the latter (809 ± 710 vs. 380 ± 391 pg/mL, p = 0.04). Plasma norepinephrine levels did not differ significantly (2421 ± 1374 vs. 1724 ± 1591 pg/mL, p = 0.25). No significant differences were observed in other demographic/physiologic variables, echocardiographic parameters, frequency of ECG abnormalities, and 90-day mortality. Moreover, none of the patients who underwent a follow-up TTE exhibited morphologic change from one type to the other. CONCLUSIONS The pathomechanisms in TTC and r-TTC may not be identical: however, distinguishing the two conditions may not have great importance from the standpoint of clinical management and prognostication.
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Yayehd K, N'da NW, Belle L, Bataille V, Hanssen M, Leddet P, Aupetit JF, Commeau P, Filippi E, Georges JL, Albert F, Rangé G, Meimoun P, Marcaggi X, Baleynaud S, Nallet O, Dibie A, Barnay C, Jouve B, Legrand M, Cattan S, Mulak G, Simon T, Danchin N, Dujardin JJ. Management of Takotsubo cardiomyopathy in non-academic hospitals in France: The Observational French SyndromEs of TakoTsubo (OFSETT) study. Arch Cardiovasc Dis 2015; 109:4-12. [PMID: 26507532 DOI: 10.1016/j.acvd.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening of the heart. TTC can mimic acute myocardial infarction and is associated with a minimal release of myocardial biomarkers in the absence of obstructive coronary artery disease. AIMS To provide an extensive description of patients admitted to hospital for TTC throughout France and to study the management and outcomes of these patients. METHODS In 14 non-academic hospitals, we collected clinical, electrocardiographic, biological, psychological and therapeutic data in patients with a diagnosis of TTC according to the Mayo Clinic criteria. RESULTS Of 117 patients, 91.5% were women, mean ± SD age was 71.4 ± 12.1 years and the prevalence of risk factors was high (hypertension: 57.9%, dyslipidaemia: 33.0%, diabetes: 11.5%, obesity: 11.5%). The most common initial symptoms were chest pain (80.5%) and dyspnoea (24.1%). A triggering psychological event was detected in 64.3% of patients. ST-segment elevation was found in 41.7% of patients and T-wave inversion in 71.6%. Anterior leads were most frequently associated with ST-segment elevation, whereas T-wave inversion was more commonly associated with lateral leads, and Q-waves with septal leads. The ratio of peak B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) level to peak troponin level was 1.01. No deaths occurred during the hospital phase. After 1 year of follow-up, 3 of 109 (2.8%) patients with available data died, including one cardiovascular death. Rehospitalizations occurred in 17.4% of patients: 2.8% due to acute heart failure and 14.7% due to non-cardiovascular causes. There was no recurrence of TTC. CONCLUSIONS This observational study of TTC included primarily women with atherosclerotic risk factors and mental stress. T-wave inversion was more common than ST-segment elevation. There were few adverse cardiovascular outcomes in these patients after 1-year follow-up.
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Affiliation(s)
- Komlavi Yayehd
- Department of Cardiology, Campus University Teaching Hospital, Lomé, Togo
| | - N'kenon W N'da
- Department of Cardiology, Campus University Teaching Hospital, Lomé, Togo
| | - Loïc Belle
- Department of Cardiology, Annecy Hospital, 74000 Annecy, France.
| | - Vincent Bataille
- Department of Cardiology and Epidemiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Michel Hanssen
- Department of Cardiology, Haguenau Hospital, 67500 Haguenau, France
| | - Pierre Leddet
- Department of Cardiology, Haguenau Hospital, 67500 Haguenau, France
| | | | - Philippe Commeau
- Department of Cardiology, polyclinique Les Fleurs, 83190 Ollioules, France
| | - Emmanuelle Filippi
- Department of Cardiology, Bretagne-Atlantique Hospital, 56000 Vannes, France
| | | | - Franck Albert
- Department of Cardiology, Chartres Hospital, 28000 Chartres, France
| | - Grégoire Rangé
- Department of Cardiology, Chartres Hospital, 28000 Chartres, France
| | - Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, 60200 Compiègne, France
| | - Xavier Marcaggi
- Department of Cardiology, Vichy Hospital, 03200 Vichy, France
| | - Serge Baleynaud
- Department of Cardiology, Bretagne Hospital, 56100 Lorient, France
| | - Olivier Nallet
- Department of Cardiology, Le Raincy-Montfermeil Intercity Hospital, 93370 Montfermeil, France
| | - Alain Dibie
- Institut mutualiste Montsouris, 75000 Paris, France
| | - Claude Barnay
- Department of Cardiology, Pays d'Aix Hospital, 13100 Aix-en-Provence, France
| | - Bernard Jouve
- Department of Cardiology, Pays d'Aix Hospital, 13100 Aix-en-Provence, France
| | - Maud Legrand
- Department of Cardiology, Le Mans Hospital, 72000 Le Mans, France
| | - Simon Cattan
- Department of Cardiology, Le Raincy-Montfermeil Intercity Hospital, 93370 Montfermeil, France
| | | | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research, Saint-Antoine University Hospital, 75000 Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Georges-Pompidou University Hospital, 75000 Paris, France
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