1
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Dai Q, Li P, Bose A, Cai P, Jin L, Pan S, Dixon RAF, Laidlaw D, Liu Q. Association of atrial fibrillation burden with in-hospital outcomes in patients with Takotsubo cardiomyopathy. Am J Med Sci 2023; 365:345-352. [PMID: 35793734 DOI: 10.1016/j.amjms.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/15/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND The effects of atrial fibrillation (AF) and its burden on in-hospital mortality in patients with Takotsubo cardiomyopathy (TCM) are unclear. Here, we examined the effect of AF and paroxysmal AF on in-hospital outcomes in patients with TCM. METHODS We used ICD-10 codes to retrospectively identify patients with a primary diagnosis of TCM in the National Inpatient Sample database 2016-2018. We compared in-hospital outcomes in TCM patients with and without AF before and after propensity score matching. The effect of AF burden on outcomes was assessed in patients with paroxysmal AF and no AF. RESULTS Of the 4,733 patients with a primary diagnosis of TCM, 650 (13.7%) had AF, and 4,083 (86.3%) did not. Of TCM patients with AF, 368 (56.6%) had paroxysmal AF. In-hospital mortality was higher in patients with AF before (3.4% vs 1.2%, P < 0.001) and after propensity matching (3.4% vs 1.7%, P = 0.021) but did not differ between the paroxysmal AF and the no AF groups (P = 0.205). In the matched cohorts, both AF and paroxysmal AF groups were associated with a higher rate of cardiogenic shock (AF, P < 0.001; paroxysmal AF, P < 0.001), ventricular arrhythmia (AF, P = 0.002; paroxysmal AF, P = 0.02), acute kidney injury (AF, P = 0.007; paroxysmal AF, P = 0.008), and acute respiratory failure (AF, P < 0.001; paroxysmal AF, P < 0.001) compared with the no AF group. CONCLUSIONS Although AF was associated with increased in-hospital mortality, paroxysmal AF did not affect in-hospital mortality, suggesting a higher AF burden is associated with worse clinical outcome in patients with TCM.
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Affiliation(s)
- Qiying Dai
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA.
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Abhishek Bose
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Ling Jin
- Department of Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - Su Pan
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Richard A F Dixon
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Douglas Laidlaw
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Qi Liu
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
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2
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Braschi A, Frasheri A, Lombardo RM, Abrignani MG, Lo Presti R, Vinci D, Traina M. Erythrocyte Indices in Patients With Takotsubo Syndrome. Crit Pathw Cardiol 2023; 22:31-39. [PMID: 36812342 DOI: 10.1097/hpc.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Although the prognosis of patients with Takotsubo syndrome (TTS) is relatively favorable, serious complications may occur. This study aimed to investigate the relationship between blood parameters and the occurrence of in-hospital complications. METHODS Clinical charts of 51 patients with TTS were retrospectively evaluated, and data regarding blood parameters assessed during the first 24 hours of hospitalization were studied. RESULTS Levels of hemoglobin less than 13 g/dL in men and 12 g/dL in women (P < 0.01), levels of mean corpuscular hemoglobin concentration (MCHC) less than 33 g/dL (P = 0.01), and levels of red blood cell distribution width-coefficient of variation higher than 14.5% (P = 0.01) were significantly associated to the occurrence of major adverse cardiovascular events (MACE). Markers, such as, platelets to lymphocytes ratio, lymphocytes to monocytes ratio, neutrophils to lymphocytes ratio, and white blood cell count to mean platelet volume, were unable to differentiate patients with and without complications (P > 0.05). MCHC and estimated glomerular filtration rate were independent predictors of MACE. CONCLUSIONS Blood parameters may have a role in the stratification risk of patients with TTS. Patients showing low levels of MCHC and decreased estimated glomerular filtration rate were more likely to have in-hospital MACE. This should encourage physicians to closely monitor blood parameters in patients with TTS.
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Affiliation(s)
- Annabella Braschi
- From the Sport and Exercise Sciences, Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
| | - Arian Frasheri
- Coronary Care Unit and Catheterization Laboratory, S.Antonio Abate Hospital, Casa Santa-Erice (Trapani), Italy
| | - Renzo M Lombardo
- Coronary Care Unit and Catheterization Laboratory, S.Antonio Abate Hospital, Casa Santa-Erice (Trapani), Italy
| | - Maurizio G Abrignani
- Operative Unit of Cardiology, S.Antonio Abate Hospital, Casa Santa-Erice (Trapani), Italy
| | - Rosalia Lo Presti
- From the Sport and Exercise Sciences, Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
| | - Daniele Vinci
- Coronary Care Unit and Catheterization Laboratory, S.Antonio Abate Hospital, Casa Santa-Erice (Trapani), Italy
| | - Marcello Traina
- From the Sport and Exercise Sciences, Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
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3
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Ferreira C. Takotsubo syndrome: We are still "halfway". A complex heart-brain duality? Rev Port Cardiol 2023; 42:247-249. [PMID: 36639105 DOI: 10.1016/j.repc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Catarina Ferreira
- Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal; Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal; Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.
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4
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Zweiker D, Pogran E, Gargiulo L, Abd El-Razek A, Lechner I, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Czedik-Eysenberg C, Roithinger A, Weihs V, Kaufmann CC, Zirlik A, Bauer A, Metzler B, Lambert T, Steinwender C, Huber K. Neutrophile-Lymphocyte Ratio and Outcome in Takotsubo Syndrome. BIOLOGY 2022; 11:biology11081154. [PMID: 36009781 PMCID: PMC9404721 DOI: 10.3390/biology11081154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Background: Takotsubo syndrome (TTS) is an important type of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients and present long-term outcomes. Methods: In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of independent predictors on long-term survival was evaluated. Results: A total of 338 patients (median age 72 years, 86.9% female) from six centers were included. Severe in-hospital complications occurred in 14.5% of patients. In multivariable analysis, high neutrophile-lymphocyte-ratio (NLR; OR 1.04 [95% CI 1.02−1.07], p = 0.009) and low LVEF (OR 0.92 [0.90−0.95] per %, p < 0.001) were significant predictors of severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were significantly associated with reduced 5-year survival. Conclusions: Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short- and long-term outcome after TTS.
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Affiliation(s)
- David Zweiker
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
- Correspondence: ; Tel.: +43-664-8650460; Fax: +43-1-49150-2309
| | - Edita Pogran
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Laura Gargiulo
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Ahmed Abd El-Razek
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Ivan Lechner
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Ivan Vosko
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Stefan Rechberger
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Günter Christ
- 5th Medical Department for Cardiology, Clinic Favoriten, 1100 Vienna, Austria; (G.C.); (D.B.)
| | - Diana Bonderman
- 5th Medical Department for Cardiology, Clinic Favoriten, 1100 Vienna, Austria; (G.C.); (D.B.)
| | | | | | - Antonia Roithinger
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Valerie Weihs
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Core Facility, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christoph C. Kaufmann
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Axel Bauer
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Bernhard Metzler
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Thomas Lambert
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Clemens Steinwender
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
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5
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Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. IJC HEART & VASCULATURE 2022; 39:100990. [PMID: 35281752 PMCID: PMC8913320 DOI: 10.1016/j.ijcha.2022.100990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
Takotsubo cardiomyopathy (TTS) has become a recognised clinical entity since the Japanese scientist Sato first described it in 1990. Despite an increasing number of confirmed cases, especially during the COVID-19 pandemic, its pathophysiology remains incompletely understood, and decision-making differs in the diagnosis and treatment. In addition, it is not evident whether a significant increase in TTS is due to better understanding among practitioners and widespread access to coronary angiography, or if it is a reflection of an actual increase in incidence. We analysed a series of international research studies from 1990 to 2021. Beyond epidemiology and clinical presentation, we evaluated and summarised fundamental knowledge about various predisposing factors, with particular attention to the iatrogenic impact of certain drugs, namely antidepressants, chemotherapy, and antiarrhythmics. Furthermore, we highlighted the main pathophysiological theories to date. In addition, based on published studies and clinical cases, we investigated the role of numerous diagnostic approaches in the differential diagnosis of TTS and identified predictors of TTS complications, such as cardiogenic shock, ventricular fibrillation, and left ventricular thrombi. Accordingly, we sought to propose a diagnostic algorithm and further treatment management of TTS under the presence of possible complications to help practitioners make more informed decisions, as the initial presentation continues to pose a challenge due to its close similarity to acute coronary syndrome with ST-elevation. In conclusion, this article examines Takotsubo cardiomyopathy from different perspectives and, along with future systematic reviews and meta-analyses, can be of particular interest to practising cardiologists and researchers in developing clinical guidelines.
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Affiliation(s)
- Anastasiia V Bairashevskaia
- Department of Paediatrics, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sofiya Y Belogubova
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia.,AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| | - Mikhail R Kondratiuk
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria S Rudnova
- International School "Medicine of the Future", Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Susanna S Sologova
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Olga I Tereshkina
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Esma I Avakyan
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia.,AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
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6
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Rathore SS, Iqbal K, Shafqat S, Tariq E, Tousif S, UlHaq ZG, Fernández-Sánchez D, Hernández-Woodbine MJ, Granados-Mendoza SC, Lacouture-Cárdenas NA, Avendaño-Capriles CA, Maheshwari C, Iqbal A, Mahalwar G, Shariff M, Kumar A. Meta-analysis of Incidence and outcomes of life-threatening arrhythmias in Takotsubo Cardiomyopathy. Indian Heart J 2022; 74:110-119. [PMID: 35122776 PMCID: PMC9039676 DOI: 10.1016/j.ihj.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/21/2022] Open
Abstract
Background Takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy is a transient heart condition that clinically resembles an acute coronary syndrome. This study aims to assess the incidence of life-threatening arrhythmias in patients with Takotsubo cardiomyopathy and evaluate the outcomes of patients with life-threatening arrhythmias (LTAs) in Takotsubo cardiomyopathy compared with those without LTA. Methods We comprehensively searched the PubMed, Google Scholar, and Embase databases from inception to February 2021. The primary aim of the study was to determine the incidence of LTAs in TC patients. Other outcomes of interest were the odds of in-hospital, long-term mortality, and cardiogenic shock (CS) in TC patients with LTAs versus those without LTAs. For all statistical analyses, ReviewManager and MedCalc were used. Results Eighteen studies were included in this study involving 55,557 participants (2,185 with LTAs and 53,372 without LTAs). The pooled incidence of LTAs in the patients of TC was found to be 6.29% (CI: 4.70–8.08%; I2 = 94.67%). There was a statistically significant increased risk of in-hospital mortality (OR = 4.74; CI: 2.24–10.04; I2 = 77%, p < 0.0001) and cardiogenic shock (OR = 5.60; CI: 3.51–8.95; I2 = 0%, p < 0.00001) in the LTA group versus the non-LTA group. LTA was not associated with long-term mortality (OR = 2.23; CI: 0.94–5.28; I2 = 53%, p = 0.07). Conclusion The pooled incidence of life-threatening arrhythmias in the patients of TC was found to be 6.29%. In the group of TC patients with LTAs, the odds of in-hospital mortality and CS, was higher than in the TC patients without LTAs.
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Affiliation(s)
- Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Shameel Shafqat
- Department of Internal Medicine, Aga Khan University, Karachi, Pakistan
| | - Eleze Tariq
- Department of Internal Medicine, Aga Khan University, Karachi, Pakistan
| | - Sohaib Tousif
- Department of Internal Medicine, Ziauddin University, Karachi, Pakistan
| | | | | | | | | | | | | | - Chanchal Maheshwari
- Department of Internal Medicine, Karachi Medical College and Hospital, Karachi, Pakistan
| | - Aimen Iqbal
- Bahria University Medical and Dental College, Karachi, Pakistan
| | - Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | | | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA.
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7
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Li P, Li C, Mishra AK, Cai P, Lu X, Sherif AA, Jin L, Wang B. Impact of malnutrition on in-hospital outcomes in takotsubo cardiomyopathy. Nutrition 2022; 93:111495. [PMID: 34735920 DOI: 10.1016/j.nut.2021.111495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study assesses the effect of malnutrition on the in-hospital outcomes of patients with takotsubo cardiomyopathy (TCM). METHODS We performed a retrospective cohort analysis using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for a primary diagnosis of TCM from the National Inpatient Sample database (2016-2018). A concurrent diagnosis of malnutrition was then identified, and these patients were divided into the malnutrition group and non-malnutrition group. To adjust for underlying risk factors, a multivariable logistic regression model was employed followed by a propensity score matching analysis for the malnutrition and the non-malnutrition group. We then compared the in-hospital outcomes between these two groups. RESULTS Among 4733 patients with a primary diagnosis of TCM, 221 (4.7%) patients with TCM were found to be malnourished. After propensity score matching, patients with TCM with malnutrition were found to have a higher mortality rate (8.3% versus 2.0%, P < 0.001), a higher rate of complications including cardiogenic shock (16.1% versus 7.0%, P < 0.001), ventricular arrhythmia (8.8% versus 3.9%, P = 0.01), acute kidney injury (24.9% versus 10.6%, P < 0.001), and acute respiratory failure (32.7% versus 17.8%, P < 0.001). There was no statistically significant difference in the incidence of cardiac arrest between the two groups. Malnutrition of severe degree was associated with a sevenfold (odds ratio 6.8, 95% confidence interval, 3.2-13.4) increased risk of in-hospital mortality compared with those without malnutrition. CONCLUSION Patients with malnutrition who were admitted with TCM were associated with higher rates of in-hospital mortality and complications compared with those without malnutrition.
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Affiliation(s)
- Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Chenlin Li
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Ajay Kumar Mishra
- Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, Massachusetts, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Akil Adrian Sherif
- Department of Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, Massachusetts, USA
| | - Ling Jin
- Department of Medicine, Metrowest Medical Center, Framingham, Massachusetts, USA
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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8
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Finsterer J, Mehri S. The diagnosing of pediatric severe acute respiratory syndrome coronavirus 2 associated myocarditis requires validated criteria. Pediatr Int 2022; 64:e15393. [PMID: 36269205 PMCID: PMC9874621 DOI: 10.1111/ped.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 01/28/2023]
Affiliation(s)
| | - Sounira Mehri
- Biochemistry Laboratory, Faculty of Medicine, LR12ES05 "Nutrition-Functional Foods and Vascular Health", Monastir, Tunisia
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9
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Lu X, Li P, Teng C, Cai P, Jin L, Li C, Liu Q, Pan S, Dixon RA, Wang B. Prognostic factors of Takotsubo cardiomyopathy: a systematic review. ESC Heart Fail 2021; 8:3663-3689. [PMID: 34374223 PMCID: PMC8497208 DOI: 10.1002/ehf2.13531] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by reversible ventricular dysfunction, has similar mortality to acute coronary syndrome. With the growing interest in the diagnosis of and interventions for TCM, many risk factors had been found to affect the prognosis of TCM patients, such as age, sex, and pre-existing diseases. Because of the incomplete understanding of the pathophysiologic mechanism in TCM, evidence-based medical therapy for this condition is lacking. Early intervention on risk factors may improve the outcomes of TCM. In this review, we sought to provide up-to-date evidence on risk factors and medical therapies that affect TCM outcome. We found that male sex, physical triggers, and certain comorbidities such as chronic kidney disease, malignant disease, higher body mass index, sepsis, chronic obstructive pulmonary disease, and anaemia were associated with poor TCM prognosis. In contrast, race, hyperlipidaemia, diabetes mellitus, and mood disorders were not clearly associated with TCM prognosis. We also reviewed the effect of medical therapies on TCM outcome, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, calcium channel blockers, and statins. The evidence that these medications confer a survival benefit on TCM patients is limited. Understanding these prognostic factors could help develop risk-stratification tools for TCM and establish effective prevention and interventions for this not-so-benign condition. Further multicentre clinical studies with large samples and meta-analyses of findings from previous studies are needed to address the inconsistent findings among the many potential risk factors for TCM.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Pengyang Li
- Division of CardiologyPauley Heart Center, Virginia Commonwealth UniversityRichmondVAUSA
| | - Catherine Teng
- Department of MedicineYale New Haven Health Greenwich HospitalGreenwichCTUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Ling Jin
- Department of MedicineMetrowest Medical CenterFraminghamMAUSA
| | - Chenlin Li
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Qi Liu
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Su Pan
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Richard A.F. Dixon
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
- Clinical Research Centerthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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10
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Pogran E, Abd El-Razek A, Gargiulo L, Weihs V, Kaufmann C, Horváth S, Geppert A, Nürnberg M, Wessely E, Smetana P, Huber K. Long-term outcome in patients with takotsubo syndrome : A single center study from Vienna. Wien Klin Wochenschr 2021; 134:261-268. [PMID: 34415428 DOI: 10.1007/s00508-021-01925-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is an increasing amount of evidence suggesting multiple fatal complications in takotsubo syndrome; however, findings on the long-term outcome are scarce and show inconsistent evidence. METHODS This is a single center study of long-term prognosis in takotsubo patients admitted to the Klinik Ottakring, Vienna, Austria, from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with takotsubo syndrome. Furthermore, survivors and non-survivors and patients with a different cause of death were compared. RESULTS Overall, 147 patients were included in the study and 49 takotsubo patients (33.3%) died during the follow-up, with a median of 126 months. The most common cause of death was a non-cardiac cause (71.4% of all deaths), especially malignancies (26.5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Adjusted analysis showed no feature of an independent predictor of cardiovascular mortality for takotsubo patients. Female gender (HR = 0.32, CI: 0.16-0.64, p < 0.001), cancer (HR = 2.35, CI: 1.15-4.8, p = 0.019) and chronic kidney disease (HR = 2.61, CI: 1.11-6.14, p = 0.028) showed to be independent predictors of non-cardiovascular mortality. CONCLUSION Long-term prognosis of takotsubo patients is not favorable, mainly due to noncardiac comorbidities. Hence, consequent outpatient care in regular intervals after a takotsubo event based on risk factor control and early detection of malignancies seems justified.
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Affiliation(s)
- Edita Pogran
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria. .,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ahmed Abd El-Razek
- Medical School, Sigmund Freud Private University, Freudplatz 1, 1020, Vienna, Austria
| | - Laura Gargiulo
- Medical School, Sigmund Freud Private University, Freudplatz 1, 1020, Vienna, Austria
| | - Valerie Weihs
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria
| | - Christoph Kaufmann
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Samuel Horváth
- King Abdullah University of Science and Technology, 23955, Thuwal, Saudi Arabia
| | - Alexander Geppert
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Nürnberg
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Emil Wessely
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Smetana
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Medical School, Sigmund Freud Private University, Freudplatz 1, 1020, Vienna, Austria
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Liang J, Zhang J, Xu Y, Teng C, Lu X, Wang Y, Zuo X, Li Q, Huang Z, Ma J, Li P. Conventional cardiovascular risk factors associated with Takotsubo cardiomyopathy: A comprehensive review. Clin Cardiol 2021; 44:1033-1040. [PMID: 34080694 PMCID: PMC8364728 DOI: 10.1002/clc.23661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by transient left ventricular dysfunction, was first reported in Japan in 1990. Current research suggests that TCM can be affected by conventional cardiovascular factors such as hypertension (HTN), diabetes, hyperlipidemia (HLD), and obesity. Despite the increasing interest in this disease, research on TCM remains limited. Conventional cardiovascular factors are clinically related to the outcome of TCM. We reviewed the publications published in PubMed database between January 01 2010 and January 15 2021, and summarized the most current available evidence on the correlation between TCM and the conventional cardiovascular factors. TCM patients are predominantly postmenopausal women. Men and young patients are less commonly seen, but are prone to acute adverse complications and poor prognosis. HTN is common in patients with recurrent TCM. Existing evidence suggests that obesity and chronic kidney disease are related to poor prognosis in TCM. HLD is reported to be associated with fewer complications, though current evidence is limited. Finally, the relationship between diabetes and TCM prognosis is ambivalent. Current evidence suggests conventional cardiovascular risk factors are associated with the outcome of TCM, especially with mortality and complications. More prospective studies are needed to clarify the relationship between each risk factor and the prognosis of TCM.
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Affiliation(s)
- Jing Liang
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Jingyi Zhang
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Yidan Xu
- Human Anatomy Laboratory, the First Clinical CollegeXinxiang Medical UniversityHenanChina
| | - Catherine Teng
- Department of MedicineYale New Haven Health‐Greenwich HospitalGreenwichConnecticutUSA
| | - Xiaojia Lu
- Department of CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeGuangdongChina
| | - Yanxuan Wang
- Human Anatomy Laboratory, School of International EducationXinxiang Medical UniversityHenanChina
| | - Xinyu Zuo
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Qiuyue Li
- Human Anatomy Laboratory, School of International EducationXinxiang Medical UniversityHenanChina
| | - Zirui Huang
- Human Anatomy Laboratory, School of International EducationXinxiang Medical UniversityHenanChina
| | - Jianjun Ma
- Human Anatomy Laboratory, School of Basic MedicineXinxiang Medical UniversityHenanChina
| | - Pengyang Li
- Department of MedicineSaint Vincent HospitalWorcesterMassachusettsUSA
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Electrocardiographic changes in Takotsubo cardiomyopathy. J Electrocardiol 2021; 65:28-33. [PMID: 33482618 DOI: 10.1016/j.jelectrocard.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 01/20/2023]
Abstract
Takotsubo Cardiomyopathy (TC) is a syndrome characterized by reversible left ventricular dysfunction in the presence of possible emotional or physical triggers but without evidence of obstructive coronary artery disease. It has become increasingly reported worldwide and is associated with significant morbidity and mortality. TC may present with an array of electrocardiographic (ECG) findings. These ECG findings, if accurately interpreted, can play an important role in the diagnosis and risk stratification of this syndrome. In the last three decades since the disease was first described, multiple diagnostic criteria have been established. The key diagnostic tools for TC include clinical symptomatology, cardiac biomarkers, non-invasive cardiac imaging, and coronary angiography. The ECG findings in TC can be variable, however, some ECG scores have been proposed in association with TC with reasonably good diagnostic sensitivity and specificity. This article aims to provide a succinct review of important electrocardiographic findings associated with TC and its impact on clinical outcomes.
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Oliveira GMMD, Fontes-Carvalho R, Gonçalves L, Cardim N, Rochitte CE. The top 10 original articles published in the Brazilian Archives of Cardiology and in the Portuguese Journal of Cardiology in 2019. Rev Port Cardiol 2020; 39:115-121. [PMID: 32376062 DOI: 10.1016/j.repc.2020.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Glaucia Maria Moraes de Oliveira
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ricardo Fontes-Carvalho
- Departamento de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Lino Gonçalves
- Departamento de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; Hospital do Coração (HCOR), São Paulo, SP, Brasil
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Oliveira GMMD, Fontes-Carvalho R, Gonçalves L, Cardim N, Rochitte CE. The top 10 original articles published in the Brazilian Archives of Cardiology and in the Portuguese Journal of Cardiology in 2019. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Li P, Lu X, Teng C, Cai P, Kranis M, Dai Q, Wang B. The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy. Int J Chron Obstruct Pulmon Dis 2020; 15:2333-2341. [PMID: 33061351 PMCID: PMC7532913 DOI: 10.2147/copd.s267289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential triggering factor of TCM. The association between COPD and in-hospital outcomes and complications among TCM patients is not well established. We sought to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM. METHODS We conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD using the latest National Inpatient Sample from 2016-2017. We identified 3139 patients admitted with a primary diagnosis of TCM by the ICD-10-CM coding system; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis. RESULTS Before matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs 3.27±3.39 days, p<0.001), hospitalization charges ($55,242.68±47,637.40 vs $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs1.0%, p=0.005), longer LOS (4.02±3.00 days vs 3.40±3.54 days, p<0.001), higher hospitalization charges ($55,409.23±47,809.13 vs $46,469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs 8.2%, p<0.001) and cardiogenic shock (5.6% vs 3.3%, p=0.024), respectively. CONCLUSION Patients with COPD who are hospitalized for TCM have higher rates of inpatient mortality, ARF, cardiogenic shock, as well as a longer LOS, and higher charges of stay than those without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short- and long-term outcomes of TCM.
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Affiliation(s)
- Pengyang Li
- Department of Medicine, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Xiaojia Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
| | - Catherine Teng
- Department of Internal Medicine, Yale New Haven Health-Greenwich Hospital, Greenwich, CT06830, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA01609, USA
| | - Mark Kranis
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Qiying Dai
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA01608, USA
| | - Bin Wang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of China
- Correspondence: Bin Wang Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, Guangdong515041, People’s Republic of ChinaTel +86-75488905399Fax +86 75488259850 Email
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Mimoso J. Prognosis of Takotsubo syndrome in Portugal. Rev Port Cardiol 2019; 38:359-360. [DOI: 10.1016/j.repc.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mimoso J. Prognosis of Takotsubo syndrome in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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