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Kreimer F, Koepsel K, Gotzmann M, Kovacs B, Dreher TC, Blockhaus C, Klein N, Kuntz T, Shin DI, Lapp H, Rosenkaimer S, Abumayyaleh M, Hamdani N, Saguner AM, Erath JW, Duru F, Beiert T, Schiedat F, Weth C, Custodis F, Akin I, Mügge A, Aweimer A, El-Battrawy I. Predictors of ventricular tachyarrhythmia in patients with a wearable cardioverter defibrillator: an international multicenter registry. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01869-w. [PMID: 38985244 DOI: 10.1007/s10840-024-01869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND AIMS Wearable cardioverter defibrillator (WCD) can protect patients from sudden cardiac death due to ventricular tachyarrhythmias and serve as a bridge to decision of definite defibrillator implantation. The aim of this analysis from an international, multicenter WCD registry was to identify predictors of sustained ventricular tachycardia (VT) and/or ventricular fibrillation (VF) in this population. METHODS One thousand six hundred seventy-five patients with WCD were included in a multicenter registry from 9 European centers, with a median follow-up of 440 days (IQR 120-893). The primary study end point was the occurrence of sustained VT/VF. RESULTS Sustained VT was detected by WCD in 5.4% and VF in 0.9% of all patients. Of the 30.3% of patients receiving ICD implantation during follow-up, sustained VT was recorded in 9.3% and VF in 2.6%. Non-ischemic cardiomyopathy (HR 0.5, p < 0.001), and medication with angiotensin-converting enzyme inhibitors (HR 0.7, p = 0.027) and aldosterone antagonists (HR 0.7, p = 0.005) were associated with a significantly lower risk of VT/VF. CONCLUSIONS Patients who received WCD due to a transient increased risk of sudden cardiac death have a comparatively lower risk of VT/VF in the presence of non-ischemic cardiomyopathy. Of note, optimal medical treatment for heart failure not only results in an improvement in left ventricular ejection fraction but also in a reduction in the risk for VT/VF.
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Affiliation(s)
- Fabienne Kreimer
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
- Department of Cardiology, University Hospital Münster, Münster, Germany
| | - Katharina Koepsel
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Michael Gotzmann
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Boldizsar Kovacs
- Department of Cardiology University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952, Schlieren, Switzerland
| | - Tobias C Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Blockhaus
- Department of Cardiology Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Norbert Klein
- Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Leipzig, Germany
| | - Thomas Kuntz
- Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Leipzig, Germany
| | - Dong-In Shin
- Department of Cardiology Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
- Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany
| | - Hendrik Lapp
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Nazha Hamdani
- Institute of Physiology, Department of Cellular and Translational Physiology and Institut Für Forschung Und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany
| | - Ardan Muammer Saguner
- Department of Cardiology University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952, Schlieren, Switzerland
| | - Julia W Erath
- Department of Cardiology, Frankfurt University Hospital Goethe University, Frankfurt Am Main, Germany
| | - Firat Duru
- Department of Cardiology University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952, Schlieren, Switzerland
| | - Thomas Beiert
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
- Department of Cardiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Christian Weth
- Department of Internal Medicine II, Klinikum Saarbruecken, Saarbruecken, Germany
| | - Florian Custodis
- Department of Internal Medicine II, Klinikum Saarbruecken, Saarbruecken, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Andreas Mügge
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Rhythmology, University Hospital St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
- Institute of Physiology, Department of Cellular and Translational Physiology and Institut Für Forschung Und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany.
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2
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Aweimer A, Dietrich JW, Santoro F, Fàbregas MC, Mügge A, Núñez-Gil IJ, Vazirani R, Vedia O, Pätz T, Ragnatela I, Arcari L, Volpe M, Corbì-Pascual M, Martinez-Selles M, Almendro-Delia M, Sionis A, Uribarri A, Thiele H, Brunetti ND, Eitel I, Stiermaier T, Hamdani N, Abumayyaleh M, Akin I, El-Battrawy I. Takotsubo syndrome outcomes predicted by thyroid hormone signature: insights from cluster analysis of a multicentre registry. EBioMedicine 2024; 102:105063. [PMID: 38502972 PMCID: PMC10963195 DOI: 10.1016/j.ebiom.2024.105063] [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: 10/16/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into "endocrine-type" and "stress-type" responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry. METHODS In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain. Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at admission. Data were collected both retrospectively and prospectively from 2017 onwards. Primary endpoints included in-hospital and all-cause fatality, determined by cluster analysis using an unsupervised machine learning algorithm (k-medoids). FINDINGS Three clusters were identified, classifying TTS with low (TSLT), high (TSHT) and normal (TSNT) thyroid output, based on TSH and FT4 levels in relation to the median thyroid's secretory capacity (SPINA-GT). Although TSH and FT4 concentrations were similar among survivors and non-survivors, these clusters were significantly associated with patient outcomes. In the longitudinal Kaplan-Meier analysis including in- and out-of-hospital survival, the prognosis related to concentrations of TSH, FT4, and FT3 as well as SPINA-GT, deiodinase activity (SPINA-GD) and clusters. Patients in the TSHT cluster and with cardiogenic shock had a lower initial left ventricular ejection fraction (LVEF). INTERPRETATION This study suggests that thyroid hormones may impact the evolution and prognosis of TTS. The findings indicate that thyroid-derived biomarkers may help identify high-risk patients and pave the way for novel personalized and preventive therapeutic options. FUNDING This research was not funded by any public, commercial, or not-for-profit agencies.
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Affiliation(s)
- Assem Aweimer
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany.
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Mireia Camins Fàbregas
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Andreas Mügge
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
| | - Iván J Núñez-Gil
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Ravi Vazirani
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Oscar Vedia
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Toni Pätz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ilaria Ragnatela
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Rome, Italy
| | | | - Manuel Martinez-Selles
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Alessandro Sionis
- Servicio de Cardiología, Hospital Virgen de la Macarena, Sevilla, Spain
| | - Aitor Uribarri
- Cardiology Service, Vall d'Hebron, University Hospital, Barcelona, Spain; CIBERCV, Madrid, Spain
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | | | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany; Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
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Shadmand M, Lautze J, Md AM. Takotsubo pathophysiology and complications: what we know and what we do not know. Heart Fail Rev 2024; 29:497-510. [PMID: 38150119 DOI: 10.1007/s10741-023-10381-8] [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: 12/20/2023] [Indexed: 12/28/2023]
Abstract
Takotsubo cardiomyopathy or stress cardiomyopathy (SCM), was first described in 1990 and initially, it was thought to be only associated with short-term complications and mortality with a benign long-term prognosis comparable to a healthy population. However recent investigations have proven otherwise and have shown SCM patients might have comparable long-term morbidity and mortality to ST-elevation myocardial infarction (STEMI) patients. Many emotional, or physical stressors can trigger SCM, and have been able to describe an interplay of neurohormonal and inflammatory mechanisms as the pathophysiology of this disease. Additionally, given the significantly higher prevalence of SCM in post-menopausal women, estrogen levels have been thought to play a role in the pathogenesis of this disease. Furthermore, there is an elusive disparity in prognosis depending upon different triggers. Currently, many questions remain unanswered regarding the long-term management of these patients to reduce morbidity, mortality, and improve quality of life, such as the need for long-term anticoagulation. In this paper, we review the findings of most recent published investigations regarding etiologies, pathophysiology, diagnostic criteria, prognosis, short-term and in more detail, long-term complications of SCM. Finally, we will discuss what future research is needed to learn more about this disease to improve the long-term prognosis, even though as of now, data for long-term management is still lacking.
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Affiliation(s)
- Mehdi Shadmand
- Internal Medicine, Wright State University, 128 E. Apple St., 2Nd Floor, Dayton, OH, 45409, USA.
| | - Jacob Lautze
- Internal Medicine, Wright State University, 128 E. Apple St., 2Nd Floor, Dayton, OH, 45409, USA
| | - Ali Mehdirad Md
- Internal Medicine, Wright State University, 128 E. Apple St., 2Nd Floor, Dayton, OH, 45409, USA
- Medical Center, Internal Medicine, Veteran Affairs (VA), 4100 W Third St., Dayton, OH, 45428, USA
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4
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Dubey G, Parikh R, Natrajan K, Kanabar K. An Unusual Presentation of Takotsubo Cardiomyopathy: A Case Report. J Tehran Heart Cent 2023; 18:298-301. [PMID: 38680639 PMCID: PMC11053234 DOI: 10.18502/jthc.v18i4.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/07/2023] [Indexed: 05/01/2024] Open
Abstract
Tachyarrhythmias have been well-defined in patients with Takotsubo cardiomyopathy (TTCM) and are estimated to occur in almost 13.5% of patients. However, limited data are available on bradyarrhythmias in patients with TTCM. The pathophysiology, clinical implications, and manage-ment are not well defined in this subgroup. We describe a 53-year-old woman presenting with complete heart block with TTCM and a 73-year-old woman presenting with syncope with complete heart block with TTCM. Both had persistent conduction delays despite recovery of ventricular function and eventually required permanent pacemaker implantation. The dependency on pacing was up to 90% in both patients at a 6-month follow-up.
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Affiliation(s)
- Gajendra Dubey
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Gujarat, India
| | - Rujuta Parikh
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Gujarat, India
| | - Karthik Natrajan
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Gujarat, India
| | - Kewal Kanabar
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Gujarat, India
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Khaloo P, Ledesma PA, Nahlawi A, Galvin J, Ptaszek LM, Ruskin JN. Outcomes of Patients With Takotsubo Syndrome Compared With Type 1 and Type 2 Myocardial Infarction. J Am Heart Assoc 2023; 12:e030114. [PMID: 37681546 PMCID: PMC10547303 DOI: 10.1161/jaha.123.030114] [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: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Abstract
Background Takotsubo syndrome (TS) and myocardial infarction (MI) share similar clinical and laboratory characteristics but have important differences in causes, demographics, management, and outcomes. Methods and Results In this observational study, the National Inpatient Sample and National Readmission Database were used to identify patients admitted with TS, type 1 MI, or type 2 MI in the United States between October 1, 2017, and December 31, 2019. We compared patients hospitalized with TS, type 1 MI, and type 2 MI with respect to key features and outcomes. Over the 27-month study period, 2 035 055 patients with type 1 MI, 639 075 patients with type 2 MI, and 43 335 patients with TS were identified. Cardiac arrest, ventricular fibrillation, and ventricular tachycardia were more prevalent in type 1 MI (4.02%, 3.2%, and 7.2%, respectively) compared with both type 2 MI (2.8%, 0.8%, and 5.4% respectively) and TS (2.7%, 1.8%, and 5.3%, respectively). Risk of mortality was lower in TS compared with both type 1 MI (3.3% versus 7.9%; adjusted odds ratio [OR], 0.3; P<0.001) and type 2 MI (3.3% versus 8.2%; adjusted OR, 0.3; P<0.001). Mortality rate (OR, 1.2; P<0.001) and cardiac-cause 30-day readmission rate (adjusted OR, 1.7; P<0.001) were higher in type 1 MI than in type 2 MI. Conclusions Patients with type 1 MI had the highest rates of in-hospital mortality and cardiac-cause 30-day readmission. Risk of all-cause 30-day readmission was highest in patients with type 2 MI. The risk of ventricular arrhythmias in patients with TS is lower than in patients with type 1 MI but higher than in patients with type 2 MI.
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Affiliation(s)
- Pegah Khaloo
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Pablo A. Ledesma
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Acile Nahlawi
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Jennifer Galvin
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Leon M. Ptaszek
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Jeremy N. Ruskin
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
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6
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Abstract
Takotsubo syndrome (TTS), triggered by intense emotional or physical stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4-5%) owing to cardiogenic shock, myocardial rupture, or life-threatening arrhythmias. Thus, its prognosis is not as benign as previously thought, as it may cause mechanical complications (cardiac rupture) and potentially lethal arrhythmias and sudden cardiac death (SCD). Similar to MI, some patients may perish before reaching the hospital due to out-of-hospital cardiac arrest; this may lead to underestimation of the actual SCD risk. Furthermore, after discharge, some patients may develop late SCD and/or TTS recurrence that may result in SCD. There are risk factors for SCD in TTS patients, such as severe/persistent QT-interval prolongation inciting torsade-de-pointes, other ECG abnormalities (diffuse giant negative T-waves, widened QRS-complex), bradyarrhythmias, comorbidities, concurrent obstructive coronary artery disease or vasospasm, male gender, older age, severe left ventricular dysfunction, and use of sympathomimetic drugs. All these issues are herein reviewed, case reports/series and data from large cohort studies and meta-analyses are analyzed, risk factors are tabulated, and proarrhythmic effects and management strategies are discussed and pictorially illustrated.
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Affiliation(s)
| | | | - Helen Melita
- 69106Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Abumayyaleh M, Dreher TC, Rosenkaimer S, Röger S, Erath JW, Klein N, Kovacs B, Duru F, Saguner AM, El-Battrawy I, Akin I. Sex differences and adherence of patients treated with wearable cardioverter-defibrillator: insights from an international multicenter register. J Cardiovasc Electrophysiol 2022; 33:2243-2249. [PMID: 35930623 DOI: 10.1111/jce.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
AIMS Treatment with the wearable cardioverter defibrillator (WCD) may protect against sudden cardiac death (SCD) as a bridging therapy until a cardioverter-defibrillator may be implanted. We analyzed in a multicenter setting a consecutive patient cohort wearing WCD to explore sex differences. METHODS AND RESULTS We analyzed 708 consecutive patients, 579 (81.8%) from whom were males and 129 (18.2%) females (age, 60.5±14 vs. 61.6±17 years old; p=0.44). While the rate of ischemic cardiomyopathy (ICM) as a cause of prescription of WCD was significantly higher in males as compared to females (42.7% vs. 26.4%; p=0.001), females received it more frequently due to non-ischemic cardiomyopathy (NICM) (55.8% vs. 42.7%); p=0.009). The wear time of WCD was equivalent in both groups (21.1±4.3 hours/days in males vs. 21.5±4.4 hours/days in females; p=0.27; and 62.6±44.3 days in males vs. 56.5±39 days in females; p=0.15). Mortality was comparable in both groups at 2-year-follow-up (6.8% in males vs. 9.7% in females; p=0.55). Appropriate WCD shocks and the incidence of ICD implantations were similar in both groups (2.4% in males vs. 3.9% in females; p=0.07) (35.1% in males vs. 31.8% in females; p=0.37), respectively. In age tertile analysis, compliance was observed more in 73-91 years old group as compared to 14-51 years old group (87.8% vs. 68.3%; p<0.001). CONCLUSION Compliance for wearing WCD was excellent regardless of sex. Furthermore, mortality and the incidence of ICD implantations were comparable in both sexes. Appropriate WCD shocks were similar in both sexes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Tobias C Dreher
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Stephanie Rosenkaimer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Susanne Röger
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Julia W Erath
- Department of Cardiology/Division of Clinical Electrophysiology, University Hospital Frankfurt, Goethe University, Frankfurt a. M., Germany
| | - Norbert Klein
- Department of Arrhythmias & Invasive Cardiology, St. Georg Hospital, Leipzig, Germany
| | - Boldizsar Kovacs
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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8
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Koh Y, Voskoboinik A, Neil C. Arrhythmias and Their Electrophysiological Mechanisms in Takotsubo Syndrome: A Narrative Review. Heart Lung Circ 2022; 31:1075-1084. [PMID: 35562239 DOI: 10.1016/j.hlc.2022.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS), an acute and usually reversible condition, is associated with both tachy- and bradyarrhythmias. Such arrhythmias can be life-threatening, e.g. ventricular tachycardia and fibrillation, and associated with cardiac arrest. Others, such as atrioventricular block, persist and require long-term device therapy. In this narrative review, we aim to provide a summary of the current literature on arrhythmias in TTS and their clinical sequelae. METHODS PubMed and Medline databases were searched with various permutations of TTS, arrhythmias and beta-adrenoceptors. After application of exclusion criteria and review, 84 articles were included. RESULTS Although there are no specific electrocardiograph (ECG) findings in TTS to differentiate it from ST-elevation myocardial infarction, suggestive patterns include small QRS amplitude, ST segment elevation without reciprocal ST depression and prolonged QT interval. Atrial tachyarrhythmias (incidence of 5-15%) are associated with a more unwell patient cohort. Ventricular arrhythmias (incidence 4-14%) are often associated with prolonged QT interval and are a cause of sudden death in TTS. Bradyarrhythmias are less common (incidence 1.3-2.5%), but have been reported with TTS, and usually persist beyond the acute phase. CONCLUSIONS Takotsubo syndrome, though considered primarily a disease of the myocardium, carries multiple arrhythmic manifestations that affect short- and long-term prognosis. The management of such arrhythmias represents a constantly evolving area of research.
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Affiliation(s)
- Y Koh
- Department of Cardiology, Western Health, Melbourne, Vic, Australia.
| | - A Voskoboinik
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | - C Neil
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
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El-Battrawy I, Kovacs B, Dreher TC, Klein N, Rosenkaimer S, Röger S, Kuschyk J, Saguner AM, Kowitz J, Erath JW, Duru F, Akin I. Real life experience with the wearable cardioverter-defibrillator in an international multicenter Registry. Sci Rep 2022; 12:3203. [PMID: 35217697 PMCID: PMC8881447 DOI: 10.1038/s41598-022-06007-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
Patients at high risk for sudden cardiac death (SCD) may benefit from wearable cardioverter defibrillators (WCD) by avoiding immediate implantable cardioverter defibrillator (ICD) implantation. Different factors play an important role including patient selection, compliance and optimal drug treatment. We aimed to present real world data from 4 centers from Germany and Switzerland. Between 04/2012 and 03/2019, 708 patients were included in this registry. Patients were followed up over a mean time of 28 ± 35.5 months. Outcome data including gender differences and different etiologies of cardiomyopathy were analyzed. Out of 708 patients (81.8% males, mean age 61.0 ± 14.6), 44.6% of patients had non-ischemic cardiomyopathy, 39.8% ischemic cardiomyopathy, 7.9% myocarditis, 5.4% prior need for ICD explantation and 2.1% channelopathy. The mean wear time of WCD was 21.2 ± 4.3 h per day. In 46% of patients, left ventricular ejection fraction (LVEF) was > 35% during follow-up. The younger the patient was, the higher the LVEF and the lower the wear hours per day were. The total shock rate during follow-up was 2.7%. Whereas an appropriate WCD shock was documented in 16 patients (2.2%), 3 patients received an inappropriate ICD shock (0.5%). During follow-up, implantation of a cardiac implantable electronic device was carried out in 34.5% of patients. When comparing German patients (n = 516) to Swiss patients (n = 192), Swiss patients presented with longer wear days (70.72 ± 49.47 days versus 58.06 ± 40.45 days; p = 0.001) and a higher ICD implantation rate compared to German patients (48.4% versus 29.3%; p = 0.001), although LVEF at follow-up was similar between both groups. Young age is a negative independent predictor for the compliance in this large registry. The most common indication for WCD was non-ischemic cardiomyopathy followed by ischemic cardiomyopathy. The compliance rate was generally high with a decrease of wear hours per day at younger age. Slight differences were found between Swiss and German patients, which might be related to differences in mentality for ICD implantation.
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Affiliation(s)
- Ibrahim El-Battrawy
- grid.5570.70000 0004 0490 981XBergmannsheil University Medical Center, Ruhr University Bochum, Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Boldizsar Kovacs
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tobias C. Dreher
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Norbert Klein
- grid.470221.20000 0001 0690 7373Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH Leipzig, Delitzscher Straße 141, 04129 Leipzig, Germany
| | | | - Susanne Röger
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Ardan Muammer Saguner
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jacqueline Kowitz
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
| | - Julia W. Erath
- grid.7839.50000 0004 1936 9721Department of Cardiology, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Firat Duru
- grid.412004.30000 0004 0478 9977Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ibrahim Akin
- grid.5601.20000 0001 0943 599XUniversity of Mannheim, Mannheim, Germany
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van der Lingen ALC, Woudstra J, Becker MA, Mol MA, van Rossum AC, Rijnierse MT, Allaart CP. Recurrent Ventricular Arrhythmias and Mortality in Cardiac Arrest Survivors with a Reversible Cause With and Without an Implantable Cardioverter Defibrillator: a Systematic Review. Resuscitation 2022; 173:76-90. [DOI: 10.1016/j.resuscitation.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 12/15/2022]
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11
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Madias JE. Takotsubo Cardiomyopathy: Current Treatment. J Clin Med 2021; 10:3440. [PMID: 34362223 PMCID: PMC8347171 DOI: 10.3390/jcm10153440] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Management of takotsubo syndrome (TTS) is currently empirical and supportive, via extrapolation of therapeutic principles worked out for other cardiovascular pathologies. Although it has been emphasized that such non-specific therapies for TTS are consequent to its still elusive pathophysiology, one wonders whether it does not necessarily follow that the absence of knowledge of TTS' pathophysiological underpinnings should prevent us for searching, designing, or even finding, therapies efficacious for its management. Additionally, it is conceivable that therapy for TTS may be in response to pathophysiological/pathoanatomic/pathohistological consequences (e.g., "myocardial stunning/reperfusion injury"), common to both TTS and coronary artery disease, or other cardiovascular disorders). The present review outlines the whole range of management principles of TTS during its acute phase and at follow-up, including considerations pertaining to the recurrence of TTS, and commences with the idea that occasionally management of TTS should consist of mere observation along the "first do no harm" principle, while self-healing is under way. Finally, some new therapeutic hypotheses (i.e., large doses of insulin infusions in association with the employment of intravenous short- and ultrashort-acting β-blockers) are being entertained, based on previous extensive animal work and limited application in patients with neurogenic cardiomyopathy and TTS.
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Affiliation(s)
- John E. Madias
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; ; Tel.: +1-(718)-334-5005; Fax: +1-(718)-334-5990
- Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY 11373, USA
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12
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Santoro F, Mallardi A, Leopizzi A, Vitale E, Rawish E, Stiermaier T, Eitel I, Brunetti ND. Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 2-Treatment and Prognosis. J Clin Med 2021; 10:jcm10030468. [PMID: 33530545 PMCID: PMC7866173 DOI: 10.3390/jcm10030468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 12/15/2022] Open
Abstract
Takotsubo syndrome (TTS) represents a form of acute heart failure featured by reversible left ventricular systolic dysfunction. The management during the acute phase is mainly performed with supportive pharmacological (diuretics, ACE-inhibitors/angiotensin-receptor blockers (ARBs), anticoagulants, antiarrhythmics, non-catecholamine inotropics (levosimendan), and non-pharmacological (mechanical circulatory and respiratory support) therapy, due to the wide clinical presentation and course of the disease. However, there is a gap in evidence and there are no randomized and adequately powered studies on clinical effectiveness of therapeutic approaches. Some evidence supports the use ACE-inhibitors/ARBs at long-term. A tailored approach based on cardiovascular and non-cardiovascular risk factors is strongly suggested for long-term management. The urgent need for evidence-based treatment approaches is also reflected by the prognosis following TTS. The acute phase of the disease can be accompanied by various cardiovascular complications. In addition, long term outcome of TTS patients is also related to non-cardiovascular comorbidities. Physical triggers such as hypoxia and acute neurological disorders in TTS are associated with a poor outcome.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (A.M.); (A.L.); (E.V.); (N.D.B.)
- Correspondence: ; Tel.: +39-380-2695183; Fax: +39-0881-745424
| | - Adriana Mallardi
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (A.M.); (A.L.); (E.V.); (N.D.B.)
| | - Alessandra Leopizzi
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (A.M.); (A.L.); (E.V.); (N.D.B.)
| | - Enrica Vitale
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (A.M.); (A.L.); (E.V.); (N.D.B.)
| | - Elias Rawish
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center, 23552 Lübeck, Germany; (E.R.) (T.S.); (I.E.)
- German Center for Cardiovascular Research (DZHK), 23552 Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center, 23552 Lübeck, Germany; (E.R.) (T.S.); (I.E.)
- German Center for Cardiovascular Research (DZHK), 23552 Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center, 23552 Lübeck, Germany; (E.R.) (T.S.); (I.E.)
| | - Natale D. Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (A.M.); (A.L.); (E.V.); (N.D.B.)
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Habedank D, Thieme R, Bublak A, Heinemann F, Spencker S, Atmowihardjo I. Ventricular fibrillation and Takotsubo cardiomyopathy triggered by media panic on COVID‐19: A case report. Clin Case Rep 2021; 9:72-76. [PMID: 33362931 PMCID: PMC7753670 DOI: 10.1002/ccr3.3423] [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: 09/09/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy has potentially lethal complications and can be caused by a media‐induced diffuse atmosphere of life threatening and panic in preconditioned patients.
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Affiliation(s)
- Dirk Habedank
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Roland Thieme
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Angelika Bublak
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Felix Heinemann
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
| | - Sebastian Spencker
- DRK Kliniken Berlin Köpenick Medizinische Klinik Kardiologie Berlin Germany
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