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Duong CN, Bui QVP, Duong T, Phan DQ, Mazur J, Chung E, Truong VT. Racial Disparities in Clinical Outcomes of Takotsubo Cardiomyopathy: An Analysis of the National Inpatient Sample 2006 to 2018. J Am Heart Assoc 2024; 13:e034264. [PMID: 39101493 DOI: 10.1161/jaha.124.034264] [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: 01/02/2024] [Accepted: 06/11/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND This study aimed to evaluate the impact of race on in-hospital outcomes of Takotsubo cardiomyopathy using the National Inpatient Sample. METHODS AND RESULTS We conducted a retrospective study using data from the National Inpatient Sample database 2006 to 2018. We focused on Takotsubo cardiomyopathy hospitalizations, excluding those with acute coronary syndrome as the primary diagnosis. Two study groups consisted of White patients or Black patients. Univariate and multivariable logistic models evaluated race's effect on death, cardiac arrest, cardiogenic shock, length of stay, while adjusting for potential confounders. The Bayesian model averaging technique was used to further elucidate the factors influencing death within each racial group. Significant differences were observed between the 2 racial groups. Black patients presented at a younger age, had a higher proportion of men, a higher burden of comorbidities, and a lower median household income compared with their White counterparts. In the univariate model, the Black cohort showed an increased risk of cardiac arrest (odds ratio, 1.45 [95% CI, 1.15-1.82]). However, the difference did not reach statistical significance in the multivariable model. Black patients also had a significantly longer hospital stay in both the univariate model (risk ratio, 1.26 [95% CI, 1.22-1.31]) and the multivariable model (risk ratio, 1.06 [95% CI, 1.04-1.07]). No significant difference in all-cause death was observed between the racial groups. CONCLUSIONS The outcome differences between 2 racial groups in our study are likely influenced by racial disparities in demographics, comorbidities, and socioeconomic factors. Individualized care based on racial group needs is crucial in clinical practice.
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Affiliation(s)
| | - Quoc V P Bui
- Washington University in St. Louis, School of Medicine St. Louis MO USA
| | - Thomas Duong
- Department of Mathematics & Statistics Univ of Houston-Downtown (UHD) Houston TX USA
| | - Dai Q Phan
- Mien Dong Innovative Technology University Dong Nai Vietnam
| | - Jan Mazur
- University of Cincinnati Cincinnati OH USA
| | - Eugene Chung
- The Christ Hospital Health Network Cincinnati OH USA
| | - Vien T Truong
- The Christ Hospital Health Network Cincinnati OH USA
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2
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Demirel O, Paar V, Tolnai P, Topf A, Hoppe UC, Lichtenauer M, Mirna M. Heat Shock Protein 70 Constitutes a Promising Novel Biomarker in Differential Diagnosis between Takotsubo Syndrome and Non-ST-Segment Elevation Myocardial Infarction. J Clin Med 2024; 13:4152. [PMID: 39064192 PMCID: PMC11277720 DOI: 10.3390/jcm13144152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Due to similar clinical presentation and a lack of specific biomarkers, initial differentiation between Takotsubo syndrome (TTS) and non-ST-segment elevation myocardial infarction (NSTEMI) remains challenging in daily practice. Heat Shock Protein 70 (HSP70) is a novel biomarker that is recognized for its potential in the diagnosis and differentiation of cardiovascular conditions. (2) Methods: Data from a total of 156 patients were analyzed (32.1% NSTEMI, 32.7% TTS, and 35.3% controls). Serum concentrations of HSP70 were determined using ELISA and compared between patients and controls. ROC curve analysis, logistic regression analysis and propensity-score-weighted logistic regression were conducted. (3) Results: Concentrations of HSP70 were highest in patients with TTS (median 1727 pg/mL vs. ACS: median 1545 pg/mL vs. controls: median 583 pg/mL, p < 0.0001). HSP70 was predictive for TTS in binary logistic regression analysis (B(SE) = 0.634(0.22), p = 0.004), which even remained significant after correction for possible confounders in propensity-score-weighted analysis. ROC curve analysis also revealed a significant association of HSP70 with TTS (AUC: 0.633, p = 0.008). (4) Conclusions: Based on our findings, HSP70 constitutes a promising biomarker for discrimination between TTS and NSTEMI, especially in combination with established cardiovascular biomarkers like pBNP or high-sensitivity cardiac troponin.
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Affiliation(s)
- Ozan Demirel
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Philipp Tolnai
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Albert Topf
- Hospital Villach, Department of Internal Medicine, 9500 Villach, Austria
| | - Uta C. Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
| | - Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria (V.P.)
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3
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Eter A, Yamamoto T, Koutrouvelis A, Yamamoto S. The Association Between the Location of Subarachnoid Hemorrhage and the Occurrence of Takotsubo Cardiomyopathy: A Systematic Review and Meta-analysis. Cureus 2024; 16:e62533. [PMID: 39022462 PMCID: PMC11253893 DOI: 10.7759/cureus.62533] [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: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a syndrome characterized by transient regional cardiac dysfunction of the left ventricle. The goal of this review is to better understand the relationship between the anatomic locations of subarachnoid hemorrhages (SAHs) and the development of TCM as identified through a review of cohort studies. From inception to December 2023, we systematically explored major electronic medical information sources to identify cases of TCM that developed after SAHs. The six selected studies included in the meta-analysis suggest a modest but statistically significant increase in the odds of the events in the posterior circulation group compared to the anterior circulation group, with a combined odds ratio (OR) estimate of around 1.45-1.46. The fixed effect model gives an overall OR of 1.45 with a 95% confidence interval (CI) of 1.01 to 2.10, z = 2.01, p = 0.0442, while the random effects model yields a slightly higher OR of 1.46 with the same 95% CI, z = 2.03, p = 0.0425. There is a tendency for SAH occurrence in the posterior cerebral circulation to cause SAH-related TCM more frequently than in the anterior cerebral circulation.
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Affiliation(s)
- Asia Eter
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | | | | | - Satoshi Yamamoto
- Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, USA
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4
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Harutyunyan H, Achuthanandan S, Tamazyan V, Oo A, Khachatryan A, Batikyan A, Shetty M, Shetty V. Pulmonary Embolism as a Potential Trigger for Takotsubo Cardiomyopathy. Cureus 2024; 16:e62342. [PMID: 39006621 PMCID: PMC11246541 DOI: 10.7759/cureus.62342] [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: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
We present a case of an 83-year-old female who presented to the emergency department because of poor oral intake and dizziness. Initial assessment revealed a diagnosis of pulmonary embolism (PE). However, further investigation revealed coexisting takotsubo cardiomyopathy (TCM), a rare but critical finding. This case highlights a possible causative connection between clinically non-significant PE and TCM. Additionally, it emphasizes the diagnostic challenges posed by atypical symptoms and unremarkable medical history, which can lead to delayed diagnosis in such cases.
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Affiliation(s)
- Hakob Harutyunyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
| | | | - Vahagn Tamazyan
- Department of Medicine, Maimonides Medical Center, New York, USA
| | - Aung Oo
- Department of Medicine, Maimonides Medical Center, New York, USA
| | - Aleksan Khachatryan
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Ashot Batikyan
- Department of Internal Medicine, North Central Bronx Hospital, New York, USA
| | - Meghana Shetty
- Department of Medicine, K S Hegde Medical Academy, Mangalore, IND
| | - Vijay Shetty
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
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5
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Jaafar N, Sharma R, Sairam J, Duddu A. Volvulus is Stressful: Stress-Induced Cardiomyopathy Secondary to Gastric Volvulus and Paraesophageal Hernia. Cureus 2024; 16:e61031. [PMID: 38915959 PMCID: PMC11194533 DOI: 10.7759/cureus.61031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Stress-induced cardiomyopathy (SCM) is a cardiac systolic dysfunction caused by various stressful triggers. It is often transient and reversible upon the reversal of the underlying stressor. We present the case of a 70-year-old female with SCM in the setting of gastric volvulus and incarcerated para-esophageal hernia.
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Affiliation(s)
- Nadim Jaafar
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Rahul Sharma
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Jayashrei Sairam
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Akshay Duddu
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
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6
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Andrade VC, Rezende PC, Hueb W, Ramires JAF. Interpreting Acute Myocardial Infarction 40 Years Later. Evolution of Knowledge: What is the Best Explanation? Arq Bras Cardiol 2024; 121:e20230757. [PMID: 38695441 PMCID: PMC11081065 DOI: 10.36660/abc.20230757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/01/2023] [Accepted: 01/18/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Vitor Coutinho Andrade
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Paulo Cury Rezende
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Whady Hueb
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - José Antonio Franchini Ramires
- Universidade de São PauloFaculdade de MedicinaInstituto do Coração do Hospital das ClínicasSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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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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Gonuguntla K, Thyagaturu H, Shaik A, Roma N, Thangjui S, Alruwaili W, Patel KN, Nassar S, Valand H, Cheema MS, Jain B, Ahmed A, Raina S, Ditah CM, Sattar Y. Takotsubo cardiomyopathy and psychiatric illness- insight from National Inpatient Sample (NIS) and National Re-admission Database (NRD) 2016 to 2018. Curr Probl Cardiol 2024; 49:102429. [PMID: 38331372 DOI: 10.1016/j.cpcardiol.2024.102429] [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: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Emotional stress is a common precipitating cause of takotsubo cardiomyopathy (TC). Preexisting psychiatric disorder (PD) was linked to worsening outcomes in patients with TC1,2. However, there is limited data in literature to support this. This study aimed to determine the differences in outcomes in TC patients with and without PD. METHODS We identified all patients with a diagnosis of TC using the National Inpatient Sample (NIS) and the National Readmission Database (NRD) data from 2016 to 2018. The patients were separated into TC with PD group and TC without PD group. Multiple variable logistic regression was then performed. RESULTS Using NIS 2016-2018, we identified 23,220 patients with TC, and 43.11% had PD. The mean age was 66.73 ± 12.74 years, with 90.42% being female sex. The TC with PD group had a higher 30-readmission rate 1.25 (95% CI:1.06-1.47), Cardiogenic shock [aOR = 7.3 (95%CI 3.97-13.6), Mechanical ventilation [aOR = 4.2 (95%CI 2.4-7.5), Cardiac arrest [aOR = 2.6 (95%CI 1.1-6.3), than TC without PD group. CONCLUSION Psychiatric disorders were found in up to 43% of patients with TC. The concomitant PD in TC patients was not associated with increased mortality, AKI, but had higher rates of cardiogenic shock, use of mechanical ventilation and cardiac arrest. The TC group with PD was also associated with increased 30-day readmission, LOS and total charges compared to TC patients without PD.
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Affiliation(s)
- Karthik Gonuguntla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University, West Virginia, USA
| | - Harshith Thyagaturu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University, West Virginia, USA
| | - Ayesha Shaik
- Department of Cardiovascular Medicine, Hartford Hospital, Hartford, CT, USA
| | - Nicholas Roma
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Waleed Alruwaili
- Department of Internal Medicine, West Virginia University, West Virginia, USA
| | - Kunal N Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University, West Virginia, USA
| | - Sameh Nassar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University, West Virginia, USA
| | - Hardik Valand
- Department of Internal Medicine, Trinity Health System, Steubenville, OH, USA
| | | | - Bobby Jain
- Department of Psychiatry, Texas Tech University, TX, USA
| | - Amna Ahmed
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Chobufo Muchi Ditah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University, West Virginia, USA
| | - Yasar Sattar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, West Virginia University, West Virginia, USA.
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9
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Couch LS, Garrard JW, Henry JA, Kotronias RA, Alaour B, De Maria GL, Channon KM, Banning AP, Lyon AR, Marber M, Kaier TE. Comparison of troponin and natriuretic peptides in Takotsubo syndrome and acute coronary syndrome: a meta-analysis. Open Heart 2024; 11:e002607. [PMID: 38508657 PMCID: PMC10952941 DOI: 10.1136/openhrt-2024-002607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Takotsubo syndrome (TTS) is an acute heart failure syndrome which resembles acute coronary syndrome (ACS) at presentation. Differentiation requires coronary angiography, but where this does not occur immediately, cardiac biomarkers may provide additional utility. We performed a meta-analysis to compare troponin and natriuretic peptides (NPs) in TTS and ACS to determine if differences in biomarker profile can aid diagnosis. METHODS We searched five literature databases for studies reporting NPs (Brain NP (BNP)/NT-pro-BNP) or troponin I/T in TTS and ACS, identifying 28 studies for troponin/NPs (5618 and 1145 patients, respectively). RESULTS Troponin was significantly lower in TTS than ACS (standardised mean difference (SMD) -0.86; 95% CI, -1.08 to -0.64; p<0.00001), with an absolute difference of 75 times the upper limit of normal (×ULN) higher in ACS than TTS. Conversely, NPs were significantly higher in TTS (SMD 0.62; 95% CI, 0.44 to 0.80; p<0.00001) and 5.8×ULN greater absolutely. Area under the curve (AUC) for troponin in ACS versus TTS was 0.82 (95% CI, 0.70 to 0.93), and 0.92 (95% CI, 0.80 to 1.00) for ST-segment elevation myocardial infarction versus TTS. For NPs, AUC was 0.69 (95% CI, 0.48 to 0.89). Combination of troponin and NPs with logistic regression did not improve AUC. Recursive Partitioning and Regression Tree analysis calculated a troponin threshold ≥26×ULN that identified 95% cases as ACS where and specificity for ACS were 85.71% and 53.57%, respectively, with 94.32% positive predictive value and 29.40% negative predictive value. CONCLUSIONS Troponin is lower and NPs higher in TTS versus ACS. Troponin had greater power than NPs at discriminating TTS and ACS, and with troponin ≥26×ULN patients are far more likely to have ACS.
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Affiliation(s)
- Liam Steven Couch
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James W Garrard
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - John A Henry
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rafail A Kotronias
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Giovanni Luigi De Maria
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Adrian P Banning
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Thomas Edward Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
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10
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Khadka J, Bhattarai P, Adhikari A, Acharya R, Rayamajhi P. Myasthenic crisis-induced Takotsubo cardiomyopathy: a case report. Ann Med Surg (Lond) 2024; 86:1704-1707. [PMID: 38463080 PMCID: PMC10923365 DOI: 10.1097/ms9.0000000000001723] [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: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Myasthenic crisis (MC) is characterized by severe weakness in the bulbar and respiratory muscles. Takotsubo cardiomyopathy (TC) is a rare clinical entity mainly associated with postmenopausal women. We report a case of both these conditions in a premenopausal woman. Case presentation A 31-year-old woman with hypothyroidism presented with dyspnea. Bedside echocardiography in the ICU revealed an apical ballooning with an ejection fraction of 25%, and she was treated with losartan, furosemide, and spironolactone. She was intubated after 2 days as she developed respiratory distress and type II respiratory failure. Upon investigation, the patient tested positive for anti-acetylcholine receptor antibody. Treatment with five doses of IVIG (intravenous immunoglobulin) was given, and she made a remarkable recovery. Repeat echocardiography revealed her ejection fraction is normal and cardiac function is resolved. Clinical discussion The association between TC and MC is unusual and not commonly observed. MC can be a natural progression of myasthenia gravis or due to stressors, such as infection, medicine, pregnancy, and surgery. Stressful events can lead to TC. This leads to the possibility of TC, along with other cardiac complications, in patients with MC. Conclusion Patients with MC may be at potential risk of developing TC, thus careful cardiac monitoring is necessary while treating them for a better prognosis.
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Affiliation(s)
| | | | | | - Rajat Acharya
- Department of Internal Medicine, Kathmandu Medical College, Kathmandu, Nepal
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Ni TT, Tsang W, Nguyen ET. Approach to Imaging of Patients Presenting With Acute Coronary Syndrome With No Culprit Lesion Identified at Angiography. J Thorac Imaging 2024; 39:69-78. [PMID: 38270459 DOI: 10.1097/rti.0000000000000773] [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: 01/26/2024]
Abstract
Chest pain is a common chief complaint among patients presenting to the emergency department. However, in the scenario where the clinical presentation is consistent with acute coronary syndrome and no culprit lesions are identified on angiography, clinicians and cardiac imagers should be informed of the differential diagnosis and appropriate imaging modalities used to investigate the potential causes. This review describes an imaging-based algorithm that highlights the diagnostic possibilities, their differentiating imaging features, and the important role of cardiovascular magnetic resonance imaging for narrowing the differential diagnosis.
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Affiliation(s)
- Tiffany T Ni
- Temerty Faculty of Medicine, University of Toronto
| | - Wendy Tsang
- Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto
| | - Elsie T Nguyen
- Temerty Faculty of Medicine, University of Toronto
- Department of Medical Imaging, University of Toronto
- University Medical Imaging Toronto, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, ON, Canada
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12
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Ortega MDC, Bullard JP, Del Mar Unceta M, Sánchez-Pedreño FO, Molero P, de Asúa DR. Takotsubo cardiomyopathy secondary to electroconvulsive therapy in a young adult with Down syndrome regression disorder. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32078. [PMID: 38041246 DOI: 10.1002/ajmg.c.32078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
We report the case of an 18-year-old woman with Down syndrome (DS) who developed Takotsubo cardiomyopathy (TSC) immediately after the administration of electroconvulsive therapy (ECT), a treatment prescribed for Down syndrome regression disorder resistant to oral psychotropic drugs. TSC is a nonischemic cardiomyopathy related to psychological or physical stress, which has been described as a rare complication of ECT (Kinoshita et al., 2023, Journal of Electroconvulsive Therapy, 39, 185-192). The clinical description of the case is accompanied by a discussion of the peculiarities of the autonomic nervous system in DS.
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Affiliation(s)
- María Del Carmen Ortega
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Madrid, Spain
| | - José Pablo Bullard
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Del Mar Unceta
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Felipe Ortuño Sánchez-Pedreño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute, Navarra (IdiSNA), Pamplona, Spain
| | - Patricio Molero
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute, Navarra (IdiSNA), Pamplona, Spain
| | - Diego Real de Asúa
- Department of Internal Medicine, Adult Down Syndrome Outpatient Clinic, Hospital Universitario de La Princesa, Madrid, Spain
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13
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Mishra T, Saha R, Paramasivam G. Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction. Egypt Heart J 2024; 76:26. [PMID: 38381355 PMCID: PMC10881923 DOI: 10.1186/s43044-024-00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Owing to the limited research on Takotsubo Cardiomyopathy (TCM) in Asia, we aim to evaluate in detail the clinical profiles, lab parameters, investigations, and major adverse cardiovascular events (MACE) seen in patients with TCM in the Indian subcontinent. Additionally, we have compared the electrocardiographic findings of patients with TCM to those of patients with myocardial infarction (MI). RESULTS The average age of the patients affected was found to be 60 ± 11 years. Women (87.5%) and patients with hypertension (40%) were found to be at an increased risk of developing the syndrome. The most common presenting symptom was dyspnea (48%) following a trigger most commonly emotional (45%). ST elevation and significant T wave inversions were observed in 40% of patients with TCM. Echocardiography revealed a low left ventricular ejection fraction of 43 ± 9%. Coronary angiography was normal in 60%, the rest had mild/subcritical stenoses. The 6-month MACE was 20% and the mortality rate was 7.5%. Follow-up echocardiography of patients with TCM showed improvement in EF in 75% patients. CONCLUSIONS TCM was majorly seen in postmenopausal women following an emotional trigger, but a variety of other triggers were noted. T-wave inversions in TCM follow a diffuse pattern in contrast to specific leads seen in MI. Normal or subcritical stenosis in coronaries at presentation, along with a low EF which improves on follow up provide greater evidence for the diagnosis of TCM.
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Affiliation(s)
- Tanisha Mishra
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Rijushree Saha
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Ganesh Paramasivam
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India.
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14
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Farjoud Kouhanjani M, Hosseini SA, Mousavi SM, Noroozi Z, Sadeghi P, Jokar-Derisi A, Jamshidi Mouselou MS, Ahmadi M, Attar A. Takotsubo Cardiomyopathy and Autoimmune Disorders: A Systematic Scoping Review of Published Cases. Int J Clin Pract 2024; 2024:7259200. [PMID: 38414580 PMCID: PMC10898954 DOI: 10.1155/2024/7259200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) features transient left ventricular apical dysfunction or ballooning. The underlying mechanism remains elusive; however, evidence suggests the role of different physical and psychological stressors. We systematically reviewed patients presenting with TCM and autoimmunity to explore the link between the two conditions. Methods We applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to report this review. Using keywords related to autoimmune/immune-mediated diseases and TCM, we searched PubMed, Scopus, and WOS in March 2022. The final results were added to a data extraction sheet. Data were analyzed by SPSS version 26.0. Results Our search yielded 121 studies, including 155 patients. Females were considerably predominant. Most patients had a history of autoimmune disease, and almost a third had a history of cardiovascular disease. Dyspnea and chest pain were the most common chief complaints. More than 70% of patients had experienced physical stress. Myasthenia gravis, systemic lupus erythematosus, and multiple sclerosis were the most frequently reported autoimmune diseases. Conclusion There were similarities in age and sex compared to classic TCM. TCM should be considered as a differential diagnosis for ACS, especially in patients with a positive background of autoimmunity. A precise reporting system is required for further studies.
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Affiliation(s)
- Mohsen Farjoud Kouhanjani
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Zahra Noroozi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Paniz Sadeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armita Jokar-Derisi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Meysam Ahmadi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiology, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Scafa-Udriste A, Horodinschi RN, Babos M, Dinu B. Diagnostic challenges between takotsubo cardiomyopathy and acute myocardial infarction-where is the emergency?: a literature review. Int J Emerg Med 2024; 17:22. [PMID: 38360558 PMCID: PMC10870686 DOI: 10.1186/s12245-024-00595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/09/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is an emergency cardiovascular disease, with clinical and paraclinical manifestations similar to acute myocardial infarction (AMI), but it is characterized by reversible systolic dysfunction of the left ventricle (LV) in the absence (most of the time) of obstructive coronary artery disease (CAD). MANAGEMENT OF PATIENTS WITH TC TC seems to be more frequent in post-menopausal women and it is triggered by emotional or physical stress. The diagnosis of TC is based on the Mayo Clinic criteria. Initially, patients with TC should be treated as those with AMI and carefully monitored in intensive care unit. Urgent clinical and paraclinical distinction between TC and AMI is mandatory in all patients, because of the different therapeutical management between the two diseases. Chest pain and dyspnea are the most common symptoms in TC. Paraclinical diagnosis is based on cardiac biomarkers, electrocardiogram (ST-segment elevation/T wave inversion in precordial leads without reciprocal ST-segment depression in inferior leads and absence of Q waves), echocardiography (LV systolic dysfunction, regional wall motion abnormalities extended in more than one coronary territory), cardiac magnetic resonance and in most of the cases the positive diagnosis is established by performing CA to exclude obstructive CAD. The prognosis of patients with TC is considered benign in most cases, with a complete LV function recovery, but severe complications may occur, such as cardiogenic shock, LV free wall rupture, life-threatening arrhythmia, and cardiac arrest. Postoperative TC may develop after any type of surgical intervention due to acute stress and it should be differentiated from postoperative AMI. The management of patients with TC is medical and it is based on supportive care and the treatment of heart failure, while patients with AMI require myocardial revascularization. CONCLUSIONS TC leads to transient LV dysfunction that mimics AMI from which it should be differentiated for a good therapeutic approach. Patients with TC should be carefully monitored during hospitalization because they have a high recovery potential if optimally treated.
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Affiliation(s)
- Alexandru Scafa-Udriste
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
- Department of Cardiology, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania
| | - Ruxandra-Nicoleta Horodinschi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania.
- Department of Cardiology, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania.
| | - Miruna Babos
- Department of Emergency Medicine, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania
| | - Bogdan Dinu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania
- Department of Emergency Medicine, Clinical Emergency Hospital of Buchararest, Bucharest, 014461, Romania
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16
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Velarde-Acosta K, Sandoval R, Falcón-Quispe L, Anicama Lima WE, Baltodano-Arellano R. Takotsubo syndrome and atrial myxoma-identifying a new trigger: a case report. Front Cardiovasc Med 2024; 11:1323492. [PMID: 38414925 PMCID: PMC10897023 DOI: 10.3389/fcvm.2024.1323492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Takotsubo syndrome (TTS) is a rare cardiomyopathy, but its prevalence is increasing due to the greater availability of diagnostic tools, whose pathophysiology is unknown; however, the evidence points to an excess of catecholamines that ends up generating cardiac stunning. The cause of excessive sympathetic discharge is multifactorial, and some tumors may be related to their origin. In this case report, we present a female patient with TTS whose only identified triggering factor was an atrial myxoma, which generated an unusual clinical presentation. Current multimodal diagnostic tools together with the multidisciplinary evaluation of the HeartTeam allowed an accurate diagnosis and an adequate management of the clinical picture.
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Affiliation(s)
- Kevin Velarde-Acosta
- Clinical Cardiology Service, HospitalGuillermo Almenara Irigoyen – EsSalud, Lima, Peru
| | - Robert Sandoval
- Clinical Cardiology Service, HospitalGuillermo Almenara Irigoyen – EsSalud, Lima, Peru
| | - Luis Falcón-Quispe
- Cardiac Imaging Area of Cardiology Service, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
| | - William Efrain Anicama Lima
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Pathological Anatomy Service, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| | - Roberto Baltodano-Arellano
- Cardiac Imaging Area of Cardiology Service, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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17
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Irelli A, Ceriello L, Patruno LV, Tessitore A, Alesse E, Cannita K, Fabiani D. Takotsubo Syndrome during Pertuzumab and Trastuzumab Therapy for HER2-Positive Metastatic Breast Cancer. Biomedicines 2024; 12:179. [PMID: 38255284 PMCID: PMC10813278 DOI: 10.3390/biomedicines12010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Pertuzumab and trastuzumab have been shown to improve the outcomes of patients with metastatic breast cancer, with a rate of left ventricular dysfunction of approximately 6%. We report the case of a postmenopausal woman who presented with Takotsubo syndrome during maintenance therapy with pertuzumab and trastuzumab, in association with fulvestrant (an anti-estrogen) and denosumab. After normalization of cardiac function, therapy with pertuzumab and trastuzumab was resumed in the absence of new cardiac toxicity. We report the first clinical case of Takotsubo syndrome during double anti-HER2 blockade in association with an antiestrogen. Furthermore, we show how anti-HER2 therapy can be safely resumed after the detection of Takotsubo syndrome.
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Affiliation(s)
- Azzurra Irelli
- Medical Oncology Unit, Department of Oncology, “Giuseppe Mazzini” Hospital, AUSL 04 Teramo, 64100 Teramo, Italy; (L.V.P.); (K.C.)
| | - Laura Ceriello
- Cardiology Unit, Department of Cardiovascular Diseases, “Giuseppe Mazzini” Hospital, AUSL 04 Teramo, 64100 Teramo, Italy; (L.C.); (D.F.)
| | - Leonardo Valerio Patruno
- Medical Oncology Unit, Department of Oncology, “Giuseppe Mazzini” Hospital, AUSL 04 Teramo, 64100 Teramo, Italy; (L.V.P.); (K.C.)
| | - Alessandra Tessitore
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy; (A.T.); (E.A.)
| | - Edoardo Alesse
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy; (A.T.); (E.A.)
| | - Katia Cannita
- Medical Oncology Unit, Department of Oncology, “Giuseppe Mazzini” Hospital, AUSL 04 Teramo, 64100 Teramo, Italy; (L.V.P.); (K.C.)
| | - Donatello Fabiani
- Cardiology Unit, Department of Cardiovascular Diseases, “Giuseppe Mazzini” Hospital, AUSL 04 Teramo, 64100 Teramo, Italy; (L.C.); (D.F.)
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18
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Padilla-Lopez M, Duran-Cambra A, Belmar-Cliville D, Soriano-Amores M, Arakama-Goikoetxea S, Vila-Perales M, Bragagnini W, Rodríguez-Sotelo L, Peña-Ortega P, Sánchez-Vega J, Carreras-Mora J, Sionis A. Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome. Front Cardiovasc Med 2023; 10:1286975. [PMID: 38111891 PMCID: PMC10725917 DOI: 10.3389/fcvm.2023.1286975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Takotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS. Methods A retrospective case-control study was conducted where ECGs were reviewed at three time points from symptom onset (within the first 12 h, at 48 h, and at 5-7 days) and compared between patients with typical TTS (n = 33) and those with MV-TTS (n = 27), as classified by ventriculography. Results 12-h ECG findings revealed that typical TTS featured ST-segment elevation through anterior leads V3-V6, with maximal deviation in V3 (0.98 ± 0.99 mm) and V4 (0.91 ± 0.91 mm), whereas MV-TTS featured ST-segment depression in inferior leads (-0.24 ± 0.57 mm in II, -0.30 ± 0.52 mm in III, and -0.32 ± 0.47 mm in aVF) and in precordial leads V4-V6. In 48-h ECG findings, the most significant change was T wave inversion, which was more widespread and deeper in typical TTS, with the most pronounced negative T wave depths, exceeding 3 mm, observed in leads V3-V5; in contrast, in MV-TTS, T wave inversion was evident in fewer leads and showed less depth, with the most pronounced negative T waves reaching 1 mm at most in leads I, aVL, and V2. While the QTc interval was prolonged in both groups at 48 h, this prolongation was more pronounced in typical TTS than in MV-TTS (523 ± 52 ms vs. 487 ± 66 ms; p = 0.029). In ECGs at 5-7 days, results essentially returned to baseline. Conclusion Patients with MV-TTS exhibited a distinctive pattern of ECG abnormalities, marked by ST-segment depression in inferolateral leads, less profound and less extensive T wave inversion that mostly affected leads I, aVL and V2, and attenuated QT interval prolongation compared to typical TTS.
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Affiliation(s)
- Mireia Padilla-Lopez
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Albert Duran-Cambra
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - David Belmar-Cliville
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Marc Soriano-Amores
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sabiñe Arakama-Goikoetxea
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Montserrat Vila-Perales
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Walter Bragagnini
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Laura Rodríguez-Sotelo
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Peña-Ortega
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jesús Sánchez-Vega
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Carreras-Mora
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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Vedia O, Almendro-Delia M, López-País J, Pérez-Castellanos A, Uribarri A, Duran-Cambra A, Martín-García A, Núñez-Gil IJ. [Heart rate disorders in patients with Tako-tsubo syndrome]. Med Clin (Barc) 2023; 161:330-337. [PMID: 37507244 DOI: 10.1016/j.medcli.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES This study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (HRD) in Tako-tsubo syndrome (TTS). BACKGROUND TTS is associated with HRD. The HRD prognostic value is not well characterized in TTS yet. METHODS The HRD of patients included in the National Registry of Tako-tsubo syndrome, admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. RESULTS All types of HRD were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with TTS. HRD was more associated with diabetes mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent HRD was a new onset of atrial fibrillation. During hospitalization, patients with HRD showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more major adverse cardiac events, but with a non-significant correlation. CONCLUSIONS The incidence of HRD in patients with TTS is not infrequent. TTS, when associated with HRD, presents more complications and a worse prognosis both in hospital and in the long term.
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Affiliation(s)
- Oscar Vedia
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España.
| | | | - Javier López-País
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Ourense, España
| | - Alberto Pérez-Castellanos
- Servicio de Cardiología, Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Hospital Universitario Son Espases, Palma, España
| | - Aitor Uribarri
- Vall d'Hebron Institut de Recerca (VHIR), CIBER-CV, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Albert Duran-Cambra
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Agustín Martín-García
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, España
| | - Iván J Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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20
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Thein EKK, Ahmed D, Myint Zaw O. Takotsubo cardiomyopathy: A case report with severe electrolyte abnormality. J Arrhythm 2023; 39:834-837. [PMID: 37799804 PMCID: PMC10549820 DOI: 10.1002/joa3.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
| | - Dalia Ahmed
- Hull University Teaching Hospitals NHS Foundation TrustHullUK
| | - Okkar Myint Zaw
- Hull University Teaching Hospitals NHS Foundation TrustHullUK
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21
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Osawa T, Tajiri K, Ieda M, Ishizu T. Clinical outcomes of takotsubo syndrome in patients with cancer: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1244808. [PMID: 37840966 PMCID: PMC10570743 DOI: 10.3389/fcvm.2023.1244808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Recent studies suggested a relationship between Takotsubo syndrome (TTS) and malignancy. However, clinical outcomes of TTS associated with cancer have not been assessed completely. This study was aimed to investigate the outcomes of patients with TTS and cancer. Methods We performed a systematic review and meta-analysis to evaluate the clinical outcomes of TTS in patients with and without malignancy. We systematically reviewed and analyzed 14 studies (189,210 patients) published in PubMed and Cochrane Library databases until December 2022. The primary outcome was all-cause mortality at the longest follow-up. Results The prevalence of current or previous malignancy in patients with TTS was 8.7% (16,461 patients). Patients with TTS and malignancy demonstrated a higher risk of mortality at the longest follow-up than those with TTS alone (odds ratio [OR], 2.41; 95% confidence interval [CI]; 1.95-2.98; P < 0.001). Moreover, cancer was significantly associated with an increased risk of in-hospital or 30-day mortality (OR 2.36; 95% CI, 1.67-3.33; P < 0.001), shock (OR 1.42; 95% CI, 1.30-1.55; P < 0.001), mechanical respiratory support (OR 1.68; 95% CI, 1.59-1.77; P < 0.001), arrhythmia (OR 1.27; 95% CI, 1.21-1.34; P < 0.001), and major adverse cardiac events (OR 1.69; 95% CI, 1.18-2.442; P < 0.001). Conclusions This study revealed significant associations between previous or active cancer and an increased risk of all-cause mortality and in-hospital adverse events in patients with TTS.
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Affiliation(s)
- Takumi Osawa
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
- Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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22
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Repasos E, Kondylis M, Petropoulos I, Konstantinou G, Briasoulis A, Kanakakis I. Recurrent Takotsubo Cardiomyopathy Precipitated by Inhaled b2 Adrenergic Receptor Agonists. Am J Ther 2023; 30:e473-e475. [PMID: 37713700 DOI: 10.1097/mjt.0000000000001551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Evangelos Repasos
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Marios Kondylis
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Georgios Konstantinou
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
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Standifird C, Kaisler S, Gottula AL, Lauria MJ, Dean JT. Takotsubo Cardiomyopathy Syndrome in Critical Care Transport: A Case and Critical Review. Air Med J 2023; 42:372-376. [PMID: 37716811 DOI: 10.1016/j.amj.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 09/18/2023]
Abstract
Takotsubo cardiomyopathy syndrome, or simply takotsubo syndrome (TTS), is a form of stress cardiomyopathy thought to be caused by excess catecholamines in association with physical or emotional stress. Providers should maintain a high index of suspicion for TTS in patients with symptoms of acute coronary syndrome, acute decompensated heart failure, substernal chest pain, or dyspnea. However, TTS is a diagnosis of exclusion, and patients should initially be evaluated and treated for other causes, such as acute myocardial infarction. Critical care transport crews may encounter patients with TTS during their primary presentation, before diagnosis, or after the formal diagnosis is made in the catheterization laboratory. Therefore, crews should be familiar with unique aspects of the pathophysiology, diagnosis, and management of TTS. This article presents a case and provides a critical review of TTS for critical care transport clinicians.
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Affiliation(s)
- Colin Standifird
- Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV; OptimuMedicine, Las Vegas, NV.
| | - Sean Kaisler
- University of New Mexico School of Medicine, Albuquerque, NM; 306th Rescue Squadron, United States Air Force, Davis-Monthan AFB, Tucson, AZ
| | - Adam L Gottula
- Department of Emergency Medicine and Anesthesiology, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI
| | - Michael J Lauria
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Lifeguard Air Emergency Services, Albuquerque, NM
| | - James T Dean
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
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24
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Kinoshita M, Kinoshita M, Takahashi R, Mutoh S, Kakuta N, Tanaka K. The Safety and Strategies for Reinitiating Electroconvulsive Therapy After ECT-Induced Takotsubo Cardiomyopathy: A Case Report and Systematic Review. J ECT 2023; 39:185-192. [PMID: 36897138 DOI: 10.1097/yct.0000000000000905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Takotsubo cardiomyopathy (TCM) is a life-threatening complication of electroconvulsive therapy (ECT). We report the case of a 66-year-old woman who was rechallenged with ECT after ECT-induced TCM. Moreover, we have made a systematic review to assess the safety of and strategies for reinitiating ECT after TCM. METHODS We searched for published reports on ECT-induced TCM since 1990 in MEDLINE (PubMed), Scopus, Cochrane Library, ICHUSHI, and CiNii Research. RESULTS A total of 24 ECT-induced TCM cases were identified. Patients who developed ECT-induced TCM were predominantly middle-aged and older women. There was no specific trend in anesthetic agents used. Seventeen (70.8%) cases developed TCM by the third session in the acute ECT course. Eight (33.3%) cases developed ECT-induced TCM despite the use of β-blockers. Ten (41.7%) cases developed cardiogenic shock or abnormal vital signs related to cardiogenic shock. All cases recovered from TCM. Eight (33.3%) cases tried to receive ECT retrial. The duration until ECT retrial was between 3 weeks and 9 months. The most common preventive measures during ECT retrial were related to β-blockers; however, the type, dose, and route of administration of β-blockers varied. In all cases, ECT could be reperformed without TCM recurrence. CONCLUSIONS Electroconvulsive therapy-induced TCM is more likely to cause cardiogenic shock than nonperioperative cases; nevertheless, it has good prognosis. Cautious reinitiation of ECT after TCM recovery is possible. Further studies are required to determine preventive measures for ECT-induced TCM.
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Affiliation(s)
- Michiko Kinoshita
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Makoto Kinoshita
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Rikako Takahashi
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Sarara Mutoh
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Nami Kakuta
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Katsuya Tanaka
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
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25
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Srdanović I, Dabović D, Ivanović V, Čanković M, Pantić T, Stefanović M, Dimić S, Crnomarković B, Bjelobrk M, Govedarica M, Zdravković M. Takotsubo Cardiomyopathy Occurring Simultaneously with Acute Myocardial Infarction. Life (Basel) 2023; 13:1770. [PMID: 37629626 PMCID: PMC10455998 DOI: 10.3390/life13081770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TCM) is a reversible form of cardiomyopathy characterized by transient regional systolic dysfunction of the left ventricle. CASE OUTLINE A 78-year-old woman was admitted to the general hospital due to acute inferior STEMI late presentation. Two days after admission, the patient reported intense chest pain and an ECG registered diffuse ST-segment elevation in all leads with ST-segment denivelation in aVR. The patient also showed clinical signs of cardiogenic shock and was referred to a reference institution for further evaluation. Echocardiography revealed akinesia of all medioapical segments, dynamic obstruction of the left ventricular outflow tract (LVOT), moderate mitral regurgitation, and pericardial effusion. Coronary angiography showed the suboccluded right coronary artery, and a primary percutaneous coronary intervention was performed, which involved implanting a drug-eluting stent. The patient's condition worsened as pericardial effusion increased and led to tamponade. Pericardiocentesis was performed, resulting in the patient's stabilization. At this point, significant gradients at the LVOT and pericardial effusion were not registered. After eight days without symptoms and stable status, the patient was discharged. CONCLUSIONS The simultaneous presence of AMI and TCM increases the risk of developing cardiogenic shock. The cardio-circulatory profile of these patients is different from those with AMI.
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Affiliation(s)
- Ilija Srdanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Dragana Dabović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Vladimir Ivanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Teodora Pantić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Maja Stefanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Dimić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Branislav Crnomarković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Marija Bjelobrk
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Miljana Govedarica
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (V.I.); (M.Č.); (T.P.); (M.S.); (S.D.); (B.C.); (M.B.); (M.G.)
- Department of Obstetrics and Gynaecology, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Marija Zdravković
- University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Grosso D, Akbar S, Esposito M, Card A. Takotsubo Cardiomyopathy Associated with Acute COVID-19 Pneumonia. Cureus 2023; 15:e44483. [PMID: 37791198 PMCID: PMC10544413 DOI: 10.7759/cureus.44483] [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: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Cardiogenic shock carries a high burden of morbidity and mortality because of inadequate tissue perfusion leading to end-stage multi-organ damage. The initial work-up includes a pertinent and thorough history and physical examination to identify possible cardiac and noncardiac etiologies. The following case describes a patient presenting with symptomatic acute COVID-19 (SARS-CoV-2) pneumonia with initial findings consistent with cardiogenic shock. SARS-CoV-2 pneumonia has been associated with multiple cardiac manifestations including myocarditis, heart failure, myocardial infarction, and Takotsubo cardiomyopathy. This patient was treated with conservative medical management and had complete clinical recovery and normal cardiac angiography weeks after their initial presentation. This clinical scenario highlights the significance of a broad differential and extensive work-up when faced with a patient presenting with cardiogenic shock.
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Affiliation(s)
- Domenic Grosso
- Internal Medicine, Kettering Health Main Campus, Kettering, USA
| | - Shahzad Akbar
- Internal Medicine, Kettering Health Main Campus, Kettering, USA
| | - Melisa Esposito
- Internal Medicine, Kettering Health Main Campus, Kettering, USA
| | - Alex Card
- Internal Medicine, Kettering Health Main Campus, Kettering, USA
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27
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Saito T, Natsumeda M, Sakagami T, Murakami T, Takagi S, Ikari Y. Short-term recurrence of takotsubo syndrome with phenotypic variation: a case report. Eur Heart J Case Rep 2023; 7:ytad378. [PMID: 37601234 PMCID: PMC10439711 DOI: 10.1093/ehjcr/ytad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/09/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
Background Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome characterized as an uncommon left ventricular (LV) cardiomyopathy. Recurrence of TTS is rare, estimated to be 1-6%. We report a rare case of TTS that occurred three times in 2 months but manifested various phenotypes. Case summary A 68-year-old woman was admitted to our hospital with acute-onset chest pain and hypertension. The coronary angiography findings were normal, although left ventriculography revealed inferior wall hypokinesis, leading to a mid-ventricular TTS diagnosis. She was discharged on Day 3 after her symptoms improved and vitals stabilized. The patient's condition remained uneventful until 2-week post-discharge, when acute chest pain and hypertension recurred. She was admitted again with the same diagnosis. However, LV morphology revealed an apical ballooning pattern, with inferior LV wall hypokinesis. She was discharged on Day 7 after her symptoms and electrocardiography findings improved but was readmitted again 2 weeks later after acute chest pain and hypertension recurred. Left ventriculography performed a third time demonstrated mid-ventricular TTS. The patient was prescribed additional medications and discharged on Day 12. Her electrocardiography findings normalized, and the patient remained asymptomatic without recurrence 4 months after the initial presentation. Discussion Recurrence and phenotypic change of TTS are rare. Some cases have been reported but occurring months to years after initial diagnosis. Combined treatment with β-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists may be more effective to prevent the recurrence than monotherapies.
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Affiliation(s)
- Takafumi Saito
- Department of Cardiology, Hiratsuka City Hospital, 1-19-1 Nanbara, Hiratsuka, Kanagawa, Japan
| | - Makoto Natsumeda
- Department of Cardiology, Hiratsuka City Hospital, 1-19-1 Nanbara, Hiratsuka, Kanagawa, Japan
| | - Takato Sakagami
- Department of Cardiology, Hiratsuka City Hospital, 1-19-1 Nanbara, Hiratsuka, Kanagawa, Japan
| | - Tsutomu Murakami
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Japan
| | - Shunsuke Takagi
- Department of Cardiology, Hiratsuka City Hospital, 1-19-1 Nanbara, Hiratsuka, Kanagawa, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Japan
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Pätz T, Santoro F, Cetera R, Ragnatela I, El-Battrawy I, Mezger M, Rawish E, Andrés-Villarreal M, Almendro-Delia M, Martinez-Sellés M, Uribarri A, Pérez-Castellanos A, Guerra F, Novo G, Mariano E, Musumeci MB, Arcari L, Cacciotti L, Montisci R, Akin I, Thiele H, Brunetti ND, Vedia O, Núñez-Gil IJ, Eitel I, Stiermaier T. Trigger-Associated Clinical Implications and Outcomes in Takotsubo Syndrome: Results From the Multicenter GEIST Registry. J Am Heart Assoc 2023:e028511. [PMID: 37421264 PMCID: PMC10382102 DOI: 10.1161/jaha.122.028511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/13/2023] [Indexed: 07/10/2023]
Abstract
Background Takotsubo syndrome is usually triggered by a stressful event. The type of trigger seems to influence the outcome and should therefore be considered separately. Methods and Results Patients included in the GEIST (German-Italian-Spanish Takotsubo) registry were categorized according to physical trigger (PT), emotional trigger (ET), and no trigger (NT) of Takotsubo syndrome. Clinical characteristics as well as outcome predictors were analyzed. Overall, 2482 patients were included. ET was detected in 910 patients (36.7%), PT in 885 patients (34.4%), and NT was observed in 717 patients (28.9%). Compared with patients with PT or NT, patients with ET were younger, less frequently men, and had a lower prevalence of comorbidities. Adverse in-hospital events (NT: 18.8% versus PT: 27.1% versus ET: 12.1%, P<0.001) and long-term mortality rates (NT: 14.4% versus PT: 21.6% versus ET: 8.5%, P<0.001) were significantly lower in patients with ET. Increasing age (P<0.001), male sex (P=0.007), diabetes (P<0.001), malignancy (P=0.002), and a neurological disorder (P<0.001) were associated with a higher risk of long-term mortality, while chest pain (P=0.035) and treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (P=0.027) were confirmed as independent predictors for a lower risk of long-term mortality. Conclusions Patients with ET have better clinical conditions and a lower mortality rate. Increasing age, male sex, malignancy, a neurological disorder, chest pain, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and diabetes were confirmed as predictors of long-term mortality.
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Affiliation(s)
- Toni Pätz
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
| | - Francesco Santoro
- Department of Medical and Surgery Sciences University of Foggia Italy
| | - Rosa Cetera
- Department of Medical and Surgery Sciences University of Foggia Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgery Sciences University of Foggia Italy
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology Bergmannsheil University Hospitals, Ruhr University of Bochum Bochum Germany
- University of Mannheim, DZHK Partner Site Heidelberg/Mannheim, ECAS (European Center of Angioscience) Mannheim Germany
| | - Matthias Mezger
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
| | - Elias Rawish
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck Lübeck Germany
| | | | | | - Manuel Martinez-Sellés
- Cardiology Department Hospital General Universitario Gregorio Marañon, CIBERCV. Universidad Europea, Universidad Complutense Madrid Spain
| | - Aitor Uribarri
- Servicio de Cardiología Hospital Universitario Vall d'Hebron Barcelona Spain
| | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi" Ancona Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology Unit University of Palermo, University Hospital P. Giaccone Palermo Italy
| | | | - Maria Beatrice Musumeci
- Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology Sapienza University of Rome Rome Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital Rome Italy
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital Rome Italy
| | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health University of Cagliari Cagliari Italy
| | - Ibrahim Akin
- University of Mannheim, DZHK Partner Site Heidelberg/Mannheim, ECAS (European Center of Angioscience) Mannheim Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany
| | | | - Oscar Vedia
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Universidad Complutense de Madrid Madrid Spain
| | - Ivan J Núñez-Gil
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Universidad Complutense de Madrid Madrid Spain
| | - Ingo Eitel
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck Lübeck Germany
| | - Thomas Stiermaier
- Medical Clinic II University Heart Center Lübeck Lübeck Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck Lübeck Germany
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29
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Afzal MA, Ozgur SS, Shamoon Y, Abboud R, Shamoon F. When a Tooth Pulls the Heart Strings: Takotsubo Cardiomyopathy Post-dental Extraction. Cureus 2023; 15:e42044. [PMID: 37602089 PMCID: PMC10432250 DOI: 10.7759/cureus.42044] [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: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a temporary left ventricular dysfunction caused by a catecholamine surge under severe stress. It's characterized by chest pain, non-specific ECG changes, and left ventricular apical ballooning observed during catheterization. We present a case of a 59-year-old postmenopausal female with a past medical history of asthma who arrived at the ED complaining of chest pain following dental extraction. The patient's abnormal ECG findings and elevated cardiac enzymes required cardiac catheterization, which revealed normal coronary vasculature but demonstrated left ventricular apical ballooning. Transthoracic echocardiogram (TTE) showed septal left ventricular hypertrophy, decreased ejection fraction (EF), and akinetic segments consistent with takotsubo cardiomyopathy. Secondary takotsubo cardiomyopathy induced by stress in the setting of dental procedures like a tooth extraction for a periapical dental abscess is rarely described in the literature. Our case serves as a reminder of the potential for stress-induced cardiomyopathy in postmenopausal women, especially those with undiagnosed underlying anxiety disorders, even following minimally invasive procedures.
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Affiliation(s)
| | - Sacide S Ozgur
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Yezin Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Rachel Abboud
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Fayez Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
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30
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Yoganathan T, Perez-Liva M, Balvay D, Le Gall M, Lallemand A, Certain A, Autret G, Mokrani Y, Guillonneau F, Bruce J, Nguyen V, Gencer U, Schmitt A, Lager F, Guilbert T, Bruneval P, Vilar J, Maissa N, Mousseaux E, Viel T, Renault G, Kachenoura N, Tavitian B. Acute stress induces long-term metabolic, functional, and structural remodeling of the heart. Nat Commun 2023; 14:3835. [PMID: 37380648 DOI: 10.1038/s41467-023-39590-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/21/2023] [Indexed: 06/30/2023] Open
Abstract
Takotsubo cardiomyopathy is a stress-induced cardiovascular disease with symptoms comparable to those of an acute coronary syndrome but without coronary obstruction. Takotsubo was initially considered spontaneously reversible, but epidemiological studies revealed significant long-term morbidity and mortality, the reason for which is unknown. Here, we show in a female rodent model that a single pharmacological challenge creates a stress-induced cardiomyopathy similar to Takotsubo. The acute response involves changes in blood and tissue biomarkers and in cardiac in vivo imaging acquired with ultrasound, magnetic resonance and positron emission tomography. Longitudinal follow up using in vivo imaging, histochemistry, protein and proteomics analyses evidences a continued metabolic reprogramming of the heart towards metabolic malfunction, eventually leading to irreversible damage in cardiac function and structure. The results combat the supposed reversibility of Takotsubo, point to dysregulation of glucose metabolic pathways as a main cause of long-term cardiac disease and support early therapeutic management of Takotsubo.
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Affiliation(s)
| | | | - Daniel Balvay
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France
| | - Morgane Le Gall
- Université Paris Cité, P53 proteom'IC facility, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Alice Lallemand
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Anais Certain
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Gwennhael Autret
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France
| | - Yasmine Mokrani
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - François Guillonneau
- Institut de Cancérologie de l'Ouest, CNRS UMR6075 INSERM U1307, 15 rue André Boquel, F-49055, Angers, France
| | - Johanna Bruce
- Université Paris Cité, P53 proteom'IC facility, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Vincent Nguyen
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Inserm, CNRS, F-75006, Paris, France
| | - Umit Gencer
- Service de Radiologie, AP-HP, hôpital européen Georges Pompidou, F-75015, Paris, France
| | - Alain Schmitt
- Université Paris Cité, Cochin Imaging, Electron microscopy, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Franck Lager
- Université Paris Cité, Plateforme d'Imageries du Vivant, Institut Cochin, Inserm-CNRS, F-75014, Paris, France
| | - Thomas Guilbert
- Université Paris Cité, Cochin Imaging Photonic, IMAG'IC, Institut Cochin, Inserm, CNRS, F-75014, Paris, France
| | | | - Jose Vilar
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Nawal Maissa
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Elie Mousseaux
- Service de Radiologie, AP-HP, hôpital européen Georges Pompidou, F-75015, Paris, France
| | - Thomas Viel
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France
| | - Gilles Renault
- Université Paris Cité, Plateforme d'Imageries du Vivant, Institut Cochin, Inserm-CNRS, F-75014, Paris, France
| | - Nadjia Kachenoura
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Inserm, CNRS, F-75006, Paris, France
| | - Bertrand Tavitian
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France.
- Service de Radiologie, AP-HP, hôpital européen Georges Pompidou, F-75015, Paris, France.
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Alhuarrat MAD, Barzallo D, Seo J, Naser A, Alhuarrat MR, Minuti A, Kokkinidis DG, Schizas D. Meta-Analysis and Clinical Features of Perioperative Takotsubo Cardiomyopathy in Noncardiac Surgery. Am J Cardiol 2023; 201:78-85. [PMID: 37352669 DOI: 10.1016/j.amjcard.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
Perioperative takotsubo cardiomyopathy (pTCM) is an increasing condition defined as cardiomyopathy in the setting of emotional and physiologic stressors imposed by surgery. We aimed to classify and understand the presentation, management, and prognosis of noncardiac surgery pTCM in published cases. As such, a review of previous studies using the PubMed, Embase, Cochrane, and Web of Science databases was conducted to obtain case reports and series reporting noncardiac pTCM from inception to September 2022, and a crude analysis was conducted to classify the clinical features. Of the 1,002 studies, 96 met our inclusion criteria, of which 101 cases were extracted and included in the final systematic review. A total of 29.7% of cases occurred during general surgery and 20.8% during transplant procedures. The median age at presentation was 55 years, with a 42 to 65 interquartile range. The prevalence of hypertension and mood disorders were 22.8% and 9.9%, respectively. Before the procedures, physiologic stressors occurred more commonly than emotional stressors (20.8% and 11%, respectively). Objective findings, including ST-T-wave changes, new arrhythmias, and hypotension, were the most common initial presenting symptoms. Most cases occurred during emergence from surgery or on the first postoperative day. Mechanical circulatory support was required in 15.8% of the cases, and the all-cause in-hospital mortality was 6.9%. The ejection fraction and symptoms improved within a median of 2 weeks after diagnosis (interquartile range 1 to 6). In conclusion, the risk factors, triggers, and outcomes of pTCM appear to differ from those of classic nonperioperative TCM presentations. Future studies will help shed light on this more frequently diagnosed condition complicating some noncardiac surgical cases.
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Affiliation(s)
| | - Diego Barzallo
- Division of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center and
| | - Jiyoung Seo
- Division of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center and
| | - Ahmad Naser
- Division of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center and
| | | | - Aurelia Minuti
- Head, Research & Education, D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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32
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Sinha N, Tian Z, Zhou S, Thomas NJ, Krawiec C. Multicenter retrospective database evaluation of Takotsubo syndrome in subjects undergoing catheter ablation for atrial fibrillation. J Arrhythm 2023; 39:359-365. [PMID: 37324778 PMCID: PMC10264738 DOI: 10.1002/joa3.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 06/17/2023] Open
Abstract
Background Intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation may result in Takotsubo syndrome (TS), but the frequency, predisposing factors (age, sex, mental health disorders), and outcomes are currently unknown. This study sought to assess the frequency, predisposing factors, and outcomes of subjects who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation and were diagnosed with TS. Methods This was a retrospective observational cohort study utilizing TriNetX® electronic health record (EHR) data. We included subjects aged older than 18 years who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation. The study population was divided into two groups (no TS diagnostic code presence and TS diagnostic code presence). We analyzed the distributions of age, sex, race, diagnostic codes, common terminology procedures (CPT), and vasoactive medication codes and examined mortality rate within 30 days. Results We included 69,116 subjects. Of these, 27 (0.04%) had a TS diagnostic code, the cohort was comprised mostly of females [17 (63.0%)], and 1 (3.7%) death within 30 days was reported. There were no significant differences in age and frequency of mental health disorders between those patients in TS and non-TS cohorts. Adjusting for age, sex, race, ethnicity, patient regionality, and mental health disorder diagnostic code, those patients who developed TS had a significantly higher odds of dying in 30 days after catheter ablation compared to those without TS (OR = 15.97, 95% CI: 2.10-121.55, p = .007). Conclusions Approximately 0.04% of subjects who underwent intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation had a subsequent diagnostic code of TS. Further study is needed to determine whether there are predisposing factors associated with the development of TS in subjects who undergo catheter ablation of atrial fibrillation by pulmonary vein isolation.
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Affiliation(s)
- Neha Sinha
- Pediatric Critical Care Medicine, Department of PediatricsPenn State Hershey Children's HospitalHersheyPennsylvaniaUSA
| | - Zizhong Tian
- Division of Biostatistics and Bioinformatics, Department of Public Health SciencesPennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Shouhao Zhou
- Division of Biostatistics and Bioinformatics, Department of Public Health SciencesPennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Neal J. Thomas
- Pediatric Critical Care Medicine, Department of PediatricsPenn State Hershey Children's HospitalHersheyPennsylvaniaUSA
- Department of Public Health SciencesPennsylvania State University College of MedicineHersheyPennsylvaniaUSA
| | - Conrad Krawiec
- Pediatric Critical Care Medicine, Department of PediatricsPenn State Hershey Children's HospitalHersheyPennsylvaniaUSA
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Yazdi V, Cox Z, Patel M, Yazdi B, Chacko P. Cardiogenic Shock Due to Serotonin Syndrome Induced Takotsubo Cardiomyopathy. Cureus 2023; 15:e38595. [PMID: 37288181 PMCID: PMC10241989 DOI: 10.7759/cureus.38595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/09/2023] Open
Abstract
Takotsubo cardiomyopathy causes transient left ventricular dysfunction. It typically has a favorable prognosis but rarely leads to complications such as cardiogenic shock. Also known as stress-induced cardiomyopathy, it is precipitated by emotional or physical stress. Serotonin syndrome can cause severe stress due to excessive serotonergic activity in the central nervous system. We report a case of cardiogenic shock precipitated by serotonin syndrome-induced takotsubo cardiomyopathy. Only one other documented case has exhibited cardiogenic shock in this setting.
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Affiliation(s)
- Vahid Yazdi
- Department of Cardiovascular Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Zachary Cox
- Department of Cardiovascular Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Mitra Patel
- Department of Cardiovascular Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Bayan Yazdi
- Department of Cardiology, Loyola University Chicago Stritch School of Medicine, Maywood, USA
| | - Paul Chacko
- Department of Cardiovascular Medicine, The University of Toledo Medical Center, Toledo, USA
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Wu H, Su H, Zhu C, Wu S, Cui S, Zhou M. Establishment and effect evaluation of a stress cardiomyopathy mouse model induced by different doses of isoprenaline. Exp Ther Med 2023; 25:166. [PMID: 36936708 PMCID: PMC10015318 DOI: 10.3892/etm.2023.11865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
The optimum dose of isoprenaline (ISO) required to induce stress cardiomyopathy (SC) in mice is not known. The present study aimed to investigate the dose-response association and determine the optimum dose of ISO to establish a high-morbidity/low-mortality SC mouse model to simulate the clinical symptoms of SC. A total of 72 6-week-old wild-type female mice (C57BL/6) were randomly divided into control mice administered normal saline and mice treated with increasing ISO concentrations (5, 10, 25, 50 and 100 mg/kg ISO intraperitoneal injections daily for 14 consecutive days). All mice were analysed by body weight assessment, open field test (OFT), echocardiography (Echo), electrocardiogram (ECG), assessment of myocardial pathology and quantification of cortisol, brain natriuretic peptide (BNP), cardiac troponin T (cTnT), catecholamine (CA) and C-reactive protein (CRP). Compared with the control group, the 25 and 50 mg/kg ISO groups exhibited the most prominent weight changes and lower mortality. The open-field test showed a significant decrease in autonomous activity behaviour in the 25 and 50 mg/kg ISO groups compared with the control group (P<0.05). Echo revealed that the apex of the heart was balloon-like in the 25 and 50 mg/kg ISO groups, along with prominent left ventricular dyskinesia. ECG showed a significant increase in ST segment amplitude, QT interval and Q amplitude (P<0.05) in the 25 and 50 mg/kg ISO group compared with the control group. Haematoxylin and eosin staining of heart tissue showed a disordered arrangement of myocardial cells, dissolution of myocardial fibres and cytoplasm, notable widening of myocardial cell space, oedema and hyperaemia of the interstitium, whereas heart tissue of the control group was structurally intact. Compared with the control group, the 25 and 50 mg/kg ISO groups exhibited significantly higher levels of cortisol, BNP, cTNT, CA and CRP (P<0.05). A high-incidence low-mortality SC model was successfully and stably developed by administration of 25 and 50 mg/kg ISO. Such models may provide a basis for the development of other animal models of SC.
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Affiliation(s)
- Haosheng Wu
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Hang Su
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Chao Zhu
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Shengbing Wu
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
- College of Acupuncture and Massage, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
| | - Shuai Cui
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
- College of Acupuncture and Massage, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
- Correspondence to: Professor Meiqi Zhou or Dr Shuai Cui, Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, 103 Meishan Road, Shushan, Hefei, Anhui 230000, P.R. China
| | - Meiqi Zhou
- Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, Hefei, Anhui 230000, P.R. China
- Correspondence to: Professor Meiqi Zhou or Dr Shuai Cui, Research Institute of Acupuncture and Meridian, Anhui University of Chinese Medicine, 103 Meishan Road, Shushan, Hefei, Anhui 230000, P.R. China
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Yamazaki D, Osaki Y, Suzuki H, Shimano H. Takotsubo cardiomyopathy with left ventricle thrombus caused by subacute thyroiditis. BMJ Case Rep 2023; 16:e250540. [PMID: 36918211 PMCID: PMC10016297 DOI: 10.1136/bcr-2022-250540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
We report a rare case of takotsubo cardiomyopathy caused by subacute thyroiditis in a man in his 50s. He went to the doctor with complaints of loss of appetite, diarrhoea, chills and general malaise. He had consciousness disturbance, thyrotoxicosis and thyroid-stimulating hormone (TSH) suppression. Thyroglobulin and C reactive protein levels in the blood were elevated, but TSH receptor antibody, thyroid-stimulating antibody, antithyroglobulin antibody and antithyroid peroxidase antibody were not. We began treatment with prednisolone and propranolol after he was diagnosed with thyroid storm caused by subacute thyroiditis. The ECG revealed inverted T waves on the fifth day after admission. He was newly diagnosed with takotsubo cardiomyopathy on the day. A large thrombus was detected in the left ventricle, requiring anticoagulation therapy. Thus, even if there are no findings of takotsubo cardiomyopathy or thrombus at the onset of thyroid storm, appropriate monitoring is required because they can develop during the treatment course.
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Affiliation(s)
- Daichi Yamazaki
- Internal Medicine (Endocrinology and Metabolism), University of Tsukuba, Tsukuba, Japan
| | - Yoshinori Osaki
- Internal Medicine (Endocrinology and Metabolism), University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Suzuki
- Internal Medicine (Endocrinology and Metabolism), University of Tsukuba, Tsukuba, Japan
| | - Hitoshi Shimano
- Internal Medicine (Endocrinology and Metabolism), University of Tsukuba, Tsukuba, Japan
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Almutairi AM, Alotaibi WS, Almuhana AH, Suliman I. Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in Takotsubo Cardiomyopathy During 15 Years of Follow-Up. Cureus 2023; 15:e36509. [PMID: 37090273 PMCID: PMC10121249 DOI: 10.7759/cureus.36509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Takotsubo cardiomyopathy (TTC) or stress-induced cardiomyopathy is characterized by transient left ventricular apical ballooning in the absence of coronary occlusion. Although the underlying mechanism is still unknown, exaggerated sympathetic nervous system and catecholamine cardiotoxicity, followed by metabolic disturbance, and multi-vessel epicardial coronary artery vasospasm, are thought to be responsible for the development of this condition. TTC accounts for 1-2% of patients presenting with the acute coronary syndrome (ACS) with the majority of patients being postmenopausal women. Shark fin electrocardiogram (SFE) or triangular ST-segment elevation is an uncommon electrocardiogram (ECG) finding that is typically associated with an increased risk of ventricular fibrillation and cardiogenic shock, thus, it is considered a poor prognostic factor. We present a case of a 57-year-old postmenopausal female with TTC post-colonic perforation. Upon further investigation, an ECG revealed an SFE or triangular ST-segment elevation on the anterolateral leads, and an elevated serum troponin level was found. On trans-thoracic echocardiogram (TTE), hypokinesis and akinesis of the apex and left ventricular segments were observed with sparing of the basal segments. Eventually, the patient was successfully managed and monitored until regain of normal function.
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Affiliation(s)
- Atheer M Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Wed S Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Alanoud H Almuhana
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Ihab Suliman
- Cardiology, King Abdulaziz Medical City, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, SAU
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37
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Al Khodari K, Alhaj Tahtouh R, Abdullatef WK, Al Khodari M. Takotsubo (stress) cardiomyopathy induced by acute asthma exacerbation in elderly woman. Clin Case Rep 2023; 11:e7074. [PMID: 36911627 PMCID: PMC9995802 DOI: 10.1002/ccr3.7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/02/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
A 73-year-old patient who was admitted secondary to acute asthma exacerbation that required frequent salbutamol and adrenaline nebulization. Takotsubo cardiomyopathy (TTC) was diagnosed after the new onset of chest pain with modest troponin elevation and normal coronary angiogram. Low ejection fraction and apical akinesia were completely resolved after her symptoms got improved.
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38
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Wilk A, Król W, Anna ŻS, Ziemska-Gorczyca M, Tetera W, Konopka M, Binkiewicz-Orluk M, Braksator W. Can longitudinal strain analysis differentiate between Takotsubo syndrome and acute coronary syndrome? Echocardiography 2023; 40:174-179. [PMID: 36545784 DOI: 10.1111/echo.15510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/19/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is characterized by transient abnormalities of myocardial contractility. Noninvasive tests are currently being sought to differentiate TTS from acute coronary syndrome (ACS). THE AIM OF THE STUDY To evaluate the prevalence of TTS and echocardiographic parameters to distinguish apical TTS from acute anterior wall infarction. MATERIAL AND METHODS The medical records of patients with suspected TTS, hospitalized in the Department of Cardiology (TTS group n = 18) were analyzed. The control group included patients with STEMI of the left ventricle anterior wall and anterior and lateral wall (STEMI group n = 17). Standard transthoracic echocardiography (TTE) was supplemented with segmental longitudinal strain (LS) assessment with the use of acoustic marker tracking. RESULTS A statistically significant difference was observed in the second cardiac troponine I (CTNI) measurement (TTS: 3241.2 ng/L vs. STEMI: 12032.6 ng/L; p < 0.05). A significant difference in left and right ventricular size was observed on TTE. Left ventricular end-diastolic and end-systolic volumes were considerably smaller in TTS group; (86.1 vs. 104 ml and 48.1 vs. 74.1 ml, respectively). LS were significantly higher (in absolute values) in patients with TTS than in those with STEMI in the apical and middle lateral segments, LS in the apical four-chamber view (apSept -14.9 vs. -8.9; apLat -14.8 vs. -6.84; midLat -13.26 vs. -9.11). CONCLUSIONS Patients with TTS are characterized by a different LS pattern in the apical segments of the left ventricle compared to patients with STEMI. TTE examination with LS remains insufficient to distinguish TTS from ACS at the early stage of diagnosis.
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Affiliation(s)
- Aleksandra Wilk
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Faculty of Medicine, Medical University of Warsaw, Warsaw, Warsaw, Poland
| | - Wojciech Król
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Faculty of Medicine, Medical University of Warsaw, Warsaw, Warsaw, Poland
| | - Żarek-Starzewska Anna
- Department of Cardiology, Hypertension and Internal Diseases, Mazovian Bródnowski Hospital, Warsaw, Warsaw, Poland
| | | | - Weronika Tetera
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Warsaw, Poland
| | - Marcin Konopka
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Faculty of Medicine, Medical University of Warsaw, Warsaw, Warsaw, Poland
| | - Maria Binkiewicz-Orluk
- Department of Cardiology, Hypertension and Internal Diseases, Mazovian Bródnowski Hospital, Warsaw, Warsaw, Poland
| | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Faculty of Medicine, Medical University of Warsaw, Warsaw, Warsaw, Poland
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Takla A, Mahmoud A, Mostafa MR, Jain D. Transient Mid-Ventricular Ballooning Syndrome: An Atypical Variant of Stress Cardiomyopathy. Cureus 2023; 15:e35537. [PMID: 37007401 PMCID: PMC10058448 DOI: 10.7759/cureus.35537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/03/2023] Open
Abstract
Takotsubo cardiomyopathy, also known as stress cardiomyopathy (SCM) or broken heart syndrome, is characterized by transient systolic dysfunction of the left ventricle (LV). It typically affects the apical segment, but several rare variants exist. This report represents a rare variant of atypical stress cardiomyopathy that mimics territorial regional wall motion abnormalities of a blocked epicardial vessel.
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40
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Bachayev M, Brereton B, Mondal A, Alli-Ramsaroop BA, Dhakal R, Leon MCB, Quinones CM, Abdelal MEO, Jain A, Dhaduk K, Desai R. Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports. Transplant Proc 2023:S0041-1345(22)00778-3. [PMID: 36858907 DOI: 10.1016/j.transproceed.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) has been reported in solid-organ transplant recipients. However, the pooled data regarding TTS after liver transplant remain limited. METHODS A systematic review was performed through February 2022 using PubMed, Embase, Scopus, and Google Scholar to review case reports/series and original studies on liver transplant-associated TTS. Descriptive analysis was performed for case reports and pooled analysis for the prevalence using random effects models. RESULTS A total of 56 case reports were included from 30 articles (51.8 % male; mean age, 53 years; India 56%, US 27%, and Europe 8.93%) and 10 original studies (US 88.65%, India 10.92%) revealing liver transplant-associated TTS. The pooled prevalence of TTS was 1.1% (95% Cl, 0.6%-1.7%) of all liver transplants with comparable rates in studies from India and the US (P = .92). Indications for liver transplant included end-stage liver disease due to alcohol-related cirrhosis (25%), hepatitis C virus infection (17.9%), hepatocellular carcinoma (10.7%), and non-alcohol-related steatohepatitis (8.9%); the average Model for End-Stage Liver Disease score was 24.75. TTS commonly presented as hypotension (30%), dyspnea (14%), and oliguria, occurring mostly post-transplant (82%), whereas 14% were intraoperative. Common electrocardiogram findings were ST changes, ventricular tachycardia, and atrial fibrillation. Common echocardiogram findings showed left ventricular apical ballooning in 46.5% of cases and reduced ejection fraction < 20% in 41.9% of cases. Common complications were cardiogenic shock (32.1 %), acute kidney injury (12.5%), arrhythmia, stroke, cardiac arrest, and hepatic artery thrombosis. Mechanical circulatory support was required in 30.3%. Recurrence was reported in 15, and mortality in 30.4% of patients. CONCLUSIONS Takotsubo syndrome prevalence after liver transplant is significantly higher than TTS prevalence in general US hospitalizations with potentially worse outcomes. Prospective registries reporting TTS in liver transplant recipients are warranted.
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Affiliation(s)
- Milana Bachayev
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Brian Brereton
- Department of Medicine, Jersey General Hospital, Saint Helier, Jersey
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, Pennsylvania
| | | | - Roshan Dhakal
- Department of Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Maria C Buhl Leon
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Camila M Quinones
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Mohamed Eyad O Abdelal
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Kartik Dhaduk
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pennsylvania.
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41
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MAHADEVAPPA MANJAPPA, KULKARNI PRASHANTH, POORNIMA K. Large right-sided pneumothorax with Takotsubo cardiomyopathy. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 35:278-280. [PMID: 37167497 DOI: 10.25259/nmji_268_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Patients with left-sided pneumothorax presenting with electrocardiogram (ECG) changes resembling acute coronary syndrome (ACS) have been reported in the literature. Takotsubo cardiomyopathy (TCM) occurs predominantly in post-menopausal women with underlying intense emotional or physical stress. However, as this case report shows, it can complicate any acute illness leading to intense stress. We report a rare combination of ECG changes mimicking ACS in a man with a large right-sided pneumothorax and TCM.
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Affiliation(s)
- MANJAPPA MAHADEVAPPA
- Department of Cardiology, JSS Medical College Hospital, JSSAHER, Mysuru 570004, Karnataka, India
| | - PRASHANTH KULKARNI
- Department of Cardiology, Hospitals, Hitech City, Hyderabad, Telangana, India
| | - K.S. POORNIMA
- Department of Cardiology, JSS Medical College Hospital, JSSAHER, Mysuru 570004, Karnataka, India
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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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Elgazzar A, Surana D, Varma R. Takotsubo cardiomyopathy after microwave ablation of hepatocellular carcinoma. Radiol Case Rep 2023; 18:603-606. [DOI: 10.1016/j.radcr.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/30/2022] Open
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44
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Ghasemi H, Kazemian S, Nejadghaderi SA, Shafie M. Takotsubo syndrome and COVID‐19: A systematic review. Health Sci Rep 2023; 6:e972. [PMID: 36479387 PMCID: PMC9718950 DOI: 10.1002/hsr2.972] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is characterized by acute and transient left ventricular dysfunction and has increased during the COVID-19 pandemic. Herein, we aim to review studies on TTS that were associated with COVID-19 infection, vaccine, and other COVID-19-related etiologies including psychosocial stressors. Methods We systematically searched PubMed, EMBASE, and Scopus up to May 12, 2022. We included case reports, case series, and original articles that reported at least one TTS case associated with COVID-19, or TTS cases after receiving COVID-19 vaccines, or TTS cases secondary to psychological stress due to the COVID-19 pandemic. The quality assessment was conducted using the Joanna Briggs Institute checklist. Results Sixty-seven articles including 102 cases were included. Hypertension was the most frequently accompanying comorbidity (N = 67 [65.6%]) and the mean left ventricular ejection fraction was 36.5%. Among COVID-19 patients, the in-hospital mortality rate was 33.3%. On the other hand, only one COVID-19-negative individual expired (2.3%). The most common presenting clinical symptom was dyspnea in 42 (73.6%) patients. the mean time interval from the first symptom to admission was 7.2 days. The most common chest imaging finding was ground-glass opacity which was reported in 14 (31.1%) participants. The most common abnormalities were T-wave inversion in 35 (43.2%) and ST-segment elevation in 30 (37%). Brain natriuretic peptide and troponin were elevated in 94.7% and 95.9% of participants, respectively. Conclusion The TTS in patients with COVID-19 is almost rare, whereas it could lead to a great mortality and morbidity. An individual with COVID-19, especially an elderly woman, presented with dyspnea in addition to a rise in brain natriuretic peptide and troponin should be evaluated for TTS.
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Affiliation(s)
- Hoomaan Ghasemi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
| | - Sina Kazemian
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Systematic Review and Meta‐Analysis Expert Group (SRMEG) Universal Scientific Education and Research Network (USERN) Tehran Iran
| | - Mahan Shafie
- School of Medicine Tehran University of Medical Sciences Tehran Iran
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Winrich E, Belur AD, Shine A, Jophlin LL. Takotsubo cardiomyopathy following liver transplantation and COVID-19 infection. Proc (Bayl Univ Med Cent) 2022; 36:99-100. [PMID: 36578602 PMCID: PMC9762796 DOI: 10.1080/08998280.2022.2114069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Takotsubo cardiomyopathy involves transient systolic dysfunction of the left ventricle thought to be caused by a physiologic stress response and associated catecholamine release. We present a previously undocumented cause of this stress response involving a 53-year-old man with hepatocellular carcinoma and alcohol-associated cirrhosis who initially presented for liver transplantation. Shortly after successful transplantation, the patient developed a COVID-19 infection and takotsubo cardiomyopathy.
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Affiliation(s)
- Evan Winrich
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Corresponding author: Evan Winrich, MD, Department of Internal Medicine, University of Louisville School of Medicine, 550 S. Jackson St., Ste. A3K00, Louisville, KY40202 (e-mail: )
| | - Agastya D. Belur
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Amal Shine
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky
| | - Loretta L. Jophlin
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky,Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky
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Sethi Y, Murli H, Kaiwan O, Vora V, Agarwal P, Chopra H, Padda I, Kanithi M, Popoviciu MS, Cavalu S. Broken Heart Syndrome: Evolving Molecular Mechanisms and Principles of Management. J Clin Med 2022; 12:jcm12010125. [PMID: 36614928 PMCID: PMC9821117 DOI: 10.3390/jcm12010125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. It can be classified into two main types: Primary and Secondary TS. Primary TS occurs when the symptoms of myocardial damage, which is typically preceded by emotional stress, are the reason for hospitalization. Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions, and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines. The etiopathogenesis is now proposed to include adrenergic hormones/stress, decreased estrogen levels, altered microcirculation, endothelial dysfunction, altered inflammatory response via cardiac macrophages, and disturbances in the brain-heart axis. The role of genetics in disease progression is becoming the focus of several upcoming studies. This review focuses on potential pathophysiological mechanisms for reversible myocardial dysfunction observed in TS, and comprehensively describes its epidemiology, clinical presentation, novel diagnostic biomarkers, and evolving principles of management. We advocate for more research into molecular mechanisms and promote the application of current evidence for precise individualized treatment.
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Affiliation(s)
- Yashendra Sethi
- PearResearch, Dehradun 248001, India
- Department of Medicine, Government Doon Medical College, Dehradun 248001, India
- Correspondence: (Y.S.); (M.S.P.)
| | - Hamsa Murli
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai 400022, India
| | - Oroshay Kaiwan
- PearResearch, Dehradun 248001, India
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Vidhi Vora
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai 400022, India
| | - Pratik Agarwal
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai 400022, India
| | - Hitesh Chopra
- College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India
| | - Inderbir Padda
- Richmond University Medical Center, Staten Island, NY 10310, USA
| | - Manasa Kanithi
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Mihaela Simona Popoviciu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
- Correspondence: (Y.S.); (M.S.P.)
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
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The Role of Stress in Stable Patients with Takotsubo Syndrome-Does the Trigger Matter? J Clin Med 2022; 11:jcm11247304. [PMID: 36555921 PMCID: PMC9787463 DOI: 10.3390/jcm11247304] [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: 10/13/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is a unique type of reversible cardiomyopathy that predominantly affects elderly women. The role of physical and emotional stress in the pathophysiology of TTS is well established. However, the association between preceding emotional triggers and clinical outcomes in stable patients has not yet been fully investigated. We aimed to investigate the association between emotional triggers before symptom onset and clinical outcomes in stable patients with TTS. METHODS This is a retrospective cohort study based on the data of patients with ICD-9 discharge diagnosis of TTS between 2017 and 2022. Patients were divided into two groups: with and without obvious emotional trigger before symptom onset. Demographic, laboratory, echocardiographic, and clinical outcomes were obtained and compared between the two groups. RESULTS We included 86 patients (93% were women, mean age 68.8 ± 12.3 years). Of them, 64 (74.4%) reported an emotional trigger before symptom onset. Patients with a previous emotional trigger had a longer hospital stay (4.3 + 2.0 days vs. 3.0 + 1.4, p = 0.002) with no difference in in-hospital complications (32.8% vs. 13.6%, p = 0.069), with no difference in 30-day mortality, readmissions, or recurrence rate between the groups. CONCLUSIONS Patients with TTS related to an emotional trigger may represent a different population from patients without a preceding trigger by having more symptomatic disease and longer hospital stay, yet with no difference in the 30-day outcomes.
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Dodoo SN, Agyemang‐Sarpong A, Taka N, Akatue RA, Williams ML. Takotsubo cardiomyopathy in the setting of severe hyponatremia and beer potomania: A case report. Clin Case Rep 2022; 10:e6717. [PMID: 36514473 PMCID: PMC9734082 DOI: 10.1002/ccr3.6717] [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: 08/14/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022] Open
Abstract
Takotsubo cardiomyopathy (TC), an acute cardiac event is often associated with acute emotional stress, usually in the setting of cardiovascular risk factors. This case report attempts to review one of the triggers of TC beer potomania-induce hyponatremia with imaging findings that shows the link between severe hyponatremia and TC.
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Affiliation(s)
- Sheriff N. Dodoo
- Department of Hospital MedicinePiedmont Newnan HospitalNewnanGeorgiaUSA,Department of CardiologyNortheast Georgia Medical Center‐Georgia Heart InstituteGainsvilleGeorgiaUSA
| | | | - Nchang Taka
- Department of CardiologyWellStar West Georgia Medical CenterLaGrangeGeorgiaUSA
| | - Richmond A. Akatue
- Department of Internal MedicineMeharry Medical CollegeNashvilleTennesseeUSA
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Impact of left bundle branch block in Takotsubo Syndrome. IJC HEART & VASCULATURE 2022; 43:101123. [PMID: 36176307 PMCID: PMC9513099 DOI: 10.1016/j.ijcha.2022.101123] [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: 07/09/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
Background Left bundle branch block (LBBB) causes left ventricular dyssynchrony, and its presence with concomitant left ventricular dysfunction has been proven to play a synergistic role, worsening ventricular function. Our study seeks to further explore the association between LBBB and various in-hospital outcomes in patients with takotsubo syndrome (TTS). Methods The national inpatient sample was queried from 2016 to 2019 to identify all admissions with a primary diagnosis of TTS. International classification of diseases, tenth revision codes were used to divide patients based on the presence or absence of LBBB. Multivariate regression analysis was performed to assess the effect of LBBB among all the pre-specified outcomes. Results A total of 26,615 admissions were included in the analysis. Admissions with LBBB were more likely to be older (72.2 vs. 66.2 years) and have a higher burden of comorbidities. The presence of a LBBB was associated with ventricular arrhythmias (OR = 1.97, 95% CI 1.08–3.61, p = 0.028) but not with sudden cardiac arrest (SCA), acute heart failure, cardiogenic shock, and all-cause intra-hospital mortality. Conclusions Intraventricular dyssynchrony appears to play a significant role in ventricular arrhythmogenesis and SCA, as several trials have demonstrated that cardiac resynchronization therapy alone without defibrillator function reduces the rate of ventricular arrhythmias and SCA in patients with heart failure with systolic dysfunction and a widened QRS complex. The most likely mechanism of arrhythmia development in TTS is related to the elevated plasma levels of catecholamines and their proarrhythmic effects in the ventricular myocardium.
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Alsheikh H, Shaheen N, Saber W, Meshref M, Amro Y, Shaheen A, Ahmed MG, Swed S. A rare case of Takotsubo syndrome with ventricular septal rupture: Case report. Medicine (Baltimore) 2022; 101:e31674. [PMID: 36451414 PMCID: PMC9704957 DOI: 10.1097/md.0000000000031674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TCM) mimics acute coronary syndrome and is characterized by reversible left ventricular (LV) apical ballooning in the absence of angiographically substantial coronary artery stenosis. PATIENT CONCERNS A 31-year-old man with acute dejection, physical stress, and psychological strain from the dread of losing his work arrived at the emergency department with chest pain, and discomfort that had lasted 3 hours. DIAGNOSIS Once the coronary angiography revealed normal epicardial coronaries, the case was retroactively diagnosed, and the levels of cardiac enzymes were increased. INTERVENTIONS The amount of necrotic tissue was so little that the surgeon could only verbally convey it. It is completely closed with the help of a Dacron sheet. The patient received surgical closure of the VSR a few days after having a surgical consultation. OUTCOMES No postoperative echocardiogram was required, and the patient was sent home in great general condition. CONCLUSION The presence of TCM with a ruptured LV wall was extremely rare because our patient had neither clinical risk indicators nor a family history of coronary artery disease. As a Takotsubo syndrome severe complication, we underline the significance of identifying, diagnosing, and treating it.
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Affiliation(s)
| | - Nour Shaheen
- Alexandria University, Alexandria Faculty of Medicine, Alexandria, Egypt
| | | | | | | | - Ahmed Shaheen
- Alexandria University, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mahmoud Galal Ahmed
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
- *Correspondence: Sarya Swed, Faculty of Medicine, Aleppo University, Aleppo, Syria (e-mail: )
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