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Huang X, Guan B, Ma Y, Tian F, Yu Y, Luo Y, Li Y, Cao J, Deng Y. Values of new ultrasonic imaging methods for the diagnosis of apical Takotsubo syndrome. Quant Imaging Med Surg 2023; 13:1323-1335. [PMID: 36915330 PMCID: PMC10006141 DOI: 10.21037/qims-21-1108] [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: 11/15/2021] [Accepted: 11/03/2022] [Indexed: 12/15/2022]
Abstract
Background Takotsubo syndrome (TTS) is a multifactorial disease contributed to by several pathological factors. It is characterized by transient left ventricular dysfunction, and patients with TTS can spontaneously recover within days or weeks. This study's objective was to investigate the ultrasonic characteristics of TTS during different periods and assess the clinical application value of real-time 3-dimensional echocardiography (RT-3DE) and speckle tracking imaging (STI) in TTS. Methods In this prospective cohort study, the patients with apical TTS were evaluated by echocardiography on admission (within 1-3 days) and after 4 and 8 weeks. RT-3DE was performed to observe the structure and function of the left ventricle (LV). LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV), and ejection fraction (LVEF) were calculated. The longitudinal peak systolic strain (LPSS) of all LV myocardial segments was acquired by 2D STI. For comparison, 20 healthy individuals were included as normal controls. Results A total of 16 patients with TTS were included. Their LV was characterized as an "octopus pot" in morphology with obvious hypokinesis on admission. The LVEDV, LVESV, LVSV, and LVEF were 84.23±10.67, 55.94±8.51, 28.31±8.06 mL, and 33.59%±4.12%, respectively, in patients with TTS on admission with a significant difference from those of the controls (P=0.005, P<0.001, P<0.001, and P<0.001, respectively). A definite improvement was found upon follow-up, with these parameters even returning to normal morphology after 8 weeks. The LVEDV, LVESV, LVSV, and LVEF were 75.79±6.86, 28.05±4.33, 47.81±3.57 mL, and 63.02%±3.92%, respectively, in TTS patients after 8 weeks with no significant difference from those of the controls (P=0.907, P=0.235, P=0.162, and P=0.052, respectively). A significant decrease in LPSS was also found in patients with TTS on admission. In the eighth week of follow-up, the LPSS of the apical and middle segments in TTS patients remained significantly decreased compared with that of the normal controls (-18.54%±4.69% vs. -24.29%±3.46%, P<0.001; -19.38%±2.88% vs. -22.36%±3.23%, P<0.001), but that of the basal segments in TTS patients returned to normal and there was no significant differences from the normal controls (-20.75%±2.91% vs. -21.51%±2.85%; P=0.055). Conclusions RT-3DE and STI played an indispensable role in visually and quantitatively inspecting the abnormalities of patients with TTS, including in diagnosis and follow-up.
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Affiliation(s)
- Xin Huang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bo Guan
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yufei Ma
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Fan Tian
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Yu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yue Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Cao
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yujiao Deng
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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2
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Chen J, Lyu L, Liu Q. Magnetic resonance imaging of takotsubo syndrome triggered by stress. QJM 2022; 115:483-485. [PMID: 35312011 DOI: 10.1093/qjmed/hcac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Chen
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - L Lyu
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
| | - Q Liu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
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Anderson JL, Horne BD, Le VT, Bair TL, Min DB, Minder CM, Dhar R, Mason S, Muhlestein JB, Knowlton KU. Spectrum of radionuclide perfusion study abnormalities in takotsubo cardiomyopathy. J Nucl Cardiol 2022; 29:1034-1046. [PMID: 33090340 DOI: 10.1007/s12350-020-02385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Takotsubo (stress) cardiomyopathy (TCM) is characterized by transient apical left ventricular dysfunction precipitated by emotional or physical stress. Its presentation makes it difficult to differentiate from an acute coronary syndrome. A suggestive echocardiogram plus normal coronary angiography most often are used for diagnosis. Radionuclide perfusion study (RPS) findings in TCM, including by positron emission tomography (PET), have been poorly characterized. METHODS AND RESULTS Intermountain Healthcare electronic medical records were searched from 2009 to 2019 for patients with a discharge diagnosis of TCM, stress CM, or takotsubo syndrome. 16 TCM patients with an RPS, including by PET in 8, were identified: 13 (81%) were women; age averaged 72 years (50-89 years); 14 had an identified stressor. TCM diagnosis was definite in 11 and probable/possible in 5. RPS was abnormal in 11, with 9 showing an apical perfusion deficit, whereas angiography in 14 showed normal coronaries in 12 and non-obstructive disease in 2. Echo ejection fraction averaged 41% (29%-60%); an apical wall motion abnormality was present in 14 (88%). Troponin elevations were noted in 14/15. The presenting ECG was abnormal is 14, frequently showing ST-T-wave abnormalities. 13 patients were discharged on a beta-blocker. Follow-up echo (in 12) showed recovered ejection fraction in 9 and recovered apical wall motion in 11. CONCLUSIONS Despite having normal or non-obstructive epicardial coronary arteries on angiography, TCM patients frequently present with apical wall motion abnormalities and matching RPS perfusion defects. These findings suggest microvascular abnormalities, whose pathophysiology, temporal course, and clinical implications should be the subject of further investigation.
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Affiliation(s)
- Jeffrey L Anderson
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA.
- University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, USA.
| | - Benjamin D Horne
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Viet T Le
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA.
- Rocky Mountain University of Health Professions, Provo, UT, USA.
| | - Tami L Bair
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - David B Min
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - C Michael Minder
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - Ritesh Dhar
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - Steve Mason
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
| | - Joseph B Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
- University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, USA
| | - Kirk U Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Salt Lake City, UT, 84107, USA
- University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, USA
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Obrutu O, Maughan J, Tjoe B, Herscovici R, Moy P, Rojas N, Wei J, Shufelt C, Rutledge T, Merz CNB. Smidt Heart Institute Takotsubo Registry - Study design and baseline characteristics. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100086. [PMID: 38560083 PMCID: PMC10978169 DOI: 10.1016/j.ahjo.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 04/04/2024]
Abstract
Background Takotsubo syndrome (TTS) is an acute form of transient systolic heart failure that occurs predominantly among women and in association with emotional or physical stressors. The Smidt Heart Institute Takotsubo Registry aims to establish a database through an online patient-advocate registry for deep phenotyping of this syndrome. Methods The Takotsubo Registry is a retrospective and prospective observational registry of individuals with a prior history of TTS. Participants are sourced through physician referrals, medical records review, peer- and self-referrals using social media. Research Electronic Data Capture (REDCap) and Mitra® microsamplers are used to collect questionnaire data and blood samples to facilitate completely remote study enrollment and participation for most participants. Results From January 2019 to May 2021, 125 participants (99% female, mean age: 61.5 ± 9.9 years) enrolled in the registry across 25 US states and 3 international countries, with reported first TTS event a median of 2 years prior to enrollment. Psychosocial characteristics determined by standardized questionnaires at baseline include relatively high anxiety trait (44%), moderate to severe depression severity (19%), moderate to high severity of posttraumatic stress disorder symptoms (58%) and a history of childhood trauma/abuse (50%). Conclusions The Smidt Heart Institute Takotsubo Registry will contribute to advancing the management of TTS by deep phenotyping to understand its pathophysiology, and identify treatment targets in a participant base for future clinical trials.
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Affiliation(s)
- Okezi Obrutu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Jenna Maughan
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Benita Tjoe
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Romana Herscovici
- The Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Prizzi Moy
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Natalie Rojas
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Thomas Rutledge
- VA San Diego Healthcare System, San Diego, CA, United States of America
- Department of Psychiatry, University of California, San Diego, CA, United States of America
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
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Jahangir A, Rafay Khan Niazi M, Sahra S, Javed A, Krzyzak M. An Unfortunate Case of Takotsubo Cardiomyopathy During Plasmapheresis for Myasthenia Crisis. Cureus 2022; 14:e20865. [PMID: 35145772 PMCID: PMC8803300 DOI: 10.7759/cureus.20865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 11/05/2022] Open
Abstract
A literature review shows scarce reports of myasthenic crises (MC) complicated by Takotsubo cardiomyopathy (TC). This patient cohort (0.11%) has higher all-cause mortality and prolonged in-hospital course. We present a rare case of a 72-year-old man who developed cardiogenic shock post-plasmapheresis for myasthenia crisis. He became hemodynamically unstable and developed acute respiratory failure requiring intubation 30 minutes after completion of plasma exchange. Serum troponin peaked at 3.19 ng/mL while an emergent 12-lead electrocardiogram (EKG) showed new-onset diffuse ST-segment elevation. Hypokinesis of the entire apex, anterior septum, mid-and apical inferior septum, and mid-and apical inferior wall consistent with Takotsubo cardiomyopathy was seen on bedside echocardiogram. The patient received a continuous infusion of norepinephrine and vasopressin. The hospital course was complicated by multiorgan failure and eventual demise. This case highlights MC and the potential of plasma exchange therapy to induce TC.
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Casagrande M, Forte G, Favieri F, Agostini F, Giovannoli J, Arcari L, Passaseo I, Semeraro R, Camastra G, Langher V, Pazzaglia M, Cacciotti L. The Broken Heart: The Role of Life Events in Takotsubo Syndrome. J Clin Med 2021; 10:4940. [PMID: 34768460 PMCID: PMC8585024 DOI: 10.3390/jcm10214940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/30/2023] Open
Abstract
The onset of Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is thought to be associated with some life events. This study focuses on clarifying life event characteristics and the role of triggers in the onset of TTS. Participants with TTS (n = 54) were compared to those with acute myocardial infarction (AMI; n = 52) and healthy individuals (n = 54). Using a modified version of the Interview for Recent Life Events, information about general life events perceived as stressful and triggers preceding the onset of a cardiac syndrome was collected. The assessment included the impact of these events as indicated by the participants and estimated by the interviewer; finally, the objective impact was considered. Although the number of events and the objective impact did not differ among the groups, patients with TTS reported a more negative perceived impact. Moreover, 61% of these patients objectively and subjectively reported a more stressful trigger before the onset of the disease (in the 24 h preceding the cardiac event) than those reported by patients with AMI. The dynamic between life events and individual responses could help differentiate TTS from other cardiovascular events, such as AMI. This study suggests that patients' perception of some life events (whether triggers or general life events) could represent a possible marker of TTS.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Agostini
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Jasmine Giovannoli
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Luca Arcari
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Ilaria Passaseo
- Divisione di Cardiologia, Policlinico Casilino, Via Casilina, 00169 Roma, Italy;
| | - Raffaella Semeraro
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Giovanni Camastra
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Viviana Langher
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Luca Cacciotti
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
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Maier T, Kugelmann M, Rhee DS, Brill S, Gündel H, Friemert B, Becker HP, Waller C, Rappel M. Structural Equation Modeling of a Global Stress Index in Healthy Soldiers. J Clin Med 2021; 10:jcm10081799. [PMID: 33924268 PMCID: PMC8074902 DOI: 10.3390/jcm10081799] [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: 02/04/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Accumulation of stress is a prognostic trigger for cardiovascular disease. Classical scores for cardiovascular risk estimation typically do not consider psychosocial stress. The aim of this study was to develop a global stress index (GSI) from healthy participants by combining individual measures of acute and chronic stress from childhood to adult life. One-hundred and ninety-two female and male soldiers completed the Perceived Stress Scale (PSS4), Trier Inventory for Chronic Stress (TICS), Hospital Anxiety and Depression Scale (HADS), Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale Checklist (PDS), and the Deployment Risk and Resilience Inventory (DRRI-2). The underlying structure for the GSI was examined through structural equation modeling. The final hierarchical multilevel model revealed fair fit by taking modification indices into account. The highest order had a g-factor called the GSI. On a second level the latent variables stress, HADS and CTQ were directly loading on the GSI. A third level with the six CTQ subscales was implemented. On the lowest hierarchical level all manifest variables and the DRRI-2/PDS sum scores were located. The presented GSI serves as a valuable and individual stress profile for soldiers and could potentially complement classical cardiovascular risk factors.
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Affiliation(s)
- Tanja Maier
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
- Correspondence:
| | - Melanie Kugelmann
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | - Dae-Sup Rhee
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | | | - Harald Gündel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | | | | | - Christiane Waller
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
- Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University of Nueremberg, 90419 Nueremberg, Germany
| | - Manuela Rappel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
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Pastore MC, Mandoli GE, Contorni F, Cavigli L, Focardi M, D'Ascenzi F, Patti G, Mondillo S, Cameli M. Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6685378. [PMID: 33623788 PMCID: PMC7875622 DOI: 10.1155/2021/6685378] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/12/2020] [Accepted: 01/23/2021] [Indexed: 01/24/2023]
Abstract
Echocardiography represents a first level technique for the evaluation of coronary artery disease (CAD) which supports clinicians in the diagnostic and prognostic workup of these syndromes. However, visual estimation of wall motion abnormalities sometimes fails in detecting less clear or transient myocardial ischemia and in providing accurate differential diagnosis. Speckle tracking echocardiography (STE) is a widely available noninvasive tool that could easily and quickly provide additive information over basic echocardiography, since it is able to identify subtle myocardial damage and to localize ischemic territories in accordance to the coronary lesions, obtaining a clear visualization with a "polar map" useful for differential diagnosis and management. Therefore, it has increasingly been applied in acute and chronic coronary syndromes using rest and stress echocardiography, showing good results in terms of prediction of CAD, clinical outcome, left ventricular remodeling, presence, and quantification of new/residual ischemia. The aim of this review is to illustrate the current available evidence on STE usefulness for the assessment and follow-up of CAD, discussing the main findings on bidimensional and tridimensional strain parameters and their potential application in clinical practice.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Francesco Contorni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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9
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Al-Tkrit A, Mekaiel A, Aneeb M, Alawawdeh F, Mangla A. Left Ventricular Free Wall Rupture in Broken-Heart Syndrome: A Fatal Complication. Cureus 2020; 12:e11316. [PMID: 33282591 PMCID: PMC7714725 DOI: 10.7759/cureus.11316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy is usually a transient condition and is treated conservatively. It is rarely associated with ventricular free wall rupture, a fatal complication of the disease described in this report. Cardiothoracic surgery performed emergent ventricular wall repair; however, treatment was unsuccessful, and the patient expired.
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Affiliation(s)
- Amna Al-Tkrit
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Andrew Mekaiel
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Mohammad Aneeb
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Firas Alawawdeh
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Aditya Mangla
- Cardiology, Jamaica Hospital Medical Center, Queens, USA
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Moffet EW, Bhattal GK, Simpkins AN, Petersen JW. A biventricular takotsubo cardiomyopathy complication: large thrombus formation to stroke in 150 min. BMJ Case Rep 2020; 13:13/9/e235957. [PMID: 32878833 DOI: 10.1136/bcr-2020-235957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 67-year-old postmenopausal African American woman presented with biventricular takotsubo cardiomyopathy (TTC)-evidenced by transthoracic echocardiography (TTE) showing apical akinesis of both left and right ventricles in the absence of obstructive coronary artery disease on left heart catheterisation. On the 4th hospital day, she experienced acute left facial droop, dysarthria and dysphagia. CT of the head showed a wedge infarct of the right middle cerebral artery territory. Cardioembolism was presumed after intracranial and extracranial sources of thromboembolism were ruled out. Intravenous tissue plasminogen activator (tPA) was administered with resolution of symptoms. She was later discharged without neurological deficits. Crucially, repeat TTE after tPA infusion revealed a left ventricular mass concerning for thrombus. TTE 150 min prior to stroke onset was devoid of a mass. This case uniquely illustrates the potential for rapid thrombus formation and embolism in patients with TTC. As such, it emphasises the high index of suspicion required for management of these patients.
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Affiliation(s)
- Eric W Moffet
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA .,Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Alexis N Simpkins
- Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - John W Petersen
- Cardiology, University of Florida College of Medicine, Gainesville, Florida, USA
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11
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Nair R, Lak H, Ahmed T, Maroo A. Broken Heart Syndrome Secondary To Liver Abscess. Cureus 2020; 12:e6804. [PMID: 32140362 PMCID: PMC7047347 DOI: 10.7759/cureus.6804] [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: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/06/2022] Open
Abstract
Takotsubo cardiomyopathy is a well-known mimicker of acute coronary syndrome and is most often seen in postmenopausal women. Though it is most commonly observed after a stressful emotional episode, several infections have also been shown to precipitate this. Here, we describe a unique case of takotsubo cardiomyopathy that was precipitated by liver abscess induced sepsis.
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Affiliation(s)
- Raunak Nair
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Hassan Lak
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Taha Ahmed
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Anjli Maroo
- Cardiology, Cleveland Clinic - Fairview Hospital, Cleveland, USA
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