1
|
Lei J, Chen J, Dogra M, Gebska MA, Shetty S, Ponnapureddy R, Roy SD, Wang J, Liu K. “Takotsubo effect” in patients with ST segment elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:711-720. [DOI: 10.1177/2048872620926680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background
Myocardial infarction can be a trigger of Takotsubo syndrome. We recently characterized imaging features of acute myocardial infarction-induced Takotsubo syndrome (“Takotsubo effect”). In this study, we investigate diagnostic and prognostic implications of Takotsubo effect in patients with anterior wall ST-segment elevation myocardial infarction.
Methods
We enrolled 111 consecutive patients who developed anterior wall ST-segment elevation myocardial infarction and received percutaneous coronary intervention, and studied systolic/diastolic function, hemodynamic consequences, adverse cardiac events, as well as 30-day and five-year outcomes in patients with and without Takotsubo effect.
Results
Patients with Takotsubo effect showed significantly worse average peak systolic longitudinal strain (–9.5 ± 2.6% vs –11.1 ± 3.6%, p = 0.038), left ventricular ejection fraction (38.5 ± 6.8% vs 47.7 ± 8.7%, p = 0.000) and myocardial performance index (0.54 ± 0.17 vs 0.37 ± 0.15, p = 0.000) within 48 h of myocardial infarction. There was no significant difference between the two groups in diastolic ventricular filling pressures, hemodynamic consequences, and 30-day rehospitalization and mortality (Gehan-Breslow-Wilcoxon test: p = 0.157). However, patients with Takotsubo effect developed more major adverse cardiac events (log-rank test: p = 0.019) when tested at the five-year follow-up. Cox regression analysis revealed that age, hypotension, tricuspid annular plane systolic excursion, and Takotsubo effect were independent prediction factors for five-year major adverse cardiac events. The Doppler/tissue Doppler parameter E/e’ correlated with MACE only in patients without Takotsubo effect.
Conclusion
Takotsubo effect secondary to anterior ST-segment elevation myocardial infarction predicts a worse long-term prognosis.
Collapse
Affiliation(s)
- Juan Lei
- Division of Cardiology, State University of New York, USA
- Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, China
| | - Jian Chen
- Division of Cardiology, State University of New York, USA
- Division of Cardiology, Cardiovascular Centre, the Fifth Affiliated Hospital of Sun Yat-sen University, China
| | - Megha Dogra
- Division of Cardiology, State University of New York, USA
| | | | | | | | | | - Jingfeng Wang
- Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, China
| | - Kan Liu
- Division of Cardiology, State University of New York, USA
- Division of Cardiology, University of Iowa, USA
| |
Collapse
|
2
|
Sharkey SW, Kalra A, Henry TD, Smith TD, Pink VR, Lesser JR, Garberich RF, Maron MS, Maron BJ. Coexistence of acute takotsubo syndrome and acute coronary syndrome. Catheter Cardiovasc Interv 2019; 96:825-829. [PMID: 31696663 DOI: 10.1002/ccd.28595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2019] [Accepted: 10/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Takotsubo syndrome (TS) is an acute cardiac condition with presentation indistinguishable from acute coronary syndrome (ACS), and mechanism independent of epicardial coronary obstruction. Acute coronary artery plaque rupture/occlusion is not expected in TS. Nonetheless, the physiologic stress of ACS might itself trigger TS, leading to coexistence of both conditions, and diagnostic uncertainty. METHODS From 2011 to 2014, we encountered 137 consecutive patients with typical TS (without acute coronary plaque rupture/occlusion). During this time, among a population of 3,506 consecutive ACS patients, nine (0.3%) presented with features of both ACS and TS, that is, acute onset, troponin elevation, acute plaque rupture/occlusion, and reversible LV ballooning not corresponding to culprit coronary distribution. RESULTS The nine patients (seven female) with TS-ACS coexistence, average age 70 ± 13 years, presented with chest pain (n = 6), nausea/vomiting (n = 2), or cardiac arrest (n = 1), ST-elevation (n = 5), all with troponin elevation (peak 1.3 ± 1.2 ng/ml). Each had single vessel coronary disease; right coronary (n = 3), circumflex (n = 3), mid-LAD (n = 2), ramus intermedius (n = 1), with percutaneous coronary intervention in seven patients (78%). Initial ejection fraction was 26 ± 7%, with apical ballooning in eight patients and mid-LV ballooning in one patient. Each patient had LV ballooning resolution and ejection fraction normalization to 57 ± 3%, hospital survival was 89%. CONCLUSIONS Among patients with ACS, a subset have evidence of coexisting TS, findings which further expand the clinical profile of both conditions, raising the possibility that ACS itself may trigger TS.
Collapse
Affiliation(s)
- Scott W Sharkey
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ankur Kalra
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.,Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Timothy D Smith
- Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | - Victoria R Pink
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - John R Lesser
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ross F Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| | - Barry J Maron
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.,Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
3
|
Qiu Q, Abdelghany M, Subedi R, Scalzetti E, Feiglin D, Wang J, Liu K. Discrepant myocardial microvascular perfusion and mechanics after acute myocardial infarction: Characterization of the "Tako-tsubo effect" with real-time myocardial perfusion contrast echocardiograph. Int J Cardiol 2018; 276:1-7. [PMID: 30413307 DOI: 10.1016/j.ijcard.2018.09.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/11/2018] [Accepted: 09/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with acute anterior myocardial infarction (MI), sometimes an "apical ballooning" contractile dysfunction pattern that exceeds factual myocardial injury is identified in the ventriculography and bedside echocardiography. The hemodynamic consequences/sequela of this "Tako-tsobu effect" has not been well delineated. Of note, this anatomic imaging finding often misleads frontline physicians who assume reciprocal causation of persistent cardiac pump failure and ventricular pressure overload. METHODS AND RESULTS Using real-time myocardial perfusion contrast echocardiography (MCE), we investigated myocardial (microvascular) perfusion in 60 patients after acute MI and coronary revascularization. Twenty-eight percent of the studied patients showed significantly mismatched myocardial perfusion and contractile defects. In these patients, an integrated imaging assessment with coronary angiography/ventriculography, deformation echocardiography, and MCE proved that the myocardial mechanic abnormalities significantly exceeded the defected perfusion areas. Compared with 72% of the patients without perfusion-contractility mismatch, apparently worse systolic functions (left ventricular ejection, wall motion score, and systolic longitudinal strain) in these patients did not change diastolic ventricular filling pressures (E/E' and E/A) or hemodynamic consequences/adverse events. Both systolic and diastolic functions in patients with perfusion-contractility mismatch appeared to be comparable with those in patients with Tako-tsubo syndrome. CONCLUSIONS Real-time MCE identifies discrepant myocardial microvascular perfusion and mechanics in patients with acute MI. The "Tako-tsubo effect" in patients with perfusion-contractility mismatch does not cause diastolic filling pressure change or worse hemodynamic consequence/cardiac event.
Collapse
Affiliation(s)
- Qiong Qiu
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America; Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Mahmoud Abdelghany
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - Rogin Subedi
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - Ernest Scalzetti
- Department of Radiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - David Feiglin
- Department of Radiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America
| | - Jingfeng Wang
- Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.
| | - Kan Liu
- Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America.
| |
Collapse
|
4
|
Bill V, El-Battrawy I, Schramm K, Ansari U, Hoffmann U, Haghi D, Kuschyk J, Borggrefe M, Akin I. Coincidental coronary artery disease impairs outcome in patients with takotsubo cardiomyopathy. QJM 2017; 110:483-488. [PMID: 28340038 DOI: 10.1093/qjmed/hcx035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND AIM Takotsubo cardiomyopathy (TC) is an important differential diagnosis of coronary artery disease (CAD), mimicking acute coronary syndrome in clinical symptoms, biomarker profiles and ST-elevation in ECG. Absence of occlusive coronary disease is an essential criterion distinguishing both diseases. The aim of the study was to explore the influence of co-existing incidental CAD on poorer clinical outcomes and all-cause mortality in TC. DESIGN, METHODS AND RESULTS Our mono-centric study cohort constituted 114 consecutive patients diagnosed with TC between 2003 and 2015. The primary endpoint was the all-cause mortality. Additionally, we compared the incidence of thromboembolic events, life-threatening arrhythmias, cardiogenic shock and in-hospital death. There was no significant difference in gender distribution or mean age in both groups. Patients diagnosed with a co-existing CAD (n = 22), had a more pronounced cardiovascular risk profile. The all-cause mortality among patients with co-existing CAD after a 2-year follow-up was higher than those diagnosed with lone TC (22.7 vs. 5.4 %, P = 0.07). In a multivariate cox regression analysis CAD (HR 3.5, 95 %CI 1.0-11.6; P = 0.04), LVEF ≤ 35% (HR 3.8, 95% CI 0.0-0.6, P = 0.01) and cardiogenic shock (HR 3.8, 95% CI 1.2-11.3; P = 0.01) were independent predictors of the primary endpoint. CONCLUSION Our study reveals that co-existing CAD impairs the outcome in patients with TC. The diagnostic work-up for TC should therefore not necessarily hinge on ruling out CAD.
Collapse
Affiliation(s)
- V Bill
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - I El-Battrawy
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - K Schramm
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - U Ansari
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - U Hoffmann
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - D Haghi
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - J Kuschyk
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - M Borggrefe
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| | - I Akin
- First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany
| |
Collapse
|
5
|
Cardioembolic acute myocardial infarction associated with apical ballooning: Considerations. Int J Cardiol 2015; 192:16-7. [DOI: 10.1016/j.ijcard.2015.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022]
|