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Pambianchi G, Marchitelli L, Cundari G, Ruoli L, Conia L, Catalano C, Galea N. Takotsubo syndrome: left atrial and ventricular myocardial strain impairment in the subacute and convalescent phases assessed by CMR. Eur Radiol Exp 2024; 8:34. [PMID: 38413432 PMCID: PMC10899127 DOI: 10.1186/s41747-024-00423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique. METHODS We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30 days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7 days) and 31 during the convalescence (cTTS, 8-30 days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls. RESULTS All patients were women (mean age 63 years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670). CONCLUSIONS LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery. RELEVANCE STATEMENT Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies. KEY POINTS • In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS.
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Affiliation(s)
- Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Letizia Ruoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy.
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Celeski M, Nusca A, De Luca VM, Antonelli G, Cammalleri V, Melfi R, Mangiacapra F, Ricottini E, Gallo P, Cocco N, Rinaldi R, Grigioni F, Ussia GP. Takotsubo Syndrome and Coronary Artery Disease: Which Came First-The Chicken or the Egg? J Cardiovasc Dev Dis 2024; 11:39. [PMID: 38392253 PMCID: PMC10889783 DOI: 10.3390/jcdd11020039] [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: 01/07/2024] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Takotsubo syndrome (TTS) is a clinical condition characterized by temporary regional wall motion anomalies and dysfunction that extend beyond a single epicardial vascular distribution. Various pathophysiological mechanisms, including inflammation, microvascular dysfunction, direct catecholamine toxicity, metabolic changes, sympathetic overdrive-mediated multi-vessel epicardial spasms, and transitory ischemia may cause the observed reversible myocardial stunning. Despite the fact that TTS usually has an acute coronary syndrome-like pattern of presentation, the absence of culprit atherosclerotic coronary artery disease is often reported at coronary angiography. However, the idea that coronary artery disease (CAD) and TTS conditions are mutually exclusive has been cast into doubt by numerous recent studies suggesting that CAD may coexist in many TTS patients, with significant clinical and prognostic repercussions. Whether the relationship between CAD and TTS is a mere coincidence or a bidirectional cause-and-effect is still up for debate, and misdiagnosis of the two disorders could lead to improper patient treatment with unfavourable outcomes. Therefore, this review seeks to provide a profound understanding of the relationship between CAD and TTS by analyzing potential common underlying pathways, addressing challenges in differential diagnosis, and discussing medical and procedural techniques to treat these conditions appropriately.
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Affiliation(s)
- Mihail Celeski
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Annunziata Nusca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valeria Maria De Luca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giorgio Antonelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valeria Cammalleri
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rosetta Melfi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Fabio Mangiacapra
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Elisabetta Ricottini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Paolo Gallo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Nino Cocco
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Raffaele Rinaldi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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3
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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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4
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Cau R, Pisu F, Porcu M, Cademartiri F, Montisci R, Bassareo P, Muscogiuri G, Amadu A, Sironi S, Esposito A, Suri JS, Saba L. Machine learning approach in diagnosing Takotsubo cardiomyopathy: The role of the combined evaluation of atrial and ventricular strain, and parametric mapping. Int J Cardiol 2023; 373:124-133. [PMID: 36410545 DOI: 10.1016/j.ijcard.2022.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) is a key diagnostic tool in the differential diagnosis between non-ischemic cause of cardiac chest pain. Some patients are not eligible for a gadolinium contrast-enhanced CMR; in this scenario, the diagnosis remains challenging without invasive examination. Our purpose was to derive a machine learning model integrating some non-contrast CMR parameters and demographic factors to identify Takotsubo cardiomyopathy (TTC) in subjects with cardiac chest pain. MATERIAL AND METHODS Three groups of patients were retrospectively studied: TTC, acute myocarditis, and healthy controls. Global and regional left ventricular longitudinal, circumferential, and radial strain (RS) analysis included were assessed. Reservoir, conduit, and booster bi-atrial functions were evaluated by tissue-tracking. Parametric mapping values were also assessed in all the patients. Five different tree-based ensemble learning algorithms were tested concerning their ability in recognizing TTC in a fully cross-validated framework. RESULTS The CMR-based machine learning (ML) ensemble model, by using the Extremely Randomized Trees algorithm with Elastic Net feature selection, showed a sensitivity of 92% (95% CI 78-100), specificity of 86% (95% CI 80-92) and area under the ROC of 0.94 (95% CI 0.90-0.99) in diagnosing TTC. Among non-contrast CMR parameters, the Shapley additive explanations analysis revealed that left atrial (LA) strain and strain rate were the top imaging markers in identifying TTC patients. CONCLUSIONS Our study demonstrated that using a tree-based ensemble learning algorithm on non-contrast CMR parameters and demographic factors enables the identification of subjects with TTC with good diagnostic accuracy. TRANSLATIONAL OUTLOOK Our results suggest that non-contrast CMR features can be implemented in a ML model to accurately identify TTC subjects. This model could be a valuable tool for aiding in the diagnosis of subjects with a contraindication to the contrast media. Furthermore, the left atrial conduit strain and strain rate were imaging markers that had a strong impact on TTC identification. Further prospective and longitudinal studies are needed to validate these findings and assess predictive performance in different cohorts, such as those with different ethnicities, and social backgrounds and undergoing different treatments.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
| | - Michele Porcu
- Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
| | | | - Roberta Montisci
- Department of Cardiology, Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
| | - Pierpaolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy; University Milano Bicocca, Italy
| | | | - Sandro Sironi
- Department of Radiology, University of Milan-Bicocca, Milan, Italy
| | | | - Jasjit S Suri
- Stroke Monitoring and Diagnosis Division, AtheroPoint(tm) Roseville, CA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy.
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Atrial Impairment as a Marker in Discriminating Between Takotsubo and Acute Myocarditis Using Cardiac Magnetic Resonance. J Thorac Imaging 2022; 37:W78-W84. [PMID: 36306267 DOI: 10.1097/rti.0000000000000650] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to comprehensively compare the left and right atrium strain and strain rate (SR) parameters by cardiac magnetic resonance (CMR) between patients with Takotsubo (TS) and patients with acute myocarditis (AM). MATERIALS AND METHODS We retrospectively enrolled 3 groups of patients: TS (n=18), AM (n=14), and 11 healthy subjects. All the patients had complete CMR data for features tracking assessment.Differences in reservoir, conduit strain (εe), conduit strain rate (SRe), and booster phase of biatrial strain were analyzed between the groups using analysis of variance and multivariate analysis of covariance analyses. Intraobserver and interobserver reproducibility was assessed for all strain and SR parameters using intraclass correlation coefficients and Bland-Altman analysis. RESULTS Atrial strain was feasible in all patients and controls. In TS, left atrium (LA) reservoir strain (εs), reservoir SR, εe, and SRe were significantly lower compared with the other groups (P=0,001 for all). multivariate analysis of covariance analysis showed association of these parameters after correction for age and sex, while LA booster deformation (εa and SRa) strain parameters were preserved. LA SRe proved to have excellent sensitivity in differentiating patients with TS from those with AM (areas under the curves of 0.903, 95% confidence interval: 0.81-0.99).Biatrial strain and SR parameters showed good (excellent) intraobserver and interobserver reproducibility (ranged between 0.61 to 0.96 and 0.50 to 0.90, respectively). CONCLUSION Compared with AM, patients with TS showed significantly decreased LA reservoir, conduit strain, and SR parameters. Therefore, LA strain assessment may have a role in discriminating between TS and AM.
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Koniari I, Papageorgiou A, Artopoulou E, Velissaris D, Mplani V, Kounis N, Hahalis G, Tsigkas G. Prevalence and Impact of Atrial Fibrillation on Prognosis in Takotsubo Cardiomyopathy Patients. Angiology 2022; 73:800-808. [PMID: 35236144 DOI: 10.1177/00033197221079331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this review is to describe the impact of atrial fibrillation (AF) on the cardiovascular outcomes and prognosis in patients with Takotsubo Cardiomyopathy (TTC). The pathophysiological basis of TTC is set on the release of catecholamines, occurring post an emotional or stressful event. The cardiovascular system of patients with TTC is affected by the high concentrations of catecholamines, creating the ideal background for the development of AF: inflammation, myocardial stress, and excessive sympathetic activity. AF is considered to be the most frequent arrhythmia in TTC patients and is associated with higher rates of cardiovascular and all-cause mortality. AF is also linked with a worse prognosis concerning the hemodynamic status, cardiac fibrosis, lethal arrhythmias, thromboembolic events, and adverse heart failure associated outcomes. The early diagnosis of AF in these patients plays significant role in the prevention of adverse events, the reversibility of left ventricular function, and the restoration of sinus rhythm.
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Affiliation(s)
- Ioanna Koniari
- Department of Cardiology, NHS Foundation Trust, University Hospital of South Manchester, Manchester, UK
| | | | - Eleni Artopoulou
- Department of Internal Medicine, 37795University Hospital of Patras, Patras, Greece
| | - Dimitrios Velissaris
- Department of Internal Medicine, 37795University Hospital of Patras, Patras, Greece
| | - Virginia Mplani
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
| | - Nicholas Kounis
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
| | - George Hahalis
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, 37795University Hospital of Patras, Patras, Greece
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7
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Stepwise approach for diagnosis and management of Takotsubo syndrome with cardiac imaging tools. Heart Fail Rev 2022; 27:545-558. [PMID: 35040000 DOI: 10.1007/s10741-021-10205-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
Takotsubo syndrome is featured by transient left ventricle dysfunction in the absence of significant coronary artery disease, mainly triggered by emotional or physical stress. Its clinical presentation is similar to acute coronary syndrome; therefore, cardiac imaging tools have a crucial role. Coronary angiography is mandatory for exclusion of pathological stenosis. On the other side, transthoracic echocardiography is the first non-invasive imaging modality for an early evaluation of left ventricle systolic and diastolic function. Left ventricle morphologic patterns could be identified according to the localization of wall motion abnormalities. Moreover, an early identification of potential mechanical and electrical complications such as left ventricle outflow tract obstruction, mitral regurgitation, thrombus formation, right ventricular involvement, cardiac rupture, and cardiac rhythm disorders could provide additional information for clinical management and therapy. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. Advanced techniques, including speckle-tracking echocardiography, cardiac magnetic resonance, and nuclear imaging can provide mechanistic and pathophysiologic insights into this syndrome. This review focuses on these aspects and provide a stepwise approach of all cardiac imaging tools for the diagnosis and the management of Takotsubo syndrome.
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8
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Omerovic E, Citro R, Bossone E, Redfors B, Backs J, Bruns B, Ciccarelli M, Couch LS, Dawson D, Grassi G, Iacoviello M, Parodi G, Schneider B, Templin C, Ghadri JR, Thum T, Chioncel O, Tocchetti CG, Van Der Velden J, Heymans S, Lyon AR. Pathophysiology of Takotsubo Syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 1: Overview and the central role for catecholamines and sympathetic nervous system. Eur J Heart Fail 2021; 24:257-273. [PMID: 34907620 DOI: 10.1002/ejhf.2400] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022] Open
Abstract
This is the first part of a scientific statement from the Heart Failure Association of the European Society of Cardiology focused upon the pathophysiology of Takotsubo syndrome and is complimentary to the previous HFA Position Statement on Takotsubo syndrome which focused upon clinical management. In part 1 we provide an overview of the pathophysiology of Takotsubo syndrome and fundamental questions to consider. We then review and discuss the central role of catecholamines and the sympathetic nervous system in the pathophysiology, and the direct effects of high surges in catecholamines upon myocardial biology including β-adrenergic receptor signaling, G protein coupled receptor kinases, cardiomyocyte calcium physiology, myofilament physiology, cardiomyocyte gene expression, myocardial electrophysiology and arrhythmogenicity, myocardial inflammation, metabolism and energetics. The integrated effects upon ventricular haemodynamics are discussed and integrated into the pathophysiological model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, A. Cardarelli Hospital, Naples, Italy
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany
| | - Bastian Bruns
- Institute of Experimental Cardiology, Heidelberg University, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany.,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Michele Ciccarelli
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Liam S Couch
- National Heart and Lung Institute, Imperial College, London, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Hospital, Bari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania and University of Medicine Carol Davila, Bucharest, Romania
| | - C Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | | | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, The Netherlands and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology and Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College, London, UK.,Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
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Cau R, Bassareo P, Caredda G, Suri JS, Esposito A, Saba L. Atrial Strain by Feature-Tracking Cardiac Magnetic Resonance Imaging in Takotsubo Cardiomyopathy. Features, Feasibility, and Reproducibility. Can Assoc Radiol J 2021; 73:573-580. [PMID: 34615401 DOI: 10.1177/08465371211042497] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate whether there may be a bi-atrial dysfunction in Takotsubo syndrome (TS) during the transient course of the disease, using cardiac magnetic resonance imaging feature tracking (CMR-FT) in analyzing bi-atrial strain. METHOD Eighteen TS patients and 13 healthy controls were studied. Reservoir, conduit, and booster bi-atrial functions were analyzed by CMR-FT. The correlation between LA and RA strain parameters was assessed. Intra- and inter-observer reproducibility was evaluated for all strain and strain rate (SR) parameters using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. RESULTS Atrial strain were feasible in all patients and controls. Takotsubo patients showed an impaired LA Reservoir strain (∊s), LA Reservoir strain rate (SRs), LA and RA Conduit strain(∊e), LA and RA conduit strain rate (SRe) in comparison with controls (P < 0.001 for all of them), while no differences were found as to LA and RA booster deformation parameters (∊a and SRa). Analysis of correlation showed that LA ∊s, SRs, ∊e, and SRe were positively correlated with corresponding RA strain measurements (P < 0.001, r = 0.61 and P = 0,03, r = 0,54, respectively). Reproducibility was good to excellent for all atrial strain and strain rate parameters (ICCs ranging from 0,50 to 0,96). CONCLUSION Atrial strain analysis using CMR-FT may be a useful tool to reveal new pathophysiological insights in Takotsubo cardiomyopathy. Additional studies, with a larger number of patients, are needed to confirm the possible role of these advanced CMR tools in characterizing TS patients.
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Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Pierpaolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital, Crumlin, Dublin, Republic of Ireland
| | - Gloria Caredda
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
| | - Jasjit S Suri
- Stroke Diagnosis and Monitoring DivisionAtheroPoint, Roseville, CA, USA
| | - Antonio Esposito
- IRCCS San Raffaele Scientific Institute, Milano, Lombardia, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato (Cagliari), Italy
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Abstract
PURPOSE OF REVIEW Takotsubo syndrome (TTS) is a transient but severe myocardial dysfunction that has been known for decades and is still to be fully understood regarding its clinical presentations and pathophysiological mechanisms. Cardiac magnetic resonance (CMR) imaging plays a key role in the comprehensive analysis of patients with TTS in acute and follow-up examinations. In this review, we focus on the major advantages and latest evolutions of CMR in diagnosis and prognostication of TTS and discuss future perspectives and needs in the field of research and cardiovascular imaging in TTS. RECENT FINDINGS Specific CMR criteria for TTS diagnosis at the time of acute presentation are established. In addition to identifying the typical regional wall motion abnormalities, CMR allows for precise quantification of right ventricular and left ventricular (LV) function, the assessment of additional abnormalities/complications (e.g. pericardial and/or pleural effusion, LV thrombi), and most importantly myocardial tissue characterization (myocardial oedema, inflammation, necrosis/fibrosis). CMR enables a comprehensive assessment of the entire spectrum of functional and structural changes that occur in patients with TTS and may have also a prognostic impact. CMR can distinguish between TTS and other important differential diagnoses (myocarditis, myocardial infarction) with direct consequences on medical therapy.
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Affiliation(s)
- Philipp-Johannes Jensch
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre 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), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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11
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Lyon AR, Citro R, Schneider B, Morel O, Ghadri JR, Templin C, Omerovic E. Pathophysiology of Takotsubo Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:902-921. [PMID: 33602474 DOI: 10.1016/j.jacc.2020.10.060] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
Takotsubo syndrome (TTS) has been a recognized clinical entity for 31 years, since its first description in 1990. TTS is now routinely diagnosed in patients who present with acute chest pain, electrocardiographic changes, troponin elevation, unobstructed coronary arteries, and a typical pattern of circumferential left ventricular wall motion abnormalities that usually involve the apical and midventricular myocardium. Increasing understanding of this intriguing syndrome stems from wider recognition, possible increasing frequency, and a rising number of publications focused on the pathophysiology in clinical and laboratory studies. A comprehensive understanding of TTS pathophysiology and evidence-based treatments are lacking, and specific and effective treatments are urgently required. This paper reviews the pathophysiology of this fascinating syndrome; what is known from both clinical and preclinical studies, including review of the evidence for microvascular dysfunction, myocardial beta-adrenergic signaling, inflammation, and electrophysiology; and where focused research needs to fill gaps in understanding TTS.
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Affiliation(s)
- Alexander R Lyon
- Department of Cardiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Rodolfo Citro
- Cardio-Thoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Olivier Morel
- Department of Cardiology, University of Strasbourg, UMR INSERM 1260 Regenerative Nanomedicine, Strasbourg, France
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. https://twitter.com/ElmirOmerovic2
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12
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Rawish E, Stiermaier T, Santoro F, Brunetti ND, Eitel I. Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1-Pathophysiology and Diagnosis. J Clin Med 2021; 10:jcm10030479. [PMID: 33525539 PMCID: PMC7865728 DOI: 10.3390/jcm10030479] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
First recognized in 1990, takotsubo syndrome (TTS) constitutes an acute cardiac condition that mimics acute myocardial infarction commonly in the absence of obstructive coronary artery disease; it is characterized by temporary left ventricular dysfunction, regularly in a circumferential apical, midventricular, or basal distribution. Considering its acute clinical presentation, coronary angiography with left ventriculography constitutes the gold standard diagnostic tool to exclude or confirm TTS. Frequently, TTS is related to severe emotional or physical stress and a subsequent increased adrenergic stimulation affecting cardiac function. Beyond clinical presentation, epidemiology, and novel diagnostic biomarkers, this review draws attention to potential pathophysiological mechanisms for the observed reversible myocardial dysfunction such as sympathetic overdrive-mediated multi-vessel epicardial spasms, microvascular dysfunction, the direct toxicity of catecholamines, lipotoxicity, and inflammation. Considering the long-term prognosis, further experimental and clinical research is indispensable to elucidate further pathophysiological mechanisms underlying TTS before randomized control trials with evidence-based therapeutic management can be performed.
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Affiliation(s)
- Elias Rawish
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center, 23538 Lübeck, Germany; (E.R.); (T.S.)
- DZHK (German Centre for Cardiovascular Research), 23538 Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center, 23538 Lübeck, Germany; (E.R.); (T.S.)
- DZHK (German Centre for Cardiovascular Research), 23538 Lübeck, Germany
| | - Francesco Santoro
- Department of Medical & Surgery Sciences, University of Foggia, 71121 Foggia, Italy
| | - Natale D. Brunetti
- Department of Medical & Surgery Sciences, University of Foggia, 71121 Foggia, Italy
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center, 23538 Lübeck, Germany; (E.R.); (T.S.)
- DZHK (German Centre for Cardiovascular Research), 23538 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-500-44501
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13
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Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). J Echocardiogr 2020; 18:199-224. [PMID: 32886290 PMCID: PMC7471594 DOI: 10.1007/s12574-020-00480-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022]
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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14
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Malanchini G, Del Corral M, De Filippo P, Ferrari P, Solomon A, Krepp J. Cardiac arrhythmias and In-hospital mortality amongst patients with takotsubo cardiomyopathy: A retrospective study in an Italian population. IJC HEART & VASCULATURE 2020; 31:100608. [PMID: 32923578 PMCID: PMC7475186 DOI: 10.1016/j.ijcha.2020.100608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 01/14/2023]
Abstract
Takotsubo cardiomyopathy was more common in women and the mortality rate was 2.2%. Ventricular arrhythmias were the strongest predictor of mortality. Age was associated with increased mortality in women with takotsubo cardiomyopathy.
Background Methods Results Conclusion
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15
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Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA, Bertrand P, Donal E, Dweck M, Galderisi M, Haugaa KH, Sade LE, Stankovic I, Cosyns B, Edvardsen T. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). Eur Heart J Cardiovasc Imaging 2020; 21:1184-1207. [DOI: 10.1093/ehjci/jeaa149] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila,” Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
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16
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Clinical Impact of Atrial Fibrillation on Short-Term Outcomes and In-Hospital Mortality in Patients with Takotsubo Syndrome: A Propensity-Matched National Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:522-526. [DOI: 10.1016/j.carrev.2019.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/11/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022]
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17
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Manning WJ. Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review. J Cardiovasc Magn Reson 2019; 21:79. [PMID: 31884956 PMCID: PMC6936125 DOI: 10.1186/s12968-019-0594-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
There were 89 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 76 original research papers, 4 reviews, 5 technical notes, 1 guideline, and 3 corrections. The volume was down slightly from 2017 with a corresponding 15% decrease in manuscript submissions from 405 to 346 and thus reflects a slight increase in the acceptance rate from 25 to 26%. The decrease in submissions for the year followed the initiation of the increased author processing charge (APC) for Society for Cardiovascular Magnetic Resonance (SCMR) members for manuscripts submitted after June 30, 2018. The quality of the submissions continues to be high. The 2018 JCMR Impact Factor (which is published in June 2019) was slightly lower at 5.1 (vs. 5.46 for 2017; as published in June 2018. The 2018 impact factor means that on average, each JCMR published in 2016 and 2017 was cited 5.1 times in 2018. Our 5 year impact factor was 5.82.In accordance with Open-Access publishing guidelines of BMC, the JCMR articles are published on-line in a continuus fashion in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful for the JCMR audience to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and contemporaneous JCMR publications. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, as in the past two years, I have used this publication to also convey information regarding the editorial process and as a "State of our JCMR."This is the 12th year of JCMR as an open-access publication with BMC (formerly known as Biomed Central). The timing of the JCMR transition to the open access platform was "ahead of the curve" and a tribute to the vision of Dr. Matthias Friedrich, the SCMR Publications Committee Chair and Dr. Dudley Pennell, the JCMR editor-in-chief at the time. The open-access system has dramatically increased the reading and citation of JCMR publications and I hope that you, our authors, will continue to send your very best, high quality manuscripts to JCMR for consideration. It takes a village to run a journal and I thank our very dedicated Associate Editors, Guest Editors, Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. This entire process would also not be possible without the dedication and efforts of our managing editor, Diana Gethers. Finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 4th year as your editor-in-chief. It has been a tremendous experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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18
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Uhlig J, Freund A, Kowallick JT, Gertz RJ, Bigalke B, Villa A, Lotz J, Hasenfuß G, Thiele H, Eitel I, Schuster A. Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study. Eur Heart J Cardiovasc Imaging 2019; 20:1059-1069. [DOI: 10.1093/ehjci/jey219] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
AbstractAimsThe exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS.Methods and resultsThis multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P < 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P < 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048).ConclusionTTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Thomas Stiermaier
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, SW1 7EH London, UK
| | - Johannes Uhlig
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Anne Freund
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Roman J Gertz
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, SW1 7EH London, UK
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, 5th Floor, Acute Services Building, Reserve Road, St Leonard’s, Sydney, NSW 2065, Australia
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19
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Manning WJ. Journal of Cardiovascular Magnetic Resonance 2017. J Cardiovasc Magn Reson 2018; 20:89. [PMID: 30593280 PMCID: PMC6309095 DOI: 10.1186/s12968-018-0518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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20
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Lamata P, Uhlig J, Kowallick JT, Raaz U, Villa A, Lotz J, Hasenfuß G, Thiele H, Eitel I, Schuster A. Temporal changes within mechanical dyssynchrony and rotational mechanics in Takotsubo syndrome: A cardiovascular magnetic resonance imaging study. Int J Cardiol 2018; 273:256-262. [PMID: 30195843 PMCID: PMC6236127 DOI: 10.1016/j.ijcard.2018.04.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The pathophysiological significance of dyssynchrony and rotation in Takotsubo syndrome (TTS) is unknown. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS. METHODS This multicenter study included 152 TTS patients undergoing CMR (mean 3 days after symptom onset). Apical, midventricular and basal short axis views were analysed in a core-laboratory. Systolic torsion, diastolic recoil and dyssynchrony expressed as circumferential and radial uniformity ratio estimates (CURE and RURE: 0 to 1; 1 = perfect synchrony) were compared to a matched control group (n = 21). Follow-up CMR (n = 20 patients; mean 62 days, SD 7.2) and general follow-up (n = 136; mean 3.3 years, SD 2.4) were performed. RESULTS CURE was initially reduced compared to controls (p = 0.001) and recovered at follow-up (p < 0.001) as opposed to RURE (p = 0.116 and p = 0.179). CURE and RURE discriminated between ballooning patterns (p = 0.001 and p = 0.045). Recoil was generally impaired during the acute phase (p = 0.015), torsion only in highly dyssynchronous patients (p = 0.024). Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality. The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p < 0.01), greater reduction of left ventricular function (p < 0.001) and a strong trend towards increased mortality (p = 0.074). CONCLUSION Transient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Johannes Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Uwe Raaz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Joachim Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany; Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia.
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21
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Stiermaier T, Eitel I, Eitel C. Atrial arrhythmias in Takotsubo syndrome: is inflammation the missing link? Europace 2018; 21:184-185. [DOI: 10.1093/europace/euy171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
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22
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Prasitlumkum N, Kittipibul V, Limpruttidham N, Rattanawong P, Chongsathidkiet P, Boondarikpornpant T. The presence of atrial fibrillation in Takotsubo cardiomyopathy is predictive of mortality: Systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2018; 24:e12566. [PMID: 29938868 DOI: 10.1111/anec.12566] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/22/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is known as the most common arrhythmia and an independent risk factor for mortality. Recent studies suggest that AF is associated with morbidity and mortality in Takotsubo cardiomyopathy (TTC). However, a systematic review and meta-analysis of the literature have not been done. We assessed the association between AF in patients with TTC and mortality by a systematic review of the literature and a meta-analysis. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2018. Included studies were published prospective or retrospective cohort studies that compared all-cause mortality in TTC with AF versus without AF. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS Five studies from August 2008 to October 2017 were included in this meta-analysis involving 2,321 subjects with TTC (243 with AF and 2,078 without AF). The presence of AF was associated with all-cause mortality (pooled odds ratio = 2.19, 95% confidence interval: 1.57-3.06, p < 0.001, I 2 = 0%). CONCLUSION Atrial fibrillation increased all-cause mortality by double among patients with TTC compared to without it. Our study suggests that the presence of AF in TTC is prognostic for all-cause mortality.
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Affiliation(s)
- Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Veraprapas Kittipibul
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nath Limpruttidham
- University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii.,Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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23
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Stiermaier T, Santoro F, Eitel C, Graf T, Möller C, Tarantino N, Guastafierro F, Di Biase M, Thiele H, Brunetti ND, Eitel I. Prevalence and prognostic relevance of atrial fibrillation in patients with Takotsubo syndrome. Int J Cardiol 2017; 245:156-161. [PMID: 28743481 DOI: 10.1016/j.ijcard.2017.07.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/30/2017] [Accepted: 07/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is associated with a considerable risk of complications during the acute phase and substantial long-term mortality rates. Concomitant atrial fibrillation may have an impact on outcome in these patients. Aim of this study was to assess the prevalence and prognostic relevance of atrial fibrillation in TTS. METHODS We performed an international, multicenter study including 387 TTS patients consecutively enrolled at 3 centers. Atrial fibrillation was defined as known history before admission or documented episodes during hospital stay. Long-term mortality was evaluated in median 2.9years after the acute event. RESULTS Atrial fibrillation was found in 97 TTS patients (25.1%) and was associated with older age (p<0.01), less emotional triggers (p=0.03), higher incidence of cardiogenic shock (p<0.01), lower left ventricular ejection fraction (p<0.01), and a prolonged hospital stay (p<0.01). Determinants of atrial fibrillation at admission (n=34 patients; 9.0%) in multivariate logistic regression analysis were age (p=0.001) and cardiogenic shock (p=0.013). Long-term mortality was significantly higher in TTS patients with as compared to patients without atrial fibrillation (35.2% versus 15.3%; hazard ratio 3.02, 95% confidence interval 1.90-4.78; p<0.001). In multivariate Cox regression analysis atrial fibrillation was identified as an independent determinant of outcome even after adjustment for clinical variables, left ventricular functional parameters (ballooning pattern, ejection fraction), and cardiogenic shock. CONCLUSIONS In TTS patients, atrial fibrillation is frequent and associated with increased long-term mortality rates. Furthermore, our study identifies atrial fibrillation as an independent predictor of outcome and a potential tool for risk stratification in TTS.
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Affiliation(s)
- Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Möller
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nicola Tarantino
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | | | - Matteo Di Biase
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | - Holger Thiele
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Natale D Brunetti
- University of Foggia, Department of Medical and Surgical Science, Foggia, Italy
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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24
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Abstract
Takotsubo syndrome is an acute, profound but reversible heart failure syndrome of unknown aetiology, usually but not always triggered by physical or emotional stress. Cardiac magnetic resonance has become an important tool for the non-invasive assessment of the syndrome, allowing for a comprehensive, safe and reproducible assessment of functional and anatomical myocardial properties, including perfusion, oedema and necrosis. This review focuses on the emerging role of cardiac magnetic resonance for the characterisation, differential diagnosis as well as risk stratification of patients with Takotsubo syndrome.
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Affiliation(s)
- Konstantinos Bratis
- Cardiology Clinical Academic Group, St George's University Hospitals NHS Foundation Trust, London, UK
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