Comparison of the first episode with the first recurrent episode of takotsubo syndrome in 128 patients from the world literature: Pathophysiologic connotations

BACKGROUND

The pathophysiology of takotsubo syndrome (TTS) and its recurrence (REC-TTS) is still elusive. Various ventriculographic "ballooning" patterns in response to a variety of triggers are observed in patients with REC-TTS. Although patients with and without REC-TTS have been previously compared, no comparison of patients' 1st TTS episode (1stTTS) with the 1st REC-TTS episode (1stREC-TTS) has been attempted.

METHODS

All patients with ≥1 REC-TTS episodes with patient-based data (45 variables) from the world literature, retrieved via PubMed, were meta-analyzed, and the patients' 1st REC-TTS and stREC-TTS were compared.

RESULTS

The time interval between the 1stTTS and 1stREC-TTS of the meta-analyzed 128 patients, 117 (91.4%) female, was 30.4 ± 36.1 months, with 47 (36.7%) patients having a neurological and/or psychiatric comorbidity(ies). Among 113 patients with paired 1stTTS and 1stREC-TTS data on the ventriculographic "ballooning" appearance, 101 (78.9%) had a different variant during the 1stTTS as compared with the 1stREC-TTS. Six patients (4.7%) died during hospitalization. Thirty patients (23.4%) were taking a β-blocker prior to their 1strTTS. Among 19 variables compared between the 1st TTS and 1st REC-TTS episodes, only mean age (by 2.5 years) and use of β-blockers were statistically significantly different. The precipitating triggers, and the in-hospital adverse events were similar in the 1st TTS and 1st REC-TTS episodes.

CONCLUSIONS

A comparison of the 1st TTS and 1st REC-TTS episodes of patients with REC-TTS, revealed large variation in the ventriculographic "ballooning" patterns, similarity in the TTS triggers, and no difference in the in-hospital adverse events. There was no protective effect for imparted by β-blockers in REC-TTS.

Hippocampal Blood Flow Abnormality Associated With Depressive Symptoms and Cognitive Impairment in Patients With Chronic Heart Failure

BACKGROUND

Depressive symptoms and memory impairment are prevalent in patients with chronic heart failure (CHF). Although the mechanisms remain to be elucidated, the hippocampus (an important brain area for emotion and memory) may be a possible neural substrate for these symptoms.

METHODS AND RESULTS

We prospectively enrolled 40 Stage C patients, who had past or current CHF symptoms, and as controls 40 Stage B patients, who had structural heart disease but had never had CHF symptoms, in Brain Assessment and Investigation in Heart Failure Trial (B-HeFT) (UMIN000008584). As the primary index, we measured cerebral blood flow (CBF) in the 4 anterior-posterior segments of the hippocampus, using brain MRI analysis. Depressive symptoms, immediate memory (IM) and delayed memory (DM) were assessed using Geriatric Depression Scale (GDS), and Wechsler Memory Scale-revised (WMS-R), respectively. Hippocampus CBF in the most posterior segment was significantly lower in Stage C than in Stage B group (P=0.029 adjusted for Holm's method). Multiple regression analysis identified significant association between hippocampus CBF and GDS or DM score in Stage C group (all P<0.05). GDS score was significantly higher, and IM and DM scores were lower in Stage C patients with hippocampus CBF below the median than those with hippocampus CBF above the median (all P<0.05).

CONCLUSIONS

Hippocampus abnormalities are associated with depressive symptoms and cognitive impairment in CHF patients. (Circ J 2016; 80: 1773-1780).