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Aweimer A, Dietrich JW, Santoro F, Fàbregas MC, Mügge A, Núñez-Gil IJ, Vazirani R, Vedia O, Pätz T, Ragnatela I, Arcari L, Volpe M, Corbì-Pascual M, Martinez-Selles M, Almendro-Delia M, Sionis A, Uribarri A, Thiele H, Brunetti ND, Eitel I, Stiermaier T, Hamdani N, Abumayyaleh M, Akin I, El-Battrawy I. Takotsubo syndrome outcomes predicted by thyroid hormone signature: insights from cluster analysis of a multicentre registry. EBioMedicine 2024; 102:105063. [PMID: 38502972 PMCID: PMC10963195 DOI: 10.1016/j.ebiom.2024.105063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into "endocrine-type" and "stress-type" responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry. METHODS In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain. Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at admission. Data were collected both retrospectively and prospectively from 2017 onwards. Primary endpoints included in-hospital and all-cause fatality, determined by cluster analysis using an unsupervised machine learning algorithm (k-medoids). FINDINGS Three clusters were identified, classifying TTS with low (TSLT), high (TSHT) and normal (TSNT) thyroid output, based on TSH and FT4 levels in relation to the median thyroid's secretory capacity (SPINA-GT). Although TSH and FT4 concentrations were similar among survivors and non-survivors, these clusters were significantly associated with patient outcomes. In the longitudinal Kaplan-Meier analysis including in- and out-of-hospital survival, the prognosis related to concentrations of TSH, FT4, and FT3 as well as SPINA-GT, deiodinase activity (SPINA-GD) and clusters. Patients in the TSHT cluster and with cardiogenic shock had a lower initial left ventricular ejection fraction (LVEF). INTERPRETATION This study suggests that thyroid hormones may impact the evolution and prognosis of TTS. The findings indicate that thyroid-derived biomarkers may help identify high-risk patients and pave the way for novel personalized and preventive therapeutic options. FUNDING This research was not funded by any public, commercial, or not-for-profit agencies.
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Affiliation(s)
- Assem Aweimer
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany.
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Mireia Camins Fàbregas
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine I, St. Josef University Hospital, Ruhr University of Bochum, Bochum, NRW, Germany; Diabetes Centre Bochum/Hattingen, St. Elisabeth Hospital Blankenstein, Im Vogelsang 5-11, Hattingen 45527, Germany; Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, Bochum 44791, Germany; Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany; Centre for Thyroid Medicine, Catholic Hospitals Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | - Andreas Mügge
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
| | - Iván J Núñez-Gil
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Ravi Vazirani
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Oscar Vedia
- Hospital Clínico Universitario San Carlos, Interventional Cardiology, Cardiovascular Institute, Madrid, Spain
| | - Toni Pätz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ilaria Ragnatela
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Rome, Italy
| | | | - Manuel Martinez-Selles
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, Madrid, Spain; Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Alessandro Sionis
- Servicio de Cardiología, Hospital Virgen de la Macarena, Sevilla, Spain
| | - Aitor Uribarri
- Cardiology Service, Vall d'Hebron, University Hospital, Barcelona, Spain; CIBERCV, Madrid, Spain
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | | | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, Bochum, Germany; Institute of Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Cardiology and Angiology Department, Medical Hospital II, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, NRW, Germany
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Mohamed AA, Basaran T, Othman MH, Andersen NH, Bonnema SJ. The association between Takotsubo cardiomyopathy and thyrotoxicosis: A systematic review. Endocrine 2022; 78:418-428. [PMID: 36018537 DOI: 10.1007/s12020-022-03174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aims to review all published cases on the association between thyrotoxicosis and Takutsubo Syndrome by describing clinical characteristics, diagnostic work-up, treatment, and outcome. METHODS We searched PubMed and Embase databases from inception to the 17th of February 2022 for case reports or series reporting the above-mentioned association. We extracted data on demographic characteristics, clinical features, diagnostic work-up, treatment, and clinical outcomes. Cases were stratified into groups based on the presumed cause of the thyrotoxicosis (iatrogenic vs non-iatrogenic and Graves' diseases vs non-Graves' disease, respectively). RESULTS We identified 25 cases from 24 articles. The mean age was 61.7 years (+/- SD 14.5). Most patients were women (88%). Graves' disease (52%) was the leading cause of thyrotoxicosis. Previous cancer was significantly more common in patients with iatrogenic thyrotoxicosis (P = 0.03). The most common symptoms were respiratory symptoms (68%), chest pain (56%), and palpitations (40%). The most common ECG characteristics were T-wave abnormalities (48%) and ST-elevations (36%). Elevated troponin levels were found in 92% of the cases. Patients with Graves's disease and Takutsubo Syndrome had higher plasma levels of serum thyroxine (P = 0.03) and were more often treated with beta-blockers (P = 0.01) compared to patients with thyrotoxicosis of other origins. Notably, 40% of cases experienced in-hospital complications. No deaths were reported. All patients had improved cardiac function within a median follow-up of 42 days. CONCLUSION Evidence-based on current case reports suggests an increased risk of Takutsubo Syndrome and subsequently increased risk of in-hospital complications in patients with thyrotoxicosis.
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Affiliation(s)
| | - Tayfun Basaran
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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A Review of Nuclear Imaging in Takotsubo Cardiomyopathy. Life (Basel) 2022; 12:life12101476. [PMID: 36294911 PMCID: PMC9604781 DOI: 10.3390/life12101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
Takotsubo cardiomyopathy or Takotsubo Syndrome (TTS) is a reversible left ventricular dysfunction syndrome that is increasingly being recognized. Recent advances in nuclear imaging have allowed us to study TTS in greater detail. We searched the PubMed and Medline databases and identified 53 publications with 221 patients reporting nuclear imaging findings in TTS. The age of the patients ranged from 17 to 87 years and were predominantly women (88.2%). The TTS variant was apical (typical) in 170 (76.9%), mid-ventricular in 23 (10.4%), and basal (reverse TTS) in 2 (0.9%). Cardiac perfusion was assessed using 99mTc sestamibi (MIBI) SPECT, 99mTc tetrofosmin SPECT, 201Tl SPECT, 82Rb PET, 201Tl SPECT, and 13N ammonia PET. Additional studies used were 123I MIBG SPECT, 123I BMIPP SPECT, 18F FDG PET, 67Ga citrate, and 11C hydroxy-ephedrine. A perfusion defect was seen in 69 (31.2%), and an inverse perfusion–metabolism mismatch (normal or near-normal perfusion with absent myocardial metabolic activity) was seen in 183 (82.8%) patients. Nuclear imaging has a significant role in evaluating, diagnosing, and prognosticating patients with TTS. As nuclear imaging technology evolves, we will surely gain more insights into this fascinating disorder.
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Aweimer A, El-Battrawy I, Akin I, Borggrefe M, Mügge A, Patsalis PC, Urban A, Kummer M, Vasileva S, Stachon A, Hering S, Dietrich JW. Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study. J Intern Med 2021; 289:675-687. [PMID: 33179374 DOI: 10.1111/joim.13189] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several reports have described Takotsubo syndrome (TTS) secondary to thyrotoxicosis. A complex interaction of central and peripheral catecholamines with thyroid homeostasis has been suggested. In this study, we analysed sequential thyroid hormone profiles during the acute phase of TTS. METHODS Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at predefined time points in 32 patients presenting with TTS or acute coronary syndrome (ACS, n = 16 in each group) in a 2-year period in two German university hospitals. Data were compared to age- and sex-matched controls (10 samples, each of 16 subjects), and an unsupervised machine learning (ML) algorithm identified patterns in the hormone signature. Subjects with thyroid disease and patients receiving amiodarone were excluded from follow-up. RESULTS Among patients with TTS, FT4 concentrations were significantly higher when compared to controls or ACS. Four subjects (25%) suffered from subclinical or overt thyrotoxicosis. Two additional patients developed subclinical or overt thyrotoxicosis during stay in hospital. In four subjects (25%), FT4 concentrations were increased, despite nonsuppressed TSH concentration, representing an elevated set point of thyroid homeostasis. The thyroid hormone profile was normal in only six patients (38%) presenting with TTS. CONCLUSION Abnormal thyroid function is frequent in patients with TTS. Primary hyperthyroidism and an elevated set point of thyroid homeostasis are common in TTS, suggesting a stress-dependent endocrine response or type 2 thyroid allostasis. Thyroid function may be a worthwhile target in treating or preventing TTS.
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Affiliation(s)
- A Aweimer
- From the, Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - I El-Battrawy
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - I Akin
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - M Borggrefe
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - A Mügge
- From the, Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - P C Patsalis
- From the, Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - A Urban
- Klinik für Anästhesiologie, Intensiv- und Palliativmedizin, Klinikum Kaufbeuren, Kaufbeuren, Germany
| | - M Kummer
- First Department of Medicine, Faculty of Medicine University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - S Vasileva
- Department of Endocrinology and Diabetes, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - A Stachon
- Institut für Laboratoriumsmedizin, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - S Hering
- Medizinische Klinik III, Diabetes Zentrum Rheine, Mathias Spital, Rheine, Germany
| | - J W Dietrich
- Department of Endocrinology and Diabetes, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
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Manabe O, Naya M, Oyama-Manabe N, Koyanagawa K, Tamaki N. The role of multimodality imaging in takotsubo cardiomyopathy. J Nucl Cardiol 2019; 26:1602-1616. [PMID: 29858766 DOI: 10.1007/s12350-018-1312-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022]
Abstract
Takotsubo cardiomyopathy (TC) is a syndrome of transient left ventricular (LV) dysfunction mimicking acute coronary syndrome. Although the mechanisms underlying the occurrence of TC are unknown, several imaging techniques contribute to its diagnosis. Here we review the current knowledge about TC, in particular, the pathophysiology and the role of imaging including nuclear cardiovascular medicine.
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Affiliation(s)
- Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University of Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University of Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University of Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Gupta S, Goyal P, Idrees S, Aggarwal S, Bajaj D, Mattana J. Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review. J Am Heart Assoc 2018; 7:e009003. [PMID: 30371307 PMCID: PMC6404898 DOI: 10.1161/jaha.118.009003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sonali Gupta
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Pradeep Goyal
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
- Department of RadiologySt. Vincent's Medical CenterBridgeportCT
| | - Sana Idrees
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Sourabh Aggarwal
- Cardiology DivisionDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNE
| | - Divyansh Bajaj
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Joseph Mattana
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
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Sakuma I, Koide H, Yoshida T, Yamato A, Fujimoto M, Tamura A, Komai E, Kono T, Nagano H, Horiguchi K, Yokote K, Tanaka T. Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient. AACE Clin Case Rep 2018. [DOI: 10.4158/ep171968.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rueda D, Aguirre R, Contardo D, Finocchietto P, Hernandez S, di Fonzo H. Takotsubo Myocardiopathy and Hyperthyroidism: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:865-870. [PMID: 28781361 PMCID: PMC5560469 DOI: 10.12659/ajcr.905121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patient: Male, 34 Final Diagnosis: Takotsubo myocardiopathy and hyperthyroidism Symptoms: Chest pain • dyspnea Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Darío Rueda
- Department of Internal Medicine, Hospital de Clínicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Rafael Aguirre
- Department of Internal Medicine, Hospital de Clínicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Damián Contardo
- Department of Internal Medicine, Hospital de Clínicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Paola Finocchietto
- Department of Internal Medicine, Hospital de Clínicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Silvia Hernandez
- Department of Internal Medicine, Hospital de Clínicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Horacio di Fonzo
- Department of Internal Medicine, Hospital de Clínicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
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9
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Patel K, Griffing GT, Hauptman PJ, Stolker JM. Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis. Tex Heart Inst J 2016; 43:152-5. [PMID: 27127432 DOI: 10.14503/thij-15-5046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction caused by transient wall-motion abnormalities of the left ventricular apex and mid ventricle in the absence of obstructive coronary artery disease. Recurrent episodes are rare but have been reported, and several cases of takotsubo cardiomyopathy have been described in the presence of hyperthyroidism. We report the case of a 55-year-old woman who had recurrent takotsubo cardiomyopathy, documented by repeat coronary angiography and evaluations of left ventricular function, in the presence of recurrent hyperthyroidism related to Graves disease. After both episodes, the patient's left ventricular function returned to normal when her thyroid function normalized. These findings suggest a possible role of thyroid-hormone excess in the pathophysiology of some patients who have takotsubo cardiomyopathy.
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10
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Madias JE. Do we need MIBG in the evaluation of patients with suspected Takotsubo syndrome? Diagnostic, prognostic, and pathophysiologic connotations. Int J Cardiol 2015; 203:783-4. [PMID: 26595783 DOI: 10.1016/j.ijcard.2015.11.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 01/15/2023]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States.
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Murdoch D, O'Callaghan W, Reda E, Niranjan S. Takotsubo Cardiomyopathy Associated with Primary Hyperthyroidism Secondary to Toxic Multinodular Goiter. Int J Angiol 2015; 25:e121-e122. [PMID: 28031674 DOI: 10.1055/s-0035-1548548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Takotsubo cardiomyopathy is increasingly recognized as a distinct clinical entity. An association with thyroid disease has been identified in several case reports, mostly in the context of Grave disease. We report the case of a 67-year-old woman presenting with takotsubo cardiomyopathy and thyrotoxicosis secondary to toxic multinodular goiter. Previously unreported, this suggests that this association is related to the direct effects of thyroid hormone, rather than an autoimmune mechanism. Thyroid disease should be considered in patients presenting with takotsubo cardiomyopathy.
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Affiliation(s)
- Dale Murdoch
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - William O'Callaghan
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Australia
| | - Elham Reda
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Australia
| | - Selvanayagam Niranjan
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Australia; School of Medicine, Griffith University, Gold Coast, Australia
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Radhakrishnan A, Granato JE. An Association Between Takotsubo Cardiomyopathy and Thyroid Storm. Postgrad Med 2015; 121:126-30. [DOI: 10.3810/pgm.2009.05.2012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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De Giorgi A, Fabbian F, Tiseo R, Parisi C, Misurati E, Molino C, Pala M, Salmi R, Volpi R, Manfredini R. Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reports. Am J Emerg Med 2014; 32:1413-7. [PMID: 25261397 DOI: 10.1016/j.ajem.2014.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/17/2014] [Accepted: 07/26/2014] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria (AOU), Ferrara, Italy.
| | - Fabio Fabbian
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Ruana Tiseo
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Claudia Parisi
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Elisa Misurati
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | | | - Marco Pala
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Raffaella Salmi
- Second Internal Medicine, Department of Medicine, AOU, Ferrara, Italy.
| | - Riccardo Volpi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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Martin CS, Ionescu LN, Barbu CG, Sirbu AE, Lambrescu IM, Lacau IS, Dimulescu DR, Fica SV. Takotsubo cardiomyopathy and transient thyrotoxicosis during combination therapy with interferon-alpha and ribavirin for chronic hepatitis C. BMC Endocr Disord 2014; 14:10. [PMID: 24491229 PMCID: PMC3913789 DOI: 10.1186/1472-6823-14-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/29/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Thyroid dysfunction is a common complication of chronic hepatitis C (CHC) and its therapy. Takotsubo cardiomyopathy (TCM) is a multifactorial, stress related cardiomyopathy, rarely reported in association with thyrotoxicosis. Simultaneous occurrence of TCM and thyrotoxicosis due to hepatitis C and its treatment has never been reported. CASE PRESENTATION A 47-year-old woman was admitted for acute chest pain, dyspnea, palpitations and diaphoresis. She had been diagnosed with CHC and had undergone 7 months of IFNα and Ribavirin therapy. At admission electrocardiogram (ECG) showed ST segment elevation, negative T waves and troponin was elevated suggesting ST segment elevation myocardial infarction (STEMI). Echocardiography demonstrated left ventricular apical akinesia and ballooning, with a left ventricular ejection fraction (LVEF) of 35%. Contrast angiography showed normal epicardial coronaries, yet a ventriculogram revealed left ventricular apical ballooning, consistent with TCM. Cardiac MRI showed left ventricle apical ballooning and no late enhancement suggesting the absence of any edema, scar or fibrosis in the left myocardium. She was diagnosed with non-autoimmune destructive thyroiditis: TSH=0.001 mU/L, free T4=2.41 ng/dl, total T3=199 ng/dl and negative thyroid antibodies. The thyroid ultrasonography showed a diffuse small goiter, no nodules and normal vascularization of the parenchyma. Following supportive treatment she experienced a complete recovery after a few weeks and she successfully completed her antiviral treatment, with no thyroid or cardiovascular dysfunction ever since. In patients treated with IFNα for CHC, the prevalence of thyroid dysfunction varies between 2.5-45.3% of cases. TCM is a stress related cardiomyopathy characterized by elevated cardiac enzymes, normal coronary angiography and an acute, transient, left ventricular apical dysfunction that mimics myocardial infarction. Most of the patients survive the initial acute event, typically recover normal ventricular function within one to four weeks and have a favorable outcome, as was the case with our patient. Thyrotoxicosis induced stress cardiomyopathy is rare and has been mostly reported in association with Graves' disease, thyroid storm, thyrotoxicosis factitia or following radioiodine therapy for toxic multinodular goiter. CONCLUSION Routine thyroid screening should be done in patients receiving IFN-alpha and Ribavirin for CHC and thyrotoxicosis should be considered as a possible and treatable underlying cause of TCM.
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Affiliation(s)
- Carmen Sorina Martin
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
| | | | - Carmen Gabriela Barbu
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
| | - Anca Elena Sirbu
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
| | - Ioana Maria Lambrescu
- Endocrinology Department, Elias University Hospital, 17 Marasti Blvd, sector 1, Bucharest, Romania
| | | | - Doina Ruxandra Dimulescu
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, Bucharest, Romania
| | - Simona Vasilica Fica
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
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Eliades M, El-Maouche D, Choudhary C, Zinsmeister B, Burman KD. Takotsubo cardiomyopathy associated with thyrotoxicosis: a case report and review of the literature. Thyroid 2014; 24:383-9. [PMID: 23560557 PMCID: PMC3926154 DOI: 10.1089/thy.2012.0384] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Takotsubo or stress-induced cardiomyopathy is a form of reversible cardiomyopathy commonly associated with emotional or physical stress. Thyrotoxicosis has been identified as a rare cause of Takotsubo cardiomyopathy, with only 12 cases reported in the literature. Here, we report a case of thyroid storm presenting with Takotsubo cardiomyopathy in the setting of Graves' disease. PATIENT FINDINGS A 71-year-old woman presented with abdominal pain, vomiting, confusion, and history of weight loss. She was initially diagnosed and treated for diabetic ketoacidosis at another hospital and was transferred to our hospital one day after initial presentation because of concern for acute coronary syndrome. A diagnosis of Takotsubo cardiomyopathy was made on the basis of cardiac catheterization. At that time, she was diagnosed and treated for thyroid storm. Follow-up 7 weeks later revealed improvement of her cardiac function and near-normalization of thyroid hormone levels. SUMMARY In this patient, who presented with symptoms of heart failure, acute coronary syndrome was initially considered, but the diagnosis of Takotsubo cardiomyopathy associated with thyroid storm was ultimately made based on cardiac catheterization and laboratory investigation. CONCLUSIONS Thyrotoxicosis is associated with adverse disturbances in the cardiovascular system. Takotsubo cardiomyopathy could be a presenting manifestation of thyroid storm, perhaps related to excess catecholamine levels or sensitivity.
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Affiliation(s)
- Myrto Eliades
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Diala El-Maouche
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Chitra Choudhary
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Bruce Zinsmeister
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
- Sections of Endocrinology and Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Kenneth D. Burman
- Department of Internal Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
- Sections of Endocrinology and Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia
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16
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Sanchez-Jimenez EF. Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases. World J Cardiol 2013; 5:228-241. [PMID: 23888192 PMCID: PMC3722420 DOI: 10.4330/wjc.v5.i7.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/12/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy.
METHODS: A PubMed search using the terms “Takotsubo cardiomyopathy (TC)” and “apical ballooning syndrome” yielded 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed.
RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64 ± 14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain was the primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation + 1.6% of ST segment depression + 17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%.
CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.
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Hassid B, Azmoon S, Aronow WS, Palaniswamy C, Cohen M, Gass A. Hemodynamic support with TandemHeart in tako-tsubo cardiomyopathy - a case report. Arch Med Sci 2010; 6:971-5. [PMID: 22427775 PMCID: PMC3302713 DOI: 10.5114/aoms.2010.19311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 07/12/2009] [Accepted: 07/13/2009] [Indexed: 01/22/2023] Open
Abstract
Tako-tsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities mimicking acute myocardial infarction, akinesis or dyskinesis of apical or mid left ventricular segments, and the absence of obstructive coronary artery disease. Tako-tsubo cardiomyopathy is usually a potentially reversible form of cardiac dysfunction. A careful literature search revealed no previous report of a patient requiring mechanical circulatory support in tako-tsubo cardiomyopathy. We report a patient with tako-tsubo cardiomyopathy, ventricular fibrillation, and hemodynamic instability requiring a left ventricular assist device (TandemHeart(™)) followed by improvement of left ventricular ejection fraction to 45%.
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Affiliation(s)
- Babak Hassid
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, USA
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19
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Kuboyama O, Tokunaga T, Kobayashi K, Iwai T, Osaka Y, Umemoto T. A case of asymptomatic patient with hyperthyroidism documented the onset of Takotsubo cardiomyopathy by Holter monitoring. Int J Cardiol 2010; 151:e82-4. [PMID: 20580453 DOI: 10.1016/j.ijcard.2010.05.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/30/2010] [Indexed: 11/16/2022]
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20
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Kwon SA, Yang JH, Kim MK, Park SW, Kim SH, Park KH, Park WJ. A case of Takotsubo cardiomyopathy in a patient with iatrogenic thyrotoxicosis. Int J Cardiol 2009; 145:e111-3. [PMID: 19628289 DOI: 10.1016/j.ijcard.2009.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 01/01/2023]
Abstract
Takotsubo cardiomyopathy is a condition caused by intense emotional or physical stress leading to rapid and severe reversible cardiac dysfunction. The etiology and mechanism of this disease are unknown. Thyroid hormone has many effects on the heart and vascular system. There were some reports of Takotsubo cardiomyopathy with hyperthyroidism, especially Grave's disease. We report a patient who presented chest pain and cardiac arrest, and finally diagnosed as Takotsubo cardiomyopathy caused by iatrogenic thyrotoxicosis.
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Abstract
INTRODUCTION This manuscript reviews the current evidence for proposed pathophysiological mechanisms of Tako-tsubo syndrome and its management. DISCUSSION The Tako-tsubo syndrome is defined by the presence of transient left ventricular apical ballooning after an acute coronary syndrome in patients with angiographically normal coronary arteries. Intriguingly, only the apex is affected and compensatory basal hypercontractility is seen. Several mechanisms have been offered as explanations for the characteristic clinical presentation and echocardiographic appearance of this syndrome. CONCLUSION Tako-tsubo syndrome encompasses heterogeneous patient populations and it is likely that different pathogenic mechanisms may operate in different patients. Treatment of the condition is at present empirical and aimed at preserving ventricular function.
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Affiliation(s)
- Jason M Tarkin
- Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St. George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
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22
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Myocardial Infarction and Reversible Left Ventricular Apical Ballooning Associated With Pheochromocytoma. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/ten.0b013e318165248b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Obón Azuara B, Ortas Nadal MR, Gutiérrez Cía I, Villanueva Anadón B. [Takotsubo cardiomyopathy: transient apical dysfunction of the left ventricle]. Med Intensiva 2007; 31:146-52. [PMID: 17439770 DOI: 10.1016/s0210-5691(07)74793-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. In most of the cases published, it is a syndrome with ST segment elevation in the precordial leads, whose presentation form is also thoracic pain or dyspnea, with the possible existence of moderate elevation of cardiac biomarkers. On the contrary to the acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it.
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Affiliation(s)
- B Obón Azuara
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Zaragoza, España.
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24
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Hernández Lanchas C, Rodríguez Ballestero P, Forcada Sainz JM, Esteve Alderete JJ, Marcos Sánchez F, Vázquez García A. [Tako-Tsubo syndrome in a patient with exacerbated bronchial asthma]. Rev Clin Esp 2007; 207:291-4. [PMID: 17568517 DOI: 10.1157/13106851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Transient apical ballooning syndrome without coronary stenosis or Tako-Tsubo syndrome was described a few years ago in a Japanese population. Although new cases and series have been gradually defining its physiopathology, there is much doubt about its etiology. We describe the case of a 74-year-old Caucasian woman, with a background of hypertension, type 2 diabetes mellitus and hyperthyroidism with tracheal compression, intrinsic asthma and depression syndrome. She had an acute attack of bronchospasm and chest pain. The electrocardiogram on admission showed Q-waves and ST segment elevation in precordial leads and elevated serum cardiac markers. The coronariography found no evidence of significant lesions in the vascular tree. Ventriculography showed an apical ballooning that was also found in the echocardiography. The evolution of the clinical picture with disappearance of the symptoms and normalization of the electrocardiogram and echocardiogram lead to the diagnosis of Tako-Tsubo syndrome. We believe that this new clinical entity may have a catecholamine-mediated neurogenic mechanism as the etiopathogenic substrate and that our clinical case could support this hypothesis.
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Affiliation(s)
- C Hernández Lanchas
- Servicios de Cardiología y Medicina Interna, Hospital Ntra, Sra. del Prado, Talavera de la Reina, Toledo, España.
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Stöllberger C, Finsterer J, Schneider B. Transient left ventricular dysfunction (tako-tsubo phenomenon): Findings and potential pathophysiological mechanisms. Can J Cardiol 2006; 22:1063-8. [PMID: 17036101 PMCID: PMC2568967 DOI: 10.1016/s0828-282x(06)70322-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Tako-tsubo-like left ventricular dysfunction phenomenon (TTP) is characterized by transient left ventricular apical ballooning associated with symptoms, electrocardiographic changes and minimal cardiac enzyme release in the absence of coronary artery disease. Initially described in Japan, TTP occurs worldwide, predominantly in women and frequently after emotional or physical stress. Symptoms include anginal chest pain, dyspnea and syncope. Electrocardiographic ST elevations may be present only for several hours, and are followed by negative T waves that persist for months. Arterial hypertension is found in up to 76% of TTP patients, hyperlipidemia in up to 57% and diabetes mellitus in up to 12%. Potential pathophysiological mechanisms for TTP include catecholamine-induced myocardial stunning or hyperkinesis of the basal left ventricular segments, coronary vasospasm, plaque rupture, myocarditis and genetic factors. TTP patients should be monitored similarly to myocardial infarction patients because organ failure, cardiogenic shock, ventricular fibrillation or rupture may occur. Beta-blockers are indicated, whereas catecholamines and nitrates should be avoided. The long-term prognosis is unknown.
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Donohue D, Movahed MR. Clinical Characteristics, Demographics and Prognosis of Transient Left Ventricular Apical Ballooning Syndrome. Heart Fail Rev 2006; 10:311-6. [PMID: 16583180 DOI: 10.1007/s10741-005-8555-8] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transient left ventricular apical ballooning syndrome also called Tako-Tsubo cardiomyopathy is defined as a syndrome consisting of stress induced apical ballooning of the left ventricle and normal coronary arteries. The majority of the published reports are case reports or case series with a small number of patients. The goal of this study was to perform statistical analysis of reported cases and case series in the literature in order to study demographic, clinical characteristics and prognosis of this syndrome. METHOD A PubMed search of the terms transient left ventricular apical ballooning, Tako-Tsubo, takotsubo, and apical cardiomyopathy was conducted for this study. All reports that contained information about individual patients were included in the statistical analysis. RESULTS The majority of the patients were women (93.5%). Asians were the largest group (57.2%) followed by Caucasians (40%). The presentations mimics an acute myocardial infarction. The most frequent presenting symptom was chest pain (65.9%) followed by dyspnea (16.2%). ST elevation was the most common ECG abnormality (87.5%). Contrary to most reports, this is not a benign disease with complications occurring in 18.9% and death in 3.2%. The most common complication was shock followed by left ventricular thrombus formation and congestive heart failure. CONCLUSION Apical ballooning syndrome occurs most commonly in women and is associated with high complication rate. There are significant differences in presenting symptoms between race and gender which warrant further investigation.
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Affiliation(s)
- Daniel Donohue
- Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, CA 92868, USA
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