1
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Falola AO, Razvi N, Gada R, Thompson DR, Martin CR. Takotsubo Syndrome or Peripartum Cardiomyopathy? Depends on Who You Are Talking to. Behav Sci (Basel) 2024; 14:777. [PMID: 39335992 PMCID: PMC11428684 DOI: 10.3390/bs14090777] [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: 04/15/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
Takotsubo syndrome (otherwise known as broken-heart syndrome or left ventricular apical ballooning) is a rare cause of reversible heart failure that predominantly affects postmenopausal women. It was first described by Japanese researchers in the 1990s and has become established as a differential for heart failure following a physically or psychologically stressful event. This was popularised by a spike in cases following natural disasters in Japan. As the recognition of takotsubo syndrome in the differential diagnosis for sudden, onset heart failure in a previously healthy individual has grown, so has the discussion concerning takotsubo in the peripartum period. Peripartum cardiomyopathy is a rare cause of reversible heart failure in the latter weeks of pregnancy and the postpartum period. Morbidity and mortality for both cardiomyopathies can be highly variable, ranging from complete recovery of cardiac function to life threatening arrhythmias and even death. This rapid review highlights the similarities between both cardiomyopathies and challenges the hitherto assumption that both takotsubo and peripartum cardiomyopathies are distinct entities that can easily be distinguished from one another. The implications of this are significant within the context of the behavioural aspects of diagnosis, treatment, and outcome.
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Affiliation(s)
- Abigail O. Falola
- East Suffolk and North Essex NHS Foundation Trust, Ipswich IP4 5PD, UK
- Institute of Health and Wellbeing, University of Suffolk, Suffolk IP4 1QJ, UK
| | - Naveed Razvi
- East Suffolk and North Essex NHS Foundation Trust, Ipswich IP4 5PD, UK
| | - Ruta Gada
- East Suffolk and North Essex NHS Foundation Trust, Ipswich IP4 5PD, UK
| | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Colin R. Martin
- Institute of Health and Wellbeing, University of Suffolk, Suffolk IP4 1QJ, UK
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2
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Abuelazm M, Saleh O, Hassan AR, Ahmad S, Albarakat MM, Abdalshafy H, Katamesh BE, Abdelazeem B, Paul TK. Sex Difference in Clinical and Management Outcomes in Patients With Takotsubo Syndrome: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101545. [PMID: 36563919 DOI: 10.1016/j.cpcardiol.2022.101545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome (TTS) is being increasingly recognized globally with a female sex predilection. However, sex-related differences in clinical outcomes are yet to be identified. Therefore, we aim to investigate the sex differences in clinical outcomes in patients with TTS. We included cohort studies retrieved from the Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until September 14, 2022. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42022363349. Thirteen retrospective cohort studies, with a total of 104,410 patients were included. Men had a higher risk of in-hospital mortality (RR: 2.42 with 95% CI [1.53, 3.83], P = 0.0002), long-term mortality (RR: 1.59 with 95% CI [1.40, 1.80], P = 0.00001), cardiogenic shock (RR: 1.65 with 95% CI [1.52, 1.79], P = 0.00001), arrhythmia (RR: 1.70 with 95% CI [1.56, 1.86], P = 0.00001), and acute kidney injury (RR: 1.71 with 95% CI [1.50, 1.96]. P = 0.00001), as compared with women. However, no significant difference was observed in stroke (RR: 1.22 with 95% CI [0.78, 1.89], P = 0.39), left ventricular thrombus (RR: 0.96 with 95% CI [0.40, 2.33], P = 0.93), and TTS recurrence (RR: 1.11 with 95% CI [0.68, 1.82], P = 0.67) between men and women. Despite women having a higher incidence of TTS, men have higher morbidity and mortality rates. Hence, further studies are necessary to identify the pathophysiological factors of this sex difference in clinical outcomes, including hormonal and psychological variables.
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Affiliation(s)
| | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC
| | - Majd M Albarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI; Department of Internal Medicine, Michigan State University, East Lansing, MI
| | - Timir K Paul
- Department of Clinical Medical Education, The University of Tennessee Health Sciences Center at Nashville, Nashville, TN
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3
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Menchaca K, Ostos Perez CA, Draguljevic N, Isaac S. Management Challenge: An Atypical Variant of Takotsubo Presenting With Multiple Complications. Cureus 2022; 14:e26836. [PMID: 35854952 PMCID: PMC9286025 DOI: 10.7759/cureus.26836] [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] [Accepted: 07/14/2022] [Indexed: 11/05/2022] Open
Abstract
An 84-year-old woman with depression, who witnessed the suicide of a close friend, presented with symptoms of chest pain, palpitations, and cold and clammy extremities. An electrocardiogram showed alternating tachycardia and bradycardia. Urgent transthoracic echocardiogram demonstrated left greater than right ventricular dysfunction, moderate mitral regurgitation, global hypokinesis, and an estimated ejection fraction of 20%. Cardiac catheterization demonstrated non-obstructive coronary artery disease and decreased cardiac output. Findings were consistent with Takotsubo cardiomyopathy complicated with cardiogenic shock, acute mitral regurgitation, and sinus node dysfunction. Management of this patient required the use of a mechanical device intra-aortic balloon pump, and pacemaker insertion for persistent symptomatic arrhythmia. This case highlights the challenging management of potentially fatal acute complications of Takotsubo cardiomyopathy and inadequate data on how to approach them.
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4
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Patel RS, Webeler P, Gudur UM. Peripheral Thromboembolism Formation in a Case of Takotsubo Cardiomyopathy. Cureus 2022; 14:e24087. [PMID: 35573553 PMCID: PMC9098288 DOI: 10.7759/cureus.24087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/12/2022] [Indexed: 11/05/2022] Open
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5
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Medina YAC, López Blanco PF, González Niño RA. Hawk´s Beak Form in Midventricular Takotsubo Syndrome: Two Case Reports from Latin America. Open Cardiovasc Med J 2021. [DOI: 10.2174/1874192402115010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Takotsubo syndrome is a type of acute reversible heart failure that can involve a form of acute catecholaminergic myocardial stunning. This clinical entity shows a pattern of temporary left ventricular dysfunction in the absence of occlusion of any coronary artery. A midventricular type is a form of Takotsubo syndrome where the atypical morphological variant is Hawk’s beak. The prevalence of this type is estimated to be 10-15% in several series in Asian and Western countries (predominantly Caucasian patients). In Latin America, there are no studies reporting this type of presentation. Two cases are reported in women initially diagnosed with acute myocardial infarction with the finding of the atypical hawk's beak morphology of Takotsubo syndrome, confirmed by left ventriculography. One of them was followed up early, observing recovery in her ventricular function without structural compromise at the level of contractility and with a good response to the outpatient treatment proposed. As there is a low prevalence and few published reports, these 2 cases are presented to promote long-term studies and increase the information regarding the evolution and morbidity/mortality of this type of presentation compared with the classical form of the syndrome.
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6
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Fridlund B, Bruteig E, Dahlviken RM, Fålun N, Norekvål TM. Women's Initial Experiences and up to a Year in Retrospect of Their Life Situation With a Confirmed Takotsubo Syndrome Diagnosis: A Single Case Study Literature Review. J Holist Nurs 2021; 40:146-156. [PMID: 34029129 PMCID: PMC9121527 DOI: 10.1177/08980101211018343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To describe women's initial experiences and up to a year in
retrospect of their life situation with a confirmed Takotsubo syndrome (TS) diagnosis.
Method: A single case study literature review based on nine articles
published by nurses was analyzed deductively using a nursing life dimension model.
Results: All but one case was conducted on the North American continent and
TS had largely affected women with previous cardiac history and had been triggered by one
or two stressful life events. The biophysical life dimension manifested in distinct and
troublesome inconvenience and in retrospect in fretting and grievous ailments. The
emotional dimension manifested in pronounced ways and attitude-related sensations,
feelings or moods while the intellectual dimension manifested in an unmanageable world of
thought. The spiritual–existential dimension manifested in a life-denying view of life and
the socio-cultural dimension manifested in an asocial life. Conclusions: With
TS best practice in mind and a person-centered care and holistic approach, comprehensive
descriptions are needed of how women identify, interpret, and use knowledge to manage
their life situation. Cardiac nurses need further comprehensive descriptions to implement
actions. Prior to implementation of such programs, this knowledge needs to be disseminated
among cardiac nurses and evaluated in international randomized controlled trials.
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Affiliation(s)
| | | | | | | | - Tone M Norekvål
- 1658University of Bergen.,60498Haukeland University Hospital
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7
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van der Pas RSD, Gresnigt FMJ, Wansink L, Franssen EJF, Riezebos RK. Acute onset heart failure due to reverse type Takotsubo cardiomyopathy caused by a single dose of 4-Fluoroamphetamine in a healthy young individual. Toxicol Rep 2020; 7:1629-1633. [PMID: 33344175 PMCID: PMC7736711 DOI: 10.1016/j.toxrep.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022] Open
Abstract
4-Fluoroamphetamine (4-FA) is a popular new psychoactive stimulant that is used for recreational purposes. A single dose of 4-FA can lead to reverse type Takotsubo cardiomyopathy with cardiogenic shock. 4-FA use can cause a very sudden onset of severe symptoms. Due to mild and late onset of effect, 4-FA users have the tendency to take an extra dose. Phosphodiesterase-3-inhibitors are effective for amphetamine type stimulant induced Takotsubo cardiomyopathy.
Introduction 4-fluoroamphetamine (4-FA) is a novel psychoactive stimulant with a global presence on the drug market. Despite the popularity of 4-FA, data on severe adverse effects are scarce. We present a case of laboratory confirmed 4-FA mono intoxication causing acute heart failure due to a reverse type Takotsubo cardiomyopathy. Case A 20-year-old male with no previous medical history and no reported previous drug use, presented to the emergency department (ED) with complaints of headache, nausea and vomiting, approximately 4.5 h after the ingestion of a single 4-FA pill. After 30 min his condition deteriorated with severe hypertension, tachycardia and respiratory failure. Echocardiography showed a reverse type Takotsubo cardiomyopathy. The patient was successfully treated with mechanical ventilation, a phosphodiesterase-3-inhibitor (PDE3-inhibitor) and diuretics. Three months after hospital admission, the patient was free of complaints and his left ventricular function fully recovered. Conclusion Recreational use of 4-FA may result in acute onset life-threatening cardiorespiratory toxicity, preceded by severe hypertension, even in drug-naïve patients without any medical history. Emergency physicians and cardiologists should be cautious not to underestimate life-threatening 4-FA complications.
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Affiliation(s)
- R S D van der Pas
- Emergency medicine at OLVG hospital, Amsterdam, the Netherlands.,Emergency registrars at Sint Antonius hospital, Nieuwegein, the Netherlands
| | - F M J Gresnigt
- Emergency Physician at OLVG Hospital, Amsterdam, the Netherlands
| | - L Wansink
- Emergency medicine at OLVG hospital, Amsterdam, the Netherlands.,Emergency Physician at Dijklander ziekenhuis, Hoorn, the Netherlands
| | | | - R K Riezebos
- Cardiologist at OLVG Hospital, Amsterdam, the Netherlands
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8
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Li P, Dai Q, Cai P, Teng C, Pan S, Dixon RAF, Liu Q. Identifying different phenotypes in takotsubo cardiomyopathy by latent class analysis. ESC Heart Fail 2020; 8:555-565. [PMID: 33244882 PMCID: PMC7835582 DOI: 10.1002/ehf2.13117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/13/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
Aims This study sought to determine whether clinical clusters exist in takotsubo cardiomyopathy. Takotsubo cardiomyopathy (TCM) is a heterogeneous disorder with a complex, poorly understood pathogenesis. To better understand the heterogeneity of TCM, we identified different clinical phenotypes in a large sample of TCM patients by using latent class analysis (LCA). Methods and results Using the National Inpatient Sample (NIS) database, we identified 3139 patients admitted to hospitals in 2016–2017 with a primary diagnosis of TCM. We performed LCA based on several patient demographics and comorbidities: age, sex, hypertension, hyperlipidaemia, diabetes mellitus, obesity, current smoking, asthma, chronic obstructive pulmonary disease (COPD), and anxiety and depressive disorders. We then repeated LCA separately with the NIS 2016 and 2017 data sets and performed a robust test to validate our results. We also compared in‐hospital outcomes among the different clusters identified by LCA. Four patient clusters were identified. C1 (n = 1228, 39.4%) had the highest prevalence of hyperlipidaemia (93.4%), hypertension (61.6%), and diabetes (34.3%). In C2 (n = 440, 14.0%), all patients had COPD, and many were smokers (45.8%). C3 (n = 376, 11.8%) largely comprised patients with anxiety disorders (98.4%) and depressive disorders (80.1%). C4 (n = 1097, 34.8%) comprised patients with isolated TCM and few comorbidities. Among all clusters, C1 had the lowest in‐hospital mortality (1.0%) and the shortest length of stay (3.2 ± 3.1 days), whereas C2 had the highest in‐hospital mortality (3.4%). Conclusions Using LCA, we identified four clinical phenotypes of TCM. These may reflect different pathophysiological processes in TCM. Our findings may help identify treatment targets and select patients for future clinical trials.
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Affiliation(s)
- Pengyang Li
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Qiying Dai
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Catherine Teng
- Department of Medicine, Greenwich Hospital, Greenwich, CT, USA
| | - Su Pan
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, MC-255, Houston, TX, 77030, USA
| | - Richard A F Dixon
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, MC-255, Houston, TX, 77030, USA
| | - Qi Liu
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, MC-255, Houston, TX, 77030, USA
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9
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Abumayyaleh M, El-Battrawy I, Kummer M, Gietzen T, Behnes M, Zhou XB, Lang S, Borggrefe M, Akin I. Association Between Mortality and Left Ventricular Ejection Fraction in Patients With Takotsubo Syndrome Versus Acute Coronary Syndrome. In Vivo 2020; 34:3639-3648. [PMID: 33144479 DOI: 10.21873/invivo.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM The association between ejection fraction (EF) and mortality in TTS patients as compared to ACS is limited. This study aims to investigate the association between EF and clinical outcomes in patients with TTS as compared to ACS. PATIENTS AND METHODS This study compared in-hospital, and long-term incidence of clinical outcomes for 5 years in patients with TTS and ACS. The study was composed of two groups EF≥35% and EF<35%. RESULTS The long-term mortality of the EF≥35% for 5 years was significantly higher in TTS patients as compared to ACS (18.1% vs. 7.7%, log-Rank; p<0.01). Irrespective of EF, a non-cardiovascular death was significantly higher in TTS as compared to ACS patients with EF≥35 (6.4% vs. 2.1%; p=0.02) and with EF<35% (21.4% vs. 7.5%; p=0.03). CONCLUSION The long-term mortality is significantly higher in TTS as compared to ACS dominated by a non-cardiovascular cause of death at 5-years-follow-up.
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Affiliation(s)
- Mohammad Abumayyaleh
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany .,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Marvin Kummer
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Thorsten Gietzen
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Xiao-Bo Zhou
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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10
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Mhanna M, Beran A, Srour O, Ghazaleh S, Elzanaty A. A Case of Takotsubo Cardiomyopathy Triggered by Diabetic Ketoacidosis and Hypothermia. Cureus 2020; 12:e10842. [PMID: 33173648 PMCID: PMC7647843 DOI: 10.7759/cureus.10842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Takotsubo cardiomyopathy (TC), also recognized as stress-induced cardiomyopathy, is a transient condition of left ventricular (LV) dysfunction, which presents similarly to acute coronary syndrome (ACS) but with normal coronaries. Physical or emotional stressors usually precipitate TC. It is typically a benign condition, with a complete resolution once the triggering cause resolves. There have been a few cases of TC induced by diabetic ketoacidosis (DKA) that have been reported in the literature. A 50-year-old Caucasian female patient presented with lethargy, in addition to hypothermia and hypotension. Further investigation showed hyperglycemia with metabolic acidosis and ketonemia. Eventually, she was diagnosed with diabetic ketoacidosis (DKA). On Day 2 of the admission, the patient's condition further deteriorated despite appropriate treatment of DKA. An electrocardiogram (EKG) showed ST-segment elevation in inferior leads, and troponin levels were elevated. Cardiac catheterization showed non-obstructive coronary arteries but a severely reduced cardiac index. Echocardiography showed an ejection fraction (EF) of 25% with global hypokinetic LV. Eventually, the patient was diagnosed with TC or stress-induced cardiomyopathy. TC should always be suspected in any patient presenting with acute heart failure during DKA treatment. TC is a transient syndrome; however, it can result in dreadful complications, including cardiogenic shock, arrhythmias, or thromboembolic events. Early recognition and timely treatment are pivotal in such cases.
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Affiliation(s)
| | | | - Omar Srour
- Internal Medicine, The University of Toledo, Toledo, USA
| | - Sami Ghazaleh
- Internal Medicine, The University of Toledo, Toledo, USA
| | - Ahmed Elzanaty
- Internal Medicine, The University of Toledo, Toledo, USA
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11
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Chiang LLW, Tsang SL, Lee JX, Gong M, Liu T, Tse G, Chang D, Lakhani I, Li KHC. Takotsubo cardiomyopathy with low ventricular ejection fraction and apical ballooning predicts mortality: a systematic review and meta-analysis. Heart Fail Rev 2020; 26:309-318. [PMID: 32895749 DOI: 10.1007/s10741-020-10018-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 12/27/2022]
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by temporary wall motion abnormality of the left ventricle. There is much debate upon the prognostic parameters. We conducted a systematic review and meta-analysis to investigate whether LVEF and the presence of apical ballooning predict long-term mortality in TCM. PubMed and Embase were searched through to October 30, 2017 without language restrictions, followed by an additional search through to February 2, 2020. Our search identified 18 studies that met the inclusion criteria, with a total of 5168 patients. Reduced LVEF as a categorical variable was associated with more than threefold increase in mortality risk in TCM patients (HR 3.10; 95% CI 1.78-5.42; P < 0.0001; I2 = 57%). Further subset analyses with the exclusion of studies consisting of patients with coronary artery disease revealed another significant relationship between LVEF and mortality (HR 3.13; 95% CI 1.392-7.031; P < 0.006; I2 = 58%). LVEF as a continuous variable was also found to be associated with increased mortality risk. However, this relationship only retained significance when computing odds ratios instead of hazard ratios (OR 0.95; 95% CI 0.93-0.98; P < 0.001; I2 = 0%). Finally, the existence of apical ballooning failed to demonstrate any link with an increased risk of mortality (HR 1.26; 95% CI 0.97-1.64; P = 0.09; I2 = 34%). LVEF and apical ballooning are both potential prognostic markers for mortality.
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Affiliation(s)
| | - Shek Long Tsang
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, China
| | - Jing Xian Lee
- Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Gary Tse
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, China
| | - Dong Chang
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ishan Lakhani
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China.
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12
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Vyshlov EV, Tsoi EI, Demyanov SV, Ryabov VV. [Peripartum cardiomyopathy or takotsubo cardiomyopathy? The clinical case with arterial hypotension and pulmonary edema]. ACTA ACUST UNITED AC 2020; 60:136-140. [PMID: 33155952 DOI: 10.18087/cardio.2020.7.n742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/26/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.
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Affiliation(s)
- E V Vyshlov
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Russia
| | - E I Tsoi
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Russia
| | - S V Demyanov
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Russia
| | - V V Ryabov
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences, Russia
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13
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Pérez-Treviño P, Sepúlveda-Leal J, Altamirano J. Simultaneous assessment of calcium handling and contractility dynamics in isolated ventricular myocytes of a rat model of post-acute isoproterenol-induced cardiomyopathy. Cell Calcium 2019; 86:102138. [PMID: 31838436 DOI: 10.1016/j.ceca.2019.102138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Stress-induced cardiomyopathy (SIC) results from a profound catecholaminergic surge during strong emotional or physical stress. SIC is characterized by acute left ventricular apex hypokinesia, in the absence of coronary arteries occlusion, and can lead to arrhythmias and acute heart failure. Although, most SIC patients recover, the process could be slow, and recurrence or death may occur. Despite that the SIC common denominator is a large catecholamine discharge, the pathophysiological mechanism is incompletely understood. It is thought that catecholamines have direct cytotoxicity on apical ventricular myocytes (VM), which have the highest β-adrenergic receptors density, and whose overstimulation might cause acute Ca2+ overload and oxidative stress, causing death in some VM and stunning others. Rodents receiving acute isoproterenol (ISO) overdose (OV) mimic SIC development, however, they have not been used to simultaneously assess Ca2+ handling and contractility status in isolated VM, which might explain ventricular hypokinesia. Therefore, treating rats with a single ISO-OV (67 mg/kg body weight), we sought out to characterize, with confocal imaging, Ca2+ and shortening dynamics in Fluo-4-loaded VM, during the early (1-5 days) and late post-acute phases (15 days). We found that ISO-OV VM showed contractile dysfunction; blunted shortening with slower force development and relaxation. These correlated with Ca2+ mishandling; blunted Ca2+ transient, with slower time to peak and SR Ca2+ recovery. SR Ca2+ content was low, nevertheless, diastolic Ca2+ sparks were more frequent, and their duration increased. Contractility and Ca2+ dysfunction aggravated or remained altered over time, explaining slow recovery. We conclude that diminished VM contractility is the main determinant of ISO-OV hypokinesia and is mostly related to Ca2+ mishandling.
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Affiliation(s)
- Perla Pérez-Treviño
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto No. 3000 Pte., Monterrey, N.L., 64710, Mexico
| | - José Sepúlveda-Leal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto No. 3000 Pte., Monterrey, N.L., 64710, Mexico
| | - Julio Altamirano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto No. 3000 Pte., Monterrey, N.L., 64710, Mexico.
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Comparison of clinical profiles between takotsubo syndrome and acute coronary syndrome: a systematic review and meta-analysis. Heart Fail Rev 2019; 25:847-860. [PMID: 31446536 DOI: 10.1007/s10741-019-09846-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A systematic review and meta-analysis were performed to analyse the differences in clinical profiles between takotsubo syndrome (TTS) and acute coronary syndrome (ACS) patients and to consolidate the evidence regarding the mortality predictors in TTS patients. Literature search of PubMed, EMBASE and the Cochrane Central Register was made, and 55 studies with a total of 66,653 TTS patients were included. Compared with ACS subjects, TTS subjects had significantly lower left ventricle ejection fraction (LVEF) values on admission; however, cardiovascular risks were fewer and the recovery LVEF was notably higher at both discharge and follow-up in TTS patients than in ACS patients (all P < 0.05). No significant differences were observed either in-hospital mortality or long-term mortality between the two groups (both P > 0.05). Acute renal failure and malignancies were independent predictors of all-cause in-hospital mortality in TTS patients (both P < 0.05). Male sex (HR = 0.565, 95% CI 0.253-0.876, P < 0.001, I2 = 0.00%), advanced age (HR = 0.054, 95% CI 0.041 to 0.067, P < 0.001, I2 = 0.00%), shock (HR = 1.382. 95% CI 1.050 to 1.714, P < 0.001, I2 = 0.00%) and initial LVEF < 35% (HR = 0.962, 95% CI 0.948 to 0.977, P < 0.001, I2 = 16.8%) were associated with an increased risk of long-time mortality in TTS patients. In conclusion, TTS has significantly different clinical characteristics than ACS. However, the in-hospital and long-term overall mortality rates are not trivial for TTS patients, and some presenting features (underlying diseases, male sex, advanced age, low LVEF and shock) were significantly associated with all-cause mortality.
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