1
|
Affiliation(s)
- O M P Jolobe
- Flat 6 Suchay Caourt, 1 Clothourn Road, Manchester M20 6BR, UK
| |
Collapse
|
2
|
Madias JE. Frequent POCUS and auscultation for an earlier diagnosis of takotsubo syndrome and unraveling of its pathophysiology: The possible crucial role of LVOTO. Curr Probl Cardiol 2024; 49:102482. [PMID: 38401826 DOI: 10.1016/j.cpcardiol.2024.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
There is ample literature associating LVOTO with hypertension, AMI, LV hypertrophy, sigmoid septum, HCM, and TTS, particularly in midde aged/elderly/postmenopausal women, suggestive of a causal role for LVOTO in the pathophysiology of TTS. Although there is significant evidence that TTS is triggered by a sudden autonomic sympathetic nervous system surge and/or elevated blood-ridden catecholamines, the exact pathophysiologic trajectory leading to the clinical expression of the disease is still being debated. This review expounds on the possibility that LVOTO is a causal early component of this trajectory, and proposes that TTS is a malady within the broad spectrum of the myocardial ischemic injury/stunned myocardium states. The postulated underlying mechanism by which LVOTO causes TTS is a sudden abterload rise, with resultant oxygen/energy supply/demand mismatch, leading to a transient myocardial ischemia/injury myocardial stunning state. This needs to be explored painstakingly, and this review includes some suggestions for such undertaking. Ellucidation of the pathophysiology of TTS, and possible proof about a mechanistic role of LVOTO, may ensure that our current pharmacological and device panoply is adequate for the management of TTS.
Collapse
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.
| |
Collapse
|
3
|
Griffin M, Odanovic N, McNamara R, Altin SE, Balan S, Thompson J, Young LH. Intra-Aortic Balloon Pump Exacerbates Left Ventricular Outflow Tract Obstruction in a Patient With Takotsubo and Hypertrophic Cardiomyopathy. CASE (PHILADELPHIA, PA.) 2023; 7:502-507. [PMID: 38197115 PMCID: PMC10772928 DOI: 10.1016/j.case.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
•Obstructive HCM with superimposed takotsubo syndrome led to shock. •The use of an IABP worsened outflow obstruction. •Putting the IABP on standby improved outflow tract gradients dramatically. •An IABP should not be used in shock with LVOT obstruction.
Collapse
Affiliation(s)
- Matthew Griffin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Critical Care Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Natalija Odanovic
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Robert McNamara
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - S. Elissa Altin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Samantha Balan
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jazmyn Thompson
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence H. Young
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
4
|
Citro R, Bellino M, Merli E, Di Vece D, Sherrid MV. Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning? J Am Heart Assoc 2023; 12:e032028. [PMID: 37889174 PMCID: PMC10727392 DOI: 10.1161/jaha.123.032028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply-demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.
Collapse
Affiliation(s)
- Rodolfo Citro
- Cardio‐Thorax‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
- Department of Vascular PhysiopathologyIRCCS NeuromedPozzilliItaly
| | - Michele Bellino
- Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | - Elisa Merli
- Department of CardiologyOspedale per gli InfermiFaenzaItaly
| | - Davide Di Vece
- Department of CardiologyUniversity Hospital ZurichZurichSwitzerland
| | | |
Collapse
|
5
|
Waqar A, Jain A, Joseph C, Srivastava K, Ochuba O, Alkayyali T, Poudel S. Cardioprotective Role of Estrogen in Takotsubo Cardiomyopathy. Cureus 2022; 14:e22845. [PMID: 35382214 PMCID: PMC8977075 DOI: 10.7759/cureus.22845] [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: 10/16/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a rare, reversible cause of left ventricular wall motion abnormality (LVWMA) that mimics the presentation of acute myocardial infarction (AMI). TC is usually preceded by an emotional or physical stressor and appears to be more common in postmenopausal women. Various pathophysiological hypotheses of TC have been proposed, but the exact mechanism of action remains elusive. Elevated levels of catecholamines leading to cardiac dysfunction are the most prevalent hypothesis. The protective role of estrogen in the development of cardiomyopathies has been studied extensively. International Takotsubo Diagnostic Criteria (InterTAK) and Mayo clinic diagnostic criteria both have the stipulation stating prevalence of TC is higher in postmenopausal women which hints towards the protective role of estrogen in the development of TC. To review the protective role of estrogen in the mechanism of this novel pathology, we searched Pubmed and Google scholar for the relevant articles by using keywords such as: “takotsubo cardiomyopathy”, “apical ballooning”, “broken heart syndrome”, “stress cardiomyopathy”, “left ventricle wall motion abnormality”, “estrogen”, “estradiol” and “sex hormones”. Our research revealed that although the prevalence of TC is greater in postmenopausal women as compared to men, the prognosis is worse in men. It also revealed the involvement of multiple cellular pathways under the influence of estrogen that could explain the cardioprotective effect of estrogen. Most of the articles found were based on animal studies, thus, there is an emphasis on future human studies. However, we strongly suggest evaluating estrogen levels as part of the initial workup for any patient presenting with signs and symptoms of cardiac pathology.
Collapse
|
6
|
Ratwatte S, Yiannikas J. Case report: A patient with transient sigmoid septum in takotsubo syndrome with left ventricular outflow tract obstruction. J Cardiol Cases 2021; 24:272-275. [PMID: 34917208 DOI: 10.1016/j.jccase.2021.04.020] [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: 01/18/2021] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022] Open
Abstract
Left ventricular outflow tract obstruction is now recognized as a common complication of takotsubo syndrome, resulting in more serious acute and long-term outcomes. We describe a case of takotsubo syndrome where a transient sigmoid septum produced left ventricular outflow obstruction and explore the mechanisms leading to this occurring. This phenomenon has not been previously described. <Learning objective: Left ventricular outflow tract (LVOT) obstruction is a complication of takotsubo syndrome. A sigmoid septum is a risk factor for LVOT obstruction occurring. This case highlights that a sigmoid septum can be transient and may be secondary to surge in catecholamines and inflammatory markers.>.
Collapse
Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Concord Repatriation and General Hospital, Concord, New South Wales, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation and General Hospital, University of Sydney, Concord, New South Wales 2139, Australia
| |
Collapse
|
7
|
Ozaki K, Okubo T, Hagiya K, Kubota N, Tsuchida K, Takahashi K, Oda H, Minamino T. Unstable angina complicated with dynamic left ventricular outflow tract obstruction. J Cardiol Cases 2021; 23:181-188. [PMID: 33841598 DOI: 10.1016/j.jccase.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
Left ventricular outflow tract obstruction (LVOTO) complicated with unstable angina (uAP) has not been described widely, but patients with these two conditions have several problems. Differentiation of the two conditions is also often difficult because the chest symptoms are similar. Moreover, nitrates are commonly used for ischemic heart disease, but have the effect of worsening LVOTO. We experienced three cases of dynamic LVOTO with a sigmoid-shaped septum, and without typical hypertrophic obstructive cardiomyopathy, that were complicated with uAP. In all cases, LVOTO was improved after initial percutaneous coronary intervention (PCI) for the left anterior descending artery lesion. Next, a dobutamine stress test was performed and LVOTO was provoked again in two cases, but not in a case with small acute myocardial infarction of the basal septum during PCI. All cases remained asymptomatic with beta-blocker therapy. Therefore, PCI and beta-blocker administration for LVOTO with uAP resulted in favorable clinical courses in all three cases. These outcomes suggest that revascularization including PCI should have priority in the therapeutic strategy for a case of acute coronary syndrome with LVOTO.
Collapse
Affiliation(s)
- Kazuyuki Ozaki
- Department of Cardiology, Niigata City General Hospital, Japan.,Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| | - Takeshi Okubo
- Department of Cardiology, Niigata City General Hospital, Japan.,Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Niigata City General Hospital, Japan.,Department of Cardiology, Sakakibara Heart Institute, Japan
| | - Naoki Kubota
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| | | | | | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Chuo-ku, Niigata 951-8510, Japan
| |
Collapse
|
8
|
Abstract
Takotsubo cardiomyopathy or takotsubo syndrome (TTS) has become a well-known disease not only in Japan but also in the rest of the world. Early reports suggested that TTS is a self-limiting disease with better prognosis than acute coronary syndrome. However, recent data showed that TTS is not a benign disease as compared with acute coronary syndrome. In addition to the apical ballooning, several other types of wall motion abnormalities have been classified as variants of TTS. In particular, right ventricular involvement, or biventricular TTS, is not uncommon and is associated with poor in-hospital as well as long-term outcomes. With respect to the pathophysiology, modulation (desensitization) of the beta-adrenergic receptor is suspected as a possible mechanism for transiently depressed myocardial contraction. Although specific treatments to improve prognosis of TTS are still uncertain, observational data suggest favorable impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Finally, in the era of COVID-19, we should pay attention to a variety of cardiovascular conditions related to COVID-19. TTS is one of these conditions that can be triggered by both emotional and physical impact of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| |
Collapse
|
9
|
Orphanou N, Eftychiou C, Papasavvas E, Ioannides M, Avraamides P. Syncope in a hypertrophic heart at a wedding party: can happiness break a thick heart? Takotsubo cardiomyopathy complicated with left ventricular outflow tract obstruction in a hypertrophic heart. Oxf Med Case Reports 2020; 2020:omaa036. [PMID: 32626581 PMCID: PMC7323591 DOI: 10.1093/omcr/omaa036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 01/09/2023] Open
Abstract
A 70-year-old woman with known history of hypertension presented because of a syncopal episode during dinner at a wedding party, followed by chest pain. On physical examination a systolic murmur was noted, and her electrocardiogram showed ST segment elevation in anterior leads. She had elevated troponin levels while echocardiography showed a hypertrophic interventricular septum with dyskinetic apex and left ventricular outflow (LVOT) obstruction. Emergency coronary angiography excluded obstructive coronary artery disease and confirmed the presence of LVOT obstruction with a gradient of 90 mm Hg. A left ventriculography showed hypercontractility of the basal and mid segments with apical wall dyskinesia indicating Takotsubo cardiomyopathy. Patient was discharged after 6 days of hospitalization with normalization of left ventricular function and regression of the LVOT obstruction. This is an interesting case of Takotsubo cardiomyopathy complicated with severe LVOT obstruction in a patient with hypertensive heart disease and a sigmoid septum hypertrophy.
Collapse
Affiliation(s)
| | | | - Elias Papasavvas
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Marios Ioannides
- Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | | |
Collapse
|
10
|
Takada T, Jujo K, Ishida I, Hagiwara N. Recurrent takotsubo syndrome with worsening of left ventricular outflow obstruction during haemodialysis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32352061 PMCID: PMC7180539 DOI: 10.1093/ehjcr/ytaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/10/2019] [Accepted: 01/23/2020] [Indexed: 12/22/2022]
Abstract
Background The recurrence rate of takotsubo syndrome (TS) has been reported as 1.8% per patient-year while left ventricular outflow tract (LVOT) obstruction is comorbid in 10–25% of all instances of TS. The clinical course of recurrent TS with associated LVOT while on haemodialysis has rarely been reported. Case summary This case report involves a 60-year-old female patient receiving regular haemodialysis who was admitted for chest pain during ballroom dancing. Four years prior, she had suffered TS, and fully recovered after the hospitalization. An emergent coronary angiogram done during the second hospitalization showed no significant stenosis, and left ventriculography demonstrated mid-apical akinesia and basal hyperkinesia. Based on these findings, we diagnosed the recurrence of TS. Later in the admission, chest pain reappeared with the start of haemodialysis. A transthoracic echocardiogram demonstrated mean pressure gradient (PG) of LVOT was 58 mmHg, with systolic anterior motion of the mitral valve and basal-wall hyperkinesia. The main aetiology for her symptoms was considered as an exacerbation of LVOT obstruction due to removing intravascular volume by haemodialysis. After starting landiolol at 3 μg/kg/min, PG of LVOT and symptoms gradually improved with uptitration of landiolol. Finally, her chest pain resolved when mean PG of LVOT was down to 38 mmHg using 10 μg/kg/min of landiolol. Discussion To our knowledge, this is the first report of a recurrent TS case comorbid with LVOT obstruction while on regular haemodialysis. Landiolol, the ultrashort-acting beta-blocker, may be a promising therapeutic option for rapid recovery of increased PG due to LVOT obstruction.
Collapse
Affiliation(s)
- Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.,Department of Cardiology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Issei Ishida
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| |
Collapse
|
11
|
Takama T, Fukue M, Sato H, Taniuchi M. A case of ultrashort-acting beta-blocker landiolol hydrochloride for takotsubo syndrome with left ventricular outflow tract obstruction. J Gen Fam Med 2019; 20:65-67. [PMID: 30873307 PMCID: PMC6399582 DOI: 10.1002/jgf2.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 01/29/2023] Open
Abstract
Takotsubo syndrome (TTS) has been known to have a favorable prognosis. Beta-blockers are reported to be effective for TTS patients with cardiogenic heart failure due to left ventricular outflow tract (LVOT) obstruction. However, there is no report on ultrashort-acting beta-blockers being used for treating TTS, and there are no clear guidelines for their dosages or applications. Herein, we describe a 72-year-old woman in whom landiolol hydrochloride was used in the acute phase of TTS with LVOT obstruction. In this case, the dose of landiolol hydrochloride was increased to 10 μg/kg/min, resulting in improvement of LVOT obstruction, which led to hemodynamic stabilization.
Collapse
Affiliation(s)
- Takuro Takama
- Department of CardiologyYamachika Memorial HospitalOdawaraJapan
| | - Mitsunori Fukue
- Department of CardiologyYamachika Memorial HospitalOdawaraJapan
| | - Hiroyuki Sato
- Department of Emergency and Critical Care MedicineThe Jikei University School of MedicineTokyoJapan
| | - Masato Taniuchi
- Department of CardiologyYamachika Memorial HospitalOdawaraJapan
| |
Collapse
|
12
|
Dynamic left ventricular outflow tract obstruction complicated with takotsubo cardiomyopathy: The acute phase of takotsubo cardiomyopathy manifests latent left ventricular outflow tract obstruction. J Cardiol Cases 2018; 18:60-64. [PMID: 30279912 DOI: 10.1016/j.jccase.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/12/2018] [Accepted: 04/24/2018] [Indexed: 11/20/2022] Open
Abstract
Dynamic left ventricular (LV) outflow tract (LVOT) obstruction is sometimes complicated with takotsubo cardiomyopathy (TC). The present case involves a 70-year-old woman with chest discomfort. Seven years earlier, transthoracic echocardiography revealed LVOT obstruction due to a sigmoid-shaped septum. She underwent urgent cardiac catheterization for suspected acute coronary syndrome. She was diagnosed as having TC with LVOT obstruction. After undergoing conservative treatment, her LV function normalized and the LVOT obstruction resolved. After the LV wall motion normalized, administering an intravenous infusion of dobutamine again provoked LVOT obstruction. In this situation, the presence of TC manifested latent LVOT obstruction. <Learning objective: Although dynamic left ventricular outflow tract (LVOT) obstruction is the important compication of takotsubo cardiomyopaty (TC), the mechanism of LVOT obstruction remains unclear. This case had latent LVOT obstruction due to sigmoid-shaped septum, and LVOT obstruction might be manifested in the acute phase of TC. This phenomenon has potential for mechanism of LVOT obstruction complicated with TC.>.
Collapse
|
13
|
Abanador-Kamper N, Kamper L, Wolfertz J, Pomjanski W, Wolf-Pütz A, Seyfarth M. Evaluation of therapy management and outcome in Takotsubo syndrome. BMC Cardiovasc Disord 2017; 17:225. [PMID: 28818058 PMCID: PMC5561577 DOI: 10.1186/s12872-017-0661-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/13/2017] [Indexed: 02/07/2023] Open
Abstract
Background To date there is no validated evidence for standardized treatment of patients with Takotsubo syndrome (TTS). Medication therapy after final TTS diagnosis remains unclear. Previous data on patient outcome is ambivalent. Aim of this study was to evaluate medication therapy in TTS and to analyze patient outcome. Methods Within an observational retrospective cohort study we analyzed our medical records and included 72 patients with TTS that underwent cardiovascular magnetic resonance imaging (CMR) after a median of 2 days interquartile range (IQR 1–3.5). We investigated medication therapy at discharge. Medication implementation and major adverse clinical events (MACE) were prospectively evaluated after a median follow-up of 24 months (IQR 6–43). Left ventricular function, myocardial oedema and late gadolinium enhancement were analyzed in a CMR follow-up if available. Results Antithrombotic therapy was recommended in 69 (96%) patients including different combinations. Antiplatelet monotherapy was prescribed in 28 (39%) patients. Dual antiplatelet therapy was recommended in 29 (40%) patients. Length of therapy duration varied from one to twelve months. Only in one case oral anticoagulation was prescribed due to apical ballooning with a left ventricular ejection fraction <30%. In all other cases oral anticoagulation was recommended due to other indications. ß-adrenoceptor antagonists and ACE inhibitors were recommended in 63 (88%), mineralocorticoid receptor antagonists were prescribed in 31 (43%) patients. After a median of 2 months (IQR 1.3–2.9) left ventricular function significantly recovered (49.1% ± 10.1 vs. 64.1% ± 5.7, P < 0.001) and myocardial oedema significantly decreased (13.5 ± 11.3 vs. 0.6% ± 2.4, P = <0.001) in the CMR follow-up. The 30-day mortality was 1%. MACE rate after 24 months was 12%. Conclusion Although therapy guidelines for TTS currently do not exist, we found that the majority of patients were treated with antithrombotic and heart failure therapy for up to twelve months. Left ventricular function and myocardial oedema recovered rapidly within the first two months. Outcome analysis showed a low bleeding rate and a high short-term survival. Therefore, TTS patients might benefit from antithrombotic and heart failure therapy at least for the first two months.
Collapse
Affiliation(s)
- Nadine Abanador-Kamper
- Department of Cardiology, HELIOS Medical Center Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany. .,Center for Clinical Medicine Witten/Herdecke University Faculty of Health, Wuppertal, Germany.
| | - Lars Kamper
- Center for Clinical Medicine Witten/Herdecke University Faculty of Health, Wuppertal, Germany.,Department of Diagnostic and Interventional Radiology, HELIOS Medical Center Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany
| | - Judith Wolfertz
- Department of Cardiology, HELIOS Medical Center Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany.,Center for Clinical Medicine Witten/Herdecke University Faculty of Health, Wuppertal, Germany
| | - Witali Pomjanski
- Department of Cardiology, HELIOS Medical Center Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany.,Center for Clinical Medicine Witten/Herdecke University Faculty of Health, Wuppertal, Germany
| | - Anamaria Wolf-Pütz
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Melchior Seyfarth
- Department of Cardiology, HELIOS Medical Center Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany.,Center for Clinical Medicine Witten/Herdecke University Faculty of Health, Wuppertal, Germany
| |
Collapse
|