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Silverio A, Bossone E, Parodi G, Scudiero F, Di Maio M, Vriz O, Bellino M, Zito C, Provenza G, Iuliano G, Cristiano M, Novo G, Mauro C, Rigo F, Innelli P, Salerno-Uriarte J, Cameli M, Tremiterra G, Vecchione C, Antonini-Canterin F, Galasso G, Citro R. Arterial hypertension in patients with takotsubo syndrome: prevalence, long-term outcome, and secondary preventive strategies: a report from the Takotsubo Italian Network register. Eur J Prev Cardiol 2023; 30:1998-2005. [PMID: 37463434 DOI: 10.1093/eurjpc/zwad237] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/18/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
AIMS The aim of this study was to investigate the long-term outcome of takotsubo syndrome (TTS) patients with and without hypertension (HT) and to evaluate the effectiveness of treatment with beta-blockers (BBs) and/or renin-angiotensin-aldosterone system inhibitors (RAASi). METHODS AND RESULTS The study population includes a register-based, multicentre cohort of consecutive patients with TTS, divided into two groups according to the history of HT. Further stratification was performed for BB/RAASi prescription at discharge. The primary outcome was the composite of all-cause death and TTS recurrence at the longest available follow-up. The propensity score weighting technique was used to account for potential confounding. In the overall population (903 patients, mean age 70 ± 11 years), HT was reported in 66% of cases. At a median 2-year follow-up, there was no difference in the risk of the primary composite outcome between patients with and without HT. The adjusted Cox regression analysis showed a significantly lower risk for the primary outcome [adjusted hazard ratio (aHR): 0.69; 95% confidence interval (CI): 0.49-0.99] in patients who received BB vs. those who did not. Renin-angiotensin-aldosterone system inhibitors treatment was not associated with the primary study outcome. The lower risk for the primary outcome with BB treatment was confirmed in patients with HT (aHR: 0.37; 95% CI: 0.24-0.56) but not in patients without (aHR: 1.83; 95% CI: 0.92-3.64; Pinteraction < 0.001). CONCLUSION In this TTS study, HT did not affect the long-term risk of adverse events but increased the probability of benefit from BB treatment after discharge. Owing to the favourable outcome impact of BB prescription in TTS patients with HT, a tailored pharmacological therapy should be considered in this cohort.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Guido Parodi
- Department of Cardiology, ASL4 Liguria, Lavagna, Italy
| | | | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, University Hospital 'Policlinico G. Martino', Messina, Italy
| | - Gennaro Provenza
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Giuseppe Iuliano
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Mario Cristiano
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Ciro Mauro
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Fausto Rigo
- Cardiology Department, Ospedale dell'Angelo Mestre-Venice, Venice, Italy
| | - Pasquale Innelli
- Department of Cardiovascular Imaging, San Carlo Hospital, Potenza, Italy
| | | | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuliana Tremiterra
- Healtcare Management, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Isernia, Italy
| | - Francesco Antonini-Canterin
- Cardiology Unit, High Specialization Rehabilitation Hospital Motta di Livenza, Motta di Livenza, Treviso, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Rodolfo Citro
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Heart Tower Room 807, Largo Città d'Ippocrate, Salerno 84131, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Isernia, Italy
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Chong TK, Chen J, Lyu L, Wei Y, Liu Y, Wu L, Tao Y, Jiang L, Sun Z, Li D, Guan Q, Cheng F, Ding Y, Miao P, Lu C, Lei J, Wei T, Zhu T, Liu K. Clinical characteristics and outcome correlates of Chinese patients with takotsubo syndrome: Results from the first Chinese takotsubo syndrome registry. Int J Cardiol 2023; 387:131129. [PMID: 37355242 DOI: 10.1016/j.ijcard.2023.131129] [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: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To investigate clinical features and outcomes of Chinese patients with Takotsubo syndrome (TTS). METHODS We established the first Chinese Registry of Takotsubo Syndrome (ChiTTS Registry) and analyzed demographic, clinical, therapeutical, and outcome data to characterize clinical and outcome features of Chinese TTS patients. RESULTS In 112 enrolled patients in the ChiTTS registry from 02/01/2016 to 12/28/2021, the mean age was 59.4 ± 18.7 years old, and 27.7% were men. A total of 41.1% patients experienced respiratory and circulatory complications during hospitalization, and 17.3% patients developed cardiogenic shock. Physical triggers, dyspnea, tachycardia, and younger age (< 70 years old) predicted in-hospital complications. The MACCE rate during follow up was 13.9% per patient per year and the rate of all-cause death was 12.8% per patient per year. TTS patients with in-hospital complications developed more long-term MACCE (24.6% vs. 6.6% per patient-year, P < 0.001) and higher all-cause mortality (21.9% vs. 6.6% per patient-year, P = 0.001) than those without. The Kaplan-Meier survival analysis showed that more MACCE occurred in TTS patients with tachycardia during 3-year follow-up (HR 4.18; 95% CI 1.80-9.74; log-rank test P < 0.001). Among all medications at discharge, only beta-blocker was associated with reduced long-term MACCE (HR: 0.35; 95% CI: 0.12-0.996; P = 0.049). CONCLUSION We investigated clinical and outcome features of patients in the first Chinese TTS Registry. Tachycardiac TTS patients developed more inpatient and long-term adverse cardiovascular events.
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Affiliation(s)
- Tou Kun Chong
- Department of Cardiology, Kiang Wu Hospital, Macao Special Administrative Region of the People's Republic of China, PR China
| | - Jian Chen
- Department of Cardiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong 519000, PR China
| | - Lingchun Lyu
- Department of Cardiology, Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang 323000, PR China
| | - Yulin Wei
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510000, PR China
| | - Yusheng Liu
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Liwen Wu
- Department of Ultrasound, The sixth affiliated hospital of Guangzhou Medical University/Qingyuan People's Hospital, Qingyuan, Guangdong 511500, PR China
| | - Yuan Tao
- Department of Cardiology, Sheng Zhou People's Hospital, Shengzhou, Zhejiang 312400, PR China
| | - Lingzhi Jiang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310000, PR China
| | - Zhongxia Sun
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, PR China
| | - Dabin Li
- Department of Cardiology, Kiang Wu Hospital, Macao Special Administrative Region of the People's Republic of China, PR China
| | - Qianglin Guan
- Department of Cardiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong 519000, PR China
| | - Fangyuan Cheng
- Department of Cardiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong 519000, PR China
| | - Yongmin Ding
- Department of Respiratory and Critical Care Medicine, Sheng Zhou People's Hospital, Shengzhou, Zhejiang 312400, PR China
| | - Pengfei Miao
- Department of Cardiology, Linfen Central Hospital, Linfen, Shanxi 041000, PR China
| | - Chenying Lu
- Department of Radiology, Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang 323000, PR China
| | - Juan Lei
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510000, PR China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital of Zhejiang University School of Medicine, Lishui, Zhejiang 323000, PR China
| | - Tiangang Zhu
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People's Hospital, Beijing 100000, PR China.
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, Washington University in St Louis, Barnes-Jewish Hospital, St Louis, MO, United States of America.
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Matta AG, Carrié D. Epidemiology, Pathophysiology, Diagnosis, and Principles of Management of Takotsubo Cardiomyopathy: A Review. Med Sci Monit 2023; 29:e939020. [PMID: 36872594 PMCID: PMC9999670 DOI: 10.12659/msm.939020] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a reversible syndrome commonly found among patients presenting for acute coronary syndromes, especially women. With the COVID-19 pandemic, the incidence of takotsubo cardiomyopathy was dramatically increased. However, this clinical cardiac entity remains underdiagnosed, largely due to the interplay with acute coronary syndrome. The pathophysiology of takotsubo cardiomyopathy is miscellaneous, including coronary vasospasm, microcirculatory dysfunction, catecholamine surge, and sympathetic overdrive. Diagnosing takotsubo cardiomyopathy requires a high index of clinical suspicion and multimodality tests. To date, there are no guidelines for the management of takotsubo cardiomyopathy. Thus, available data are derived from case series, retrospective analyses, and experts' opinions. Heart failure medicines were investigated in takotsubo cardiomyopathy patients. Evidence supports the benefits of angiotensin-converting enzyme inhibitors and angiotensin receptors blockers use on mortality and recurrence rates, while results from use of beta-blockers are controversial. In complicated cases, inotropes are preferred over vasopressors, except in the presence of left ventricular outflow tract obstruction, in which medical therapy is limited to fluids administration and beta-blockers. Use of oral vitamin K antagonist can benefit patients at high thrombo-embolic risk for up to 3 months. Mechanical supports are reserved for refractory hemodynamically unstable cases. This review aims to provide an update on the epidemiology, diagnosis, and outcomes of takotsubo cardiomyopathy, and an extended discussion on the management of complicated and non-complicated cases.
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Affiliation(s)
- Anthony Georges Matta
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.,Department of Cardiology, Hôpitaux Civils de Colmar, Colmar, France
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
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Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. IJC HEART & VASCULATURE 2022; 39:100990. [PMID: 35281752 PMCID: PMC8913320 DOI: 10.1016/j.ijcha.2022.100990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
Takotsubo cardiomyopathy (TTS) has become a recognised clinical entity since the Japanese scientist Sato first described it in 1990. Despite an increasing number of confirmed cases, especially during the COVID-19 pandemic, its pathophysiology remains incompletely understood, and decision-making differs in the diagnosis and treatment. In addition, it is not evident whether a significant increase in TTS is due to better understanding among practitioners and widespread access to coronary angiography, or if it is a reflection of an actual increase in incidence. We analysed a series of international research studies from 1990 to 2021. Beyond epidemiology and clinical presentation, we evaluated and summarised fundamental knowledge about various predisposing factors, with particular attention to the iatrogenic impact of certain drugs, namely antidepressants, chemotherapy, and antiarrhythmics. Furthermore, we highlighted the main pathophysiological theories to date. In addition, based on published studies and clinical cases, we investigated the role of numerous diagnostic approaches in the differential diagnosis of TTS and identified predictors of TTS complications, such as cardiogenic shock, ventricular fibrillation, and left ventricular thrombi. Accordingly, we sought to propose a diagnostic algorithm and further treatment management of TTS under the presence of possible complications to help practitioners make more informed decisions, as the initial presentation continues to pose a challenge due to its close similarity to acute coronary syndrome with ST-elevation. In conclusion, this article examines Takotsubo cardiomyopathy from different perspectives and, along with future systematic reviews and meta-analyses, can be of particular interest to practising cardiologists and researchers in developing clinical guidelines.
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Affiliation(s)
- Anastasiia V. Bairashevskaia
- Department of Paediatrics, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sofiya Y. Belogubova
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| | - Mikhail R. Kondratiuk
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria S. Rudnova
- International School “Medicine of the Future”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Susanna S. Sologova
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Olga I. Tereshkina
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Esma I. Avakyan
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
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5
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Brain-heart communication in health and diseases. Brain Res Bull 2022; 183:27-37. [PMID: 35217133 DOI: 10.1016/j.brainresbull.2022.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022]
Abstract
Tight connections between the brain and heart have attracted a considerable amount of attention. This review focuses on the anatomical (extrinsic cardiac autonomic nervous system and intrinsic cardiac autonomic nervous system) and functional (neuroendocrine-heart axis and neuroimmune-heart axis) connections between the brain and heart, the linkage between central nervous system diseases and cardiovascular diseases, the harm of sympathetic hyperactivity to the heart, and current neuromodulation therapies. Depression is a comorbidity of cardiovascular diseases, and the two are causally related. This review summarizes the mechanisms and treatment of depression and cardiovascular diseases, providing theoretical evidence for basic research and clinical studies to improve treatment options.
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Topf A, Mirna M, Dienhart C, Jirak P, Bacher N, Boxhammer E, Gharibeh SX, Motloch LJ, Hoppe UC, Lichtenauer M. Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome. Biomedicines 2022; 10:biomedicines10020464. [PMID: 35203673 PMCID: PMC8962389 DOI: 10.3390/biomedicines10020464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Treatment with betablockers is controversial in Takotsubo syndrome (TTS); however, many physicians intuitively initiate or continue betablocker therapy in these patients. The effect of preadmission betablocker use on adverse cardiovascular events has not been studied in the literature. Methods: To investigate this issue, we evaluated clinical complications, defined by the endpoint of occurrence of hemodynamically relevant arrythmia, cardiac decompensation, and all-cause adverse cardiac events, during hospitalization, in 56 patients hospitalized for TTS between April 2017 and July 2021. We compared the risk of adverse cardiovascular events between patients with preadmission betablocker therapy and those without preadmission betablocker therapy. Pretreatment betablocker therapy was defined as daily betablocker intake for more than a week including day of admission. Results: TTS patients taking preadmission betablockers had a significantly increased risk of all-cause complications relative to patients without betablockers in preadmission medication ((52.0% vs. 19.4%, p = 0.010; OR 4.5 (95% Cl 1.38–14.80)). Furthermore, TTS patients already taking betablockers on admission showed a statistically significant increased risk of cardiac decompensation when compared to patients without pretreatment with betablockers (p = 0.013). There were no significant differences in patient characteristics in patients who were taking beta blockers as an adjunct therapy prior to admission for TTS relative to those who were not. There is however an increase in comorbidities, hypertension, and atrial fibrillation, in past medical history in patients taking a preadmission betablocker. The difference is related to therapeutic applications for beta blockers and was not significant based on endpoints of our study. Conclusions: Preadmission betablocker treatment was associated with a 4.5 times higher risk of adverse cardiac events. This increased risk of all-cause complications and of cardiac decompensation within the acute phase of TTS is presumably due to the negative inotropic effects of betablockers and upregulation of β-adrenergic receptors in patients with chronic betablocker therapy.
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Affiliation(s)
- Albert Topf
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
- Correspondence:
| | - Moritz Mirna
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Christiane Dienhart
- Clinic for Internal Medicine I, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria;
| | - Peter Jirak
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Nina Bacher
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Elke Boxhammer
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Sarah X. Gharibeh
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Lukas J. Motloch
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Uta C. Hoppe
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Michael Lichtenauer
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
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