Advancements in the diagnostic workup, prognostic evaluation, and treatment of takotsubo syndrome

Ali, Muhammad; Rigopoulos, Angelos; Ali, Khaldoun; Ikonomidis, Ignatios; Makavos, George; Matiakis, Marios; Melnyk, Hannes; Abate, Elena; Mammadov, Mammad; Prüser, Jan Lukas; Vecchis, Renato De; Wohlgemuth, Walter A.; Manginas, Athanassios; Bigalke, Boris; Mavrogeni, Sophie; Sedding, Daniel; Noutsias, Michel

doi:10.1007/s10741-019-09843-9

Cited by 11 publications

(6 citation statements)

References 90 publications

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“…Es una enfermedad infrecuente, con pocos datos epidemiológicos reportados en Latinoamérica. Además poco diagnosticada por el desconocimiento de la misma y por las similitudes en sus manifestaciones clínicas con el síndrome coronario agudo; condición que puede descartarse mediante la angiografía coronaria diagnóstica temprana 12 .…”

Section: Introductionunclassified

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia

Restrepo¹,

Munera²,

Aguilar³

et al. 2021

Rev Medicas UIS

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Introducción: El síndrome de Takotsubo es una disfunción ventricular aguda de carácter temporal, usualmente reversible, secundaria a eventos estresantes que comprometen el eje cerebro-corazón. Objetivo: describir las características clínicas, epidemiológicas y desenlaces de una cohorte de pacientes con síndrome de Takotsubo en Medellín-Colombia. Materiales y métodos: Estudio observacional, descriptivo, ambispectivo, realizado en una cohorte de pacientes. Se revisaron las historias clínicas de pacientes que ingresaron al servicio de urgencias de una institución de tercer nivel de complejidad de la ciudad de Medellín entre enero de 2011 y diciembre de 2016 con diagnóstico de síndrome de Takotsubo. Se diseñó un cuestionario para recolectar variables demográficas, clínicas, de laboratorio e imagenológicas. Se obtuvieron medidas de frecuencia y análisis estadístico con el programa SPSS versión 21. Resultados: El 66,7% de los pacientes fueron mujeres, la mortalidad fue del 11,1% y la recurrencia del 5,6%. La mayoría de los casos tuvieron un desencadenante conocido (94,5%), siendo la infección el más frecuente (44,4%). El 77,8% de los pacientes presentó disnea al ingreso y el 27,8% requirió uso de algún vasopresor. El promedio de la fracción de eyección del ventrículo izquierdo inicial fue del 34.17+7.8 con evidencia de mejoría en el control, promedio luego del control= 54,81+10.2 Discusión y conclusiones: El síndrome de Takotsubo es una condición nfrecuente, las mujeres son la población más afectada y la mayoría de los casos obedece a un factor desencadenante. La mortalidad reportada está dentro de lo esperado y se evidenció un buen pronóstico a mediano plazo.

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Section: Introductionunclassified

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia

Restrepo¹,

Munera²,

Aguilar³

et al. 2021

Rev Medicas UIS

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“…Takotsubo syndrome is considered as a form of MINOCA, which is a syndrome with different aetiologies, characterized by clinical evidence of myocardial infarction in the absence of obstructive coronary arteries on angiography. 5,6 Although the distinction between TTS and other forms of MINOCA is challenging in some cases, the normalization of LV systolic function in a relatively short period confirms the diagnosis of TTS. TTS commonly occurs in a setting in which the patient is exposed to emotional or physical stress and the resultant surge in catecholamine.…”

Section: Discussionmentioning

confidence: 97%

Takotsubo syndrome in a heart transplant recipient with poor cardiac sympathetic reinnervation

et al. 2020

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Takotsubo syndrome (TTS), also referred to as stress cardiomyopathy, is characterized by transient left ventricular apical ballooning in the absence of obstructive coronary artery disease. Catecholamine-induced cardiac injury or vasospasm has been implicated in this pathophysiology. We present a case of a 67-year-old man 10 years after heart transplantation diagnosed with TTS. Sympathetic reinnervation could not be detected by iodine-123 meta iodobenzylguanidine uptake, suggesting that TTS can occur in the absence of functional sympathetic nerve systems reconstruction.

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“…Therefore, omitting EMB diagnostics, which may also impose periinterventional complications [ 10 ], is appropriate in this patient [ 7 , 8 ], and the implementation of MCS may be deemed more important in rapidly deteriorating cardiogenic shock. TTS is a further clinical scenario which needs to be considered as differential diagnosis of cardiogenic shock following physical triggers [ 11 ]. Noticeably, TTS patients presenting with cardiogenic shock have substantially impaired prognosis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report

Ebert

Mungard

Mensch

et al. 2021

BMC Cardiovasc Disord

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Background The value of mechanical circulatory support (MCS) in cardiogenic shock, especially the combination of the ECMELLA approach (Impella combined with ECMO), remains controversial. Case presentation A previously healthy 33-year-old female patient was submitted to a local emergency department with a flu-like infection and febrile temperatures up to 39 °C. The patient was tested positive for type-A influenza, however negative for SARS-CoV-2. Despite escalated invasive ventilation, refractory hypercapnia (paCO2: 22 kPa) with severe respiratory acidosis (pH: 6.9) and a rising norepinephrine rate occurred within a few hours. Due to a Horovitz-Index < 100, out-of-centre veno-venous extracorporeal membrane oxygenation (vv-ECMO)-implantation was performed. A CT-scan done because of anisocoria revealed an extended dissection of the right vertebral artery. While the initial left ventricular function was normal, echocardiography revealed severe global hypokinesia. After angiographic exclusion of coronary artery stenoses, we geared up LV unloading by additional implantation of an Impella CP and expanded the vv-ECMO to a veno-venous-arterial ECMO (vva-ECMO). Clinically relevant bleeding from the punctured femoral arteries resulted in massive transfusion and was treated by vascular surgery later on. Under continued MCS, LVEF increased to approximately 40% 2 days after the initiation of ECMELLA. After weaning, the Impella CP was explanted at day 5 and the vva-ECMO was removed on day 9, respectively. The patient was discharged in an unaffected neurological condition to rehabilitation 25 days after the initial admission. Conclusions This exceptional case exemplifies the importance of aggressive MCS in severe cardiogenic shock, which may be especially promising in younger patients with non-ischaemic cardiomyopathy and potentially reversible causes of cardiogenic shock. This case impressively demonstrates that especially young patients may achieve complete neurological restoration, even though the initial prognosis may appear unfavourable.

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Advancements in the diagnostic workup, prognostic evaluation, and treatment of takotsubo syndrome

Cited by 11 publications

References 90 publications

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia

Takotsubo syndrome in a heart transplant recipient with poor cardiac sympathetic reinnervation

Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report

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