Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy

Eitel, Ingo; Knobelsdorff‐Brenkenhoff, Florian von; Bernhardt, Peter; Carbone, Iacopo; Muellerleile, Kai; Aldrovandi, Annachiara; Francone, Marco; Desch, Steffen; Gutberlet, Matthias; Strohm, Oliver; Schuler, Gerhard; Schulz‐Menger, Jeanette; Thiele, Holger; Friedrich, Matthias G.

doi:10.1001/jama.2011.992

Cited by 565 publications

(577 citation statements)

References 27 publications

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“…Angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers could have some benefit in term of improved survival at 1 year 3. β‐Blockers showed no effect on survival and recurrence rate,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 whereas calcium antagonists could be used if coronary vasospasm has been proven during coronary angiogram or with acetylcholine test 32…”

Section: Discussionmentioning

confidence: 99%

“…The LV ejection fraction (LVEF) was calculated biplane using the Simpson method from the apical 4‐chamber and 2‐chamber view 5. The pattern of LV dysfunction was classified as follows: apical ballooning type (akinesia/dyskinesia of the LV apex), midventricular ballooning type (akinesia/dyskinesia midventricular LV segments), and basal type (akinesia/dyskinesia of the LV basal segments) 6. In 1 institution, cardiac magnetic resonance (CMR) was also performed in patients without contraindications during hospitalization in order to confirm the diagnosis of TTS 7…”

Section: Methodsmentioning

confidence: 99%

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Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

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BackgroundLeft ventricular (LV) thrombi during Takotsubo syndrome represent a potential complication and can be associated with cerebrovascular embolic events. The aim of this study was to evaluate the exact incidence, predictors, and management strategies of LV thrombi in patients with Takotsubo syndrome.Methods and ResultsWe enrolled 541 consecutive patients in a multicenter international registry. Clinical features and echocardiographic data at admission, during hospitalization, and after 3 months were evaluated. Survival rates for long‐term follow‐up (mean 984±908 days) were recorded. Twelve Takotsubo syndrome patients (2.2%) developed LV thrombi (all female presenting with apical ballooning pattern). All patients with LV thrombi were treated with oral anticoagulation therapy; however, 2 (17%) had a stroke before treatment initiation. These patients were characterized by a higher prevalence of ST‐elevation (56% versus 16%; P<0.001) and higher troponin I levels (10.8±18.3 ng/mL versus 3.5±4.3 ng/mL; P=0.001) as compared with those without LV thrombi. At multivariate analysis including age, sex, LV ejection fraction, ST‐elevation at admission, and apical ballooning pattern, troponin I level >10 ng/mL was the only predictor for LV thrombosis (hazard ratio 6.6, confidence interval, 1.01–40.0; P=0.04). After 3 months all LV thrombi disappeared. Oral anticoagulation therapy was interrupted in all patients except 1. At long‐term follow‐up, the survival rate was not different between patients with and without LV thrombi (84% versus 85%; P=0.99).Conclusions LV thrombi have a relatively low incidence among patients with Takotsubo syndrome and were detected in female patients with apical ballooning pattern and increased troponin levels. Oral anticoagulation therapy for 3 months seems reasonable in these high‐risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

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“…10 In a large multicenter prospective study involving 7 tertiary centers in Europe and North America, Eitel et al evaluated 256 patients of TC with cardiac MRI at initial presentation, and at 1 and 6 month follow-up. 28 CMR provides important information on reversible (inflammation, ischemic edema), and irreversible (fibrosis/necrosis) myocardial injury. Out of 256 patients, 93% (239 patients) underwent MRI at a median of 3 days after presentation, and in the 34% patients who did not receive follow up MRI at 1 & 6 months, echo was used to document complete recovery of LV function.…”

Section: Non Invasive Methods -Cmrmentioning

confidence: 99%

Microvascular Dysfunction in Takotsubo Cardiomyopathy

Gowdar

Chhabra

2016

ICFJ

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Takotsubo cardiomyopathy or stress-induced cardiomyopathy, is characterized by transient cardiac dysfunction, usually but not always triggered by physical or emotional stress. Takotsubo cardiomyopathy may mimic an acute coronary syndrome due to an overlapping presenting clinical spectrum. Typically, apical involvement with hypercontraction of basal left ventricle (apical type) is predominant, but atypical types involving basal, midventricular, and right ventricular myocardium have also been described. To date, the exact pathogenic mechanism of this disease remains unclear however sympathetic or catecholaminergic hyperactivity, mutivessel coronary vasospasm, microcirculatory disorder, and estrogen deficiency have been proposed to be the likely underlying pathogenic mechanisms. In this review, we specifically highlight the association of microcirculatory dysfunction in takotsubo cardiomyopathy which has been more recently recognized as an important pathogenetic contributor to this disease.

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“…In an MRI study, biventricular involvement was observed in 42% of TC patients, a group that tended to have a worse outcome and longer hospitalisation compared to patients with only LV involvement. 48 A unique feature of CMR is tissue characterisation of acute myocardial changes observed in TC patients. The characteristic finding on short T1 inversion recovery CMR images in TC patients is oedema of the hypokinetic myocardium, showing high signal intensity with a diffuse or transmural distribution.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

“…52,53 In the largest MRI study to date, minute focal or patchy non-ischaemic LGE was seen in 9% of patients with TC when a threshold of 3 standard deviations above the mean signal intensity for normal myocardium was designated as significant enhancement. 48 Usually the LGE will be absent at follow-up. Rarely small apical transmural apical LGE persists at follow-up.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

Looi¹,

Kerr²

2016

ICFJ

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Takotsubo cardiomyopathy (TC) is a transient, reversible form of cardiomyopathy which predominantly affects post-menopausal women and is an important differential diagnosis of acute coronary syndrome. It is characterised by normal (or near-normal) coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often proceeded by a stressful event. The pathophysiologic mechanism is complex and remains to be elucidated. There is increasing awareness among physicians about TC and hence, more cases are being reported. The diagnosis of TC has important clinical implications in the management at presentation and afterward. In this review, we discuss the demographics, clinical features, prognosis and management of this cardiomyopathy.

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Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy

Abstract: The clinical profile of SC is considerably broader than reported previously. Cardiovascular magnetic resonance imaging at the time of initial clinical presentation may provide relevant functional and tissue information that might aid in the establishment of the diagnosis of SC.

Cited by 565 publications

References 27 publications

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Microvascular Dysfunction in Takotsubo Cardiomyopathy

Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

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