Determinants of Secondary Pulmonary Hypertension in Patients with Takotsubo Cardiomyopathy

Izumo, Masaki; Shiota, Maiko; Nalawadi, Smruti; Das, Jayanta R.; Dohad, Sohail; Kuwahara, Eiji; Fukuoka, Yasushi; Siegel, Robert J.; Shiota, Takahiro

doi:10.1111/echo.12949

Cited by 7 publications

(3 citation statements)

References 40 publications

(37 reference statements)

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“…Systolic heart failure is independently associated with older age, lower LVEF at presentation, higher admission rate and peak troponin levels, and a physical stressor preceding the onset of symptoms (11). In our study, old age and MR are independently associated with secondary pulmonary hypertension (57). Echocardiography evaluates cardiac function, pulmonary hypertension, and hemodynamics even in the chronic phase; that is, echocardiography is more useful than the other modalities ( Figure 2).…”

Section: Heart Failurementioning

confidence: 70%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

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Section: Heart Failurementioning

confidence: 70%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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“…Acute mitral regurgitation is associated with major adverse events (a composite of acute heart failure, cardiogenic shock, and in-hospital mortality) [ 28 ] and therefore careful observation and treatment are mandatory. In addition to LVOTO, tethering of the mitral leaflet due to acute left ventricular dilatation may cause transient and significant mitral regurgitation [ 49 ]. Detection of the mechanisms of mitral regurgitation by echocardiography is important because of its implications for treatment.…”

Section: Introductionmentioning

confidence: 99%

Update of takotsubo syndrome in the era of COVID-19

Okura

2021

Journal of Cardiology

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Highlights Takotsubo syndrome (TTS) has become a globally recognized disease and its spectrum has been widened based on the observations using multimodality images. Despite the long-standing clinical experience and efforts in basic research, its pathophysiology and specific treatments have not been well established. We should always remember possible cardiovascular complications such as coronary artery disease, thromboembolism, myocarditis, and TTS in patients with COVID-19.

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“…The mortality of patients with TS and cardiogenic shock can be as high as 28% [ 52 ]. 45% of patients with TS develop pulmonary hypertension [ 53 ]. Contractility dysfunction in TS is persistent.…”

Section: The Main Clinical Manifestations Of Takotsubo Syndromementioning

confidence: 99%

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Прокудина

Kurbatov

Zavadovsky

et al. 2021

CCR

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: The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart, lack of coronary artery obstruction, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old , than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. In many patients with TS, but not in all, physical or emotional stress precedes the disease. Many patients with TS, but not all, have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with the excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I –MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.

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Determinants of Secondary Pulmonary Hypertension in Patients with Takotsubo Cardiomyopathy

Abstract: Age and the severity of MR were independent predictors for secondary PH in patients with TTC.

Cited by 7 publications

References 40 publications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Update of takotsubo syndrome in the era of COVID-19

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

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