Distinctive Clinical Characteristics According to Age and Gender in Apical Ballooning Syndrome (Takotsubo/Stress Cardiomyopathy): An Analysis Focusing on Men and Young Women

Patel, Sandeep M.; Chokka, Ramesh G.; Prasad, Konasale; Prasad, Abhiram

doi:10.1016/j.cardfail.2013.03.007

Cited by 64 publications

(61 citation statements)

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“…Even in the cases of recurrence, women still dominate this syndrome. In young patients aged less than 50 years, the median recurrence rate was perhaps surprisingly higher than those aged 50 or more years 14 . That may reflect a greater proportion of younger patients with secondary takotsubo syndrome where the triggering event is more likely to recur.…”

Section: Epidemiologymentioning

confidence: 81%

“…Across many different series, approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome 6,11,12 , with the postmenopausal female predominance described above [13][14][15][16] . If only female cases with suspected acute coronary syndrome are considered, up to 10% patients are ultimately diagnosed with takotsubo syndrome 10 .…”

Section: Epidemiologymentioning

confidence: 99%

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Epidemiology and pathophysiology of Takotsubo syndrome

2015

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Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, and often in a circumferential apical, mid-ventricular or basal distribution. A number of pathophysiological explanations for this syndrome with its intriguing appearance have been proposed, and there is a growing awareness that these are not mutually exclusive, and that the reversible apical myocardial dysfunction observed could result from more than one pathophysiological phenomenon. The pathophysiology of takotsubo syndrome is complex, with integration of both neuroendocrine physiology involving the cognitive centres of the brain and hypothalamic-pituitary-adrenal axis, and the cardiovascular responses to the sudden sympathetic activation and surge in circulating catecholamines. The latter have been explored in detail, starting with the histological findings at biopsy, with the multiple morphological changes seen in the myocardium matching those seen after established catecholamine cardiotoxic effects. Clinically, both the acute prognosis and recurrence rate are unfortunately worse than previously reported. It is clear that the modern cardiology community has much still to learn regarding the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways. 3 Key points Approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome. There is a predominance in post-menopausal women compared to men or younger women. Both the acute and long-term mortality are higher than previously recognized.The cumulative incidence of recurrence increased from 1.2% at first 6 months to nearly 5% at 6 years, and there is no current evidence to support treatment with any specific to prevent recurrence. Systemic surges in catecholamines may cause vascular effects including acute coronary vasospasm and severe acute hypertension due to acute peripheral vasospasm followed by later peripheral vasodilation and hypotension. In the clinical setting, profound hypotension and cardiogenic shock is a common complication, however, it is not solely related to the extent of impairment of left ventricular (LV) systolic function, and thus probably relates in part to inappropriate peripheral vasodilation. Biopsies during acute takotsubo syndrome are characterized by multiple morphological changes that are similar to those after catecholamine cardiotoxic effects supporting a direct effect in addition to the vascular influences. The apical myocardium of the left ventricle has the highest density of β-adrenergic receptors (βAR), and is therefore most sensitive to circulating catecholamines.

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Section: Epidemiologymentioning

confidence: 81%

Section: Epidemiologymentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

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“…are likely associated with a sustained surge in catecholamines and thus might cause an even greater cardiac stress compared with emotional triggers 36. A further important finding of the COUNTS study is the unexpected high prevalence of cardiovascular risk factors given the absence of obstructive coronary artery disease, as 17% (range: 2-48%) of patients were obese, 54% (range: 27-83%) had hypertension , 32% (range: 7-59%) had dyslipidemia, 17% (range: 4-34%) were diabetic and 22% (range: 6-49%) were smokers.…”

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confidence: 99%

Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 Patients

Pelliccia

Parodi

Greco

et al. 2015

The American Journal of Medicine

168

125

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“…Patel et al reported that the recurrence rate was 5-fold higher in female patients <50 years of age than in those aged 50 years old or more. 6 The reason for higher recurrence rate in younger females is unknown. The recurrence of TC is more frequent in women but no statistically significant difference has shown between men and women, probably because of the low numbers of recurrence.…”

Section: Recurrence Rate Of Takotsubo Cardiomyopathymentioning

confidence: 99%

Recurrence of Takotsubo Cardiomyopathy

Kato

Kitahara

Kobayashi

2016

ICFJ

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IntroductionTakotsubo cardiomyopathy (TC) is transient systolic dysfunction of the left ventricle (LV) occurring mainly in post-menopausal women after a stressful event. It is associated with characteristic LV contraction patterns, typically apical dyskinesia and basal hyperkinesia. 1 The exact pathophysiology of TC is still unclear, although several hypotheses, such as multivessel coronary spasm, microvascular impairment, and direct catecholaminemediated myocardial stunning, have been proposed.2 While the prognosis for TC patients is generally favorable, with complete recovery from LV wall motion abnormality, some patients experience recurrence of TC, once or sometimes multiple times. There is little information about the efficacy of chronic pharmacological therapy for preventing TC recurrence. This review summarizes current knowledge of TC recurrence. Recurrence rate of takotsubo cardiomyopathyThe reported recurrence rate of TC has ranged from 0 to 10% (Table. 1). Elesber et al. reported the highest recurrence rate within the first 4 years at 2.9% per year and subsequently it decreased at 1.3% per year.3 Singh et al. performed metaanalysis from 31 cohorts (1,664 TC patients) and reported that the annual incidence of recurrence was 1.5% and the cumulative recurrence rate increased from 1.2% at 6 months to nearly 5% at 6 years. 4 Several cases of multiple recurrences have also been reported. 4 It may be interpreted that severe LV dysfunction reflects increased susceptibility to stressful events. Patel et al. reported that the recurrence rate was 5-fold higher in female patients <50 years of age than in those aged 50 years old or more. 6 The reason for higher recurrence rate in younger females is unknown. The recurrence of TC is more frequent in women but no statistically significant difference has shown between men and women, probably because of the low numbers of recurrence. Morphology and pathophysiologyMost cases of recurrent TC have the same ballooning pattern compared to that of the initial event.8-10 However, some case reports have documented recurrent TC with different ballooning patterns (i.e., apical ballooning to mid-ventricular ballooning, 11,12 mid-ventricular ballooning to apical ballooning, [13][14][15] and apical ballooning to basal ballooning. 16 These observations are inconsistent with the currently proposed mechanisms of TC such as anatomic variations in sympathetic innervation and adrenergic receptor density. The exact pathophysiology of TC and its recurrence is unknown. Dynamic variation in the sensitivity of the cardiac adrenergic receptors or differences in the degree of stress and the subsequent level of catecholamine * Corresponding author. E-mail: kkatou0424@yahoo.co.jp AbstractTakotsubo cardiomyopathy (TC) is transient systolic dysfunction of the left ventricle (LV) occurring mainly in post-menopausal women after a stressful event. It is associated with characteristic LV contraction patterns. While the prognosis for TC patients is generally favorable, some patients experience recurrenc...

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Distinctive Clinical Characteristics According to Age and Gender in Apical Ballooning Syndrome (Takotsubo/Stress Cardiomyopathy): An Analysis Focusing on Men and Young Women

Cited by 64 publications

References 11 publications

Epidemiology and pathophysiology of Takotsubo syndrome

Epidemiology and pathophysiology of Takotsubo syndrome

Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 Patients

Recurrence of Takotsubo Cardiomyopathy

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