Fatal Takotsubo syndrome in critical COVID-19 related pneumonia

Titi, Luca; Eugenia, Magnanimi; Mancone, Massimo; Infusino, Fabio; Coppola, Giulia; Nonno, Franca Del; Colombo, Daniele; Nardacci, Roberta; Falasca, Laura; d’Amati, Giulia; Tarsitano, Maria Grazia; Merlino, Lucia; Fedele, Francesco; Pugliese, Francesco

doi:10.1016/j.carpath.2020.107314

Cited by 18 publications

(19 citation statements)

References 17 publications

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“…Other two patients presented with Tako-Tsubo's syndrome. One had severe LV dysfunction with mid-apical ballooning at left ventricular angiography and died after a few hours from the procedure due to cardiogenic shock.. Cardiac autopsy revealed diffuse oedema, multiple foci of contraction band necrosis, interstitial macrophages CD68+ and occasional presence of microthrombi in the small coronary arteries ( 38 ). Molecular analysis did not detect SARS-CoV-2 genome within the myocardium ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The patient who experienced a fatal Tako-Tsubo syndrome did not present histopathological findings of myocarditis. However, abundant macrophages CD68+ were observed in the myocardial interstitium, in absence of myocyte necrosis ( 38 ). This observation is in keeping with the finding of increased interstitial macrophages recently reported by Basso et al as the most common feature in a series of 21 COVID-19 autopsies ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

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Cardiac involvement in consecutive unselected hospitalized COVID-19 population: In-hospital evaluation and one-year follow-up

Maestrini

Birtolo

Francone

et al. 2021

International Journal of Cardiology

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Background Cardiovascular disease (CVD) can occur in COVID-19 and has impact on clinical course. Data on CVD prevalence in hospitalized COVID-19 patients and sequelae in survivors is limited. Aim of this prospective study carried out on consecutive unselected COVID-19 population, was to assess: 1) CVD occurrence among hospitalized COVID-19 patients, 2) persistence or new onset of CVD at one-month and one-year follow-up. Methods Over 30 days n = 152 COVID-19 patients underwent cardiovascular evaluation. Standard electrocardiogram (ECG), Troponin and echocardiography were integrated by further tests when indicated. Medical history, arterial blood gas, blood tests, chest computed tomography and treatment were recorded. CVD was defined as the occurrence of a new condition during the hospitalization for COVID-19. Survivors attended a one-month follow-up visit and a one-year telephone follow-up. Results Forty-two patients (28%) experienced a wide spectrum of CVD with acute myocarditis being the most frequent. Death occurred in 32 patients (21%) and more frequently in patients who developed CVD ( p = 0.032). After adjustment for confounders, CVD was independently associated with death occurrence. At one-month follow-up visit, 7 patients (9%) presented persistent or delayed CVD. At one-year telephone follow-up, 57 patients (48%) reported persistent symptoms. Conclusion Cardiovascular evaluation in COVID-19 patients is crucial since the occurrence of CVD in hospitalized COVID-19 patients is common (28%), requires specific treatment and increases the risk of in-hospital mortality. Persistence or delayed presentation of CVD at 1-month (9%) and persistent symptoms at 1-year follow-up (48%) suggest the need for monitoring COVID-19 survivors.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac involvement in consecutive unselected hospitalized COVID-19 population: In-hospital evaluation and one-year follow-up

Maestrini

Birtolo

Francone

et al. 2021

International Journal of Cardiology

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“…Another manifestation of cardiac involvement was Takotsubo stress cardiomyopathy or, as it is commonly known, the "broken heart syndrome. "( 15 ) The troponin elevations, especially when accompanied by elevations of brain natriuretic peptide (BNP), carried an increased risk for adverse outcomes. Clinicians initially gravitated to myocarditis as a common underlying basis for the clinical findings, and these suspicions were reinforced by certain magnetic resonance imaging (MRI) findings in many of these patients.…”

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confidence: 99%

A novel coronavirus meets the cardiovascular system: Society for Cardiovascular Pathology Symposium 2021

Buja

Stone

2021

Cardiovascular Pathology

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“…67,68 Another manifestation of cardiac involvement is Takotsubo stress cardiomyopathy or, as it is commonly known, the "broken heart syndrome." 69 The troponin elevations, especially when accompanied by elevations of brain natriuretic peptide (BNP), carry increased risk for adverse outcomes. Although myocardial injury could reflect a COVID-19 related coronary event, angiographic studies in such patients usually do not show obstructive coronary artery disease.…”

Section: Pathologymentioning

confidence: 99%

A Comparison of the Clinical, Viral, Pathologic, and Immunologic Features of Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Coronavirus 2019 (COVID-19) Diseases

Barth

Buja

Barth

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.—The purpose of this review is to compare three coronavirus diseases: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19) caused by SARS-CoV, MERS-CoV, and SARS-CoV-2 viruses, respectively. Objective.—To cover the following topics: clinical considerations, viral characteristics, pathology, immune response, pathogenesis, and the prognosis associated with each coronavirus human disease in humans. Data Sources.—Clinically, flu-like symptoms are usual at the time of presentation for all 3 diseases, but these vary from asymptomatic to severe multi-system involvement. The pathology associated with symptomatic SARS and COVID-19 has been well described, the most prominent of which is diffuse alveolar damage (DAD). The immune response to each of these viruses is highly complex and includes both humoral and cellular components that can have a significant impact on prognosis. In severe cases of COVID-19, a dysregulated innate host immune system can initiate a hyperinflammatory syndrome dominated by endothelial dysfunction that can lead to a hypercoagulable state with microthrombi, resulting in a systemic micro- and macro-vascular disease. Conclusions.—The SARS and MERS epidemics have been limited, involving 7,500 and 2,500 individuals, respectively. In contrast, COVID-19 has resulted in a worldwide pandemic with over 177 million cases and 3.9 million deaths as of June 15, 2021, and fatality rates ranging from <0.1% to ~10% depending upon the country. Ending on a positive note, the development of a number of vaccines, at least six of which now are in clinical use, should mitigate and eventually control the devastating COVID-19 pandemic.

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Fatal Takotsubo syndrome in critical COVID-19 related pneumonia

Abstract: Highlights Takotsubo Syndrome (TTS) is increasingly reported in COVID-19 patients The pathogenic mechanisms underlying TTS in this particular setting are still unknown Autopsy findings in fatal cases may contribute to understand the possible role of SARS-CoV-2 in the onset of TTS

Cited by 18 publications

References 17 publications

Cardiac involvement in consecutive unselected hospitalized COVID-19 population: In-hospital evaluation and one-year follow-up

Cardiac involvement in consecutive unselected hospitalized COVID-19 population: In-hospital evaluation and one-year follow-up

A novel coronavirus meets the cardiovascular system: Society for Cardiovascular Pathology Symposium 2021

A Comparison of the Clinical, Viral, Pathologic, and Immunologic Features of Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Coronavirus 2019 (COVID-19) Diseases

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