Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

Neil, Christopher; Chong, Cher‐Rin; Nguyen, Thanh Ha; Horowitz, John D.

doi:10.1016/j.hlc.2011.12.004

Cited by 48 publications

(28 citation statements)

References 25 publications

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“…28 Thus, these findings are well in line with the known high incidence of psychosocial or mental triggers preceding the TTC event and could indicate potential psychiatric co-morbidities in these patients. 36,37 Frequent episodes of depression and anxiety have been implicated as potential risk factors predisposing to TTC. 38 …”

Section: Discussionmentioning

confidence: 99%

A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction

Jaguszewski¹,

Osipova

Ghadri³

et al. 2013

European Heart Journal

244

185

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AimsTakotsubo cardiomyopathy (TTC) remains a potentially life-threatening disease, which is clinically indistinguishable from acute myocardial infarction (MI). Today, no established biomarkers are available for the early diagnosis of TTC and differentiation from MI. MicroRNAs (miRNAs/miRs) emerge as promising sensitive and specific biomarkers for cardiovascular disease. Thus, we sought to identify circulating miRNAs suitable for diagnosis of acute TTC and for distinguishing TTC from acute MI.Methods and resultsAfter miRNA profiling, eight miRNAs were selected for verification by real-time quantitative reverse transcription polymerase chain reaction in patients with TTC (n = 36), ST-segment elevation acute myocardial infarction (STEMI, n = 27), and healthy controls (n = 28). We quantitatively confirmed up-regulation of miR-16 and miR-26a in patients with TTC compared with healthy subjects (both, P < 0.001), and up-regulation of miR-16, miR-26a, and let-7f compared with STEMI patients (P < 0.0001, P < 0.05, and P < 0.05, respectively). Consistent with previous publications, cardiac specific miR-1 and miR-133a were up-regulated in STEMI patients compared with healthy controls (both, P < 0.0001). Moreover, miR-133a was substantially increased in patients with STEMI compared with TTC (P < 0.05). A unique signature comprising miR-1, miR-16, miR-26a, and miR-133a differentiated TTC from healthy subjects [area under the curve (AUC) 0.835, 95% CI 0.733–0.937, P < 0.0001] and from STEMI patients (AUC 0.881, 95% CI 0.793–0.968, P < 0.0001). This signature yielded a sensitivity of 74.19% and a specificity of 78.57% for TTC vs. healthy subjects, and a sensitivity of 96.77% and a specificity of 70.37% for TTC vs. STEMI patients. Additionally, we noticed a decrease of the endothelin-1 (ET-1)-regulating miRNA-125a-5p in parallel with a robust increase of ET-1 plasma levels in TTC compared with healthy subjects (P < 0.05).ConclusionThe present study for the first time describes a signature of four circulating miRNAs as a robust biomarker to distinguish TTC from STEMI patients. The significant up-regulation of these stress- and depression-related miRNAs suggests a close connection of TTC with neuropsychiatric disorders. Moreover, decreased levels of miRNA125a-5p as well as increased plasma levels of its target ET-1 are in line with the microvascular spasm hypothesis of the TTC pathomechanism.

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Section: Discussionmentioning

confidence: 99%

A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction

Jaguszewski¹,

Osipova

Ghadri³

et al. 2013

European Heart Journal

244

185

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“…This time the patient agreed and for the first time, an antidepressant was administered. Because of latest reports of TTC associated with the use of serotonine and noradrenaline reuptake inhibitors, we selected Mirtazapine in order to avoid increased plasma catecholamine concentrations [45–47]. The psychosomatic history revealed several chronic stress factors.…”

Section: Case Presentationmentioning

confidence: 99%

Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

Hefner

Csef

Frantz

et al. 2015

BMC Cardiovasc Disord

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Background“Tako-Tsubo cardiomyopathy” (TTC) is a syndrome characterized by left ventricular (LV) wall motion abnormalities, usually without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. It most often affects post-menopausal women and TTC tends to run a benign course with very low rates of recurrence, complications or mortality. The condition is also called “stress-induced cardiomyopathy” because acute physical or emotional stress appears to be frequently related to its onset. The pathogenic role of premorbid or comorbid psychiatric illnesses has been discussed controversially. For the first time, we present a case of fourfold recurrent TTC with severe complications in a pre-menopausal woman. Furthermore, a long history of flaring posttraumatic stress symptoms anteceded the first event.Case presentationA 43-year old, pre-menopausal Caucasian woman was hospitalized with symptoms of acute coronary syndrome. Clinical examination revealed hypokinetic wall motion in the apical ventricular region with no signs of coronary artery disease and diagnosis of TTC was established. She experienced recurrence three times within the following ten months, which led to thrombembolism and myocardial scarring among others. The circumstances of chronic distress were striking. 16 years ago she miscarried after having removed a myoma according to her doctor’s suggestion. Since then, she has suffered from symptoms of posttraumatic distress which peaked annually at the day of abortion. Chronic distress became even more pronounced after the premature birth of a daughter some years later. The first event of TTC occurred after a family dispute about parenting.ConclusionThis is the first case report of fourfold TTC in a pre-menopausal woman. From somatic perspectives, the course of the disease with recurrences and complications underlines the fact that TTC is not entirely benign. Furthermore, it is the first case report of long lasting symptoms of traumatic stress anteceding TTC. Close connections between adrenergic signaling and late onset of clinical stress symptoms are well known in the psychopathology of traumatization. Although larger clinical trials are needed to elucidate possible interactions of premorbid psychiatric illnesses and TTC, cardiologists should be vigilant especially in cases of recurrent TTC.

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“…Stress-induced cardiomyopathy has been reported after overdosing with the unspecific NET inhibitor nortriptyline (27), the combined selective NET and serotonin transporter (SERT) inhibitors venlafaxine (22,91,130), and milnacipran (74), as well as with amphetamines that also exert NET inhibition (3). Among other pharmacological actions, cocaine inhibits NET function (37).…”

Section: Net Dysfunction and Chronic Heart Diseasementioning

confidence: 99%

“…However, findings from cases of drug overdosing suggest that both NET inhibition with or without additional SERT inhibition can be cardiotoxic with tachycardia and increases of blood pressure being the most frequent findings (54,77). In case reports, overdosing and, rarely, normal doses (107, 115) of NET/SERT inhibitors have been linked with frank cardiomyopathy (22,27,74,91,130).…”

Section: Long-term Cardiovascular Response To Pharmacological Net Inhmentioning

confidence: 99%

Norepinephrine transporter function and human cardiovascular disease

Schroeder

Jordan

2012

American Journal of Physiology-Heart and Circulatory Physiology

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Occurrence of Tako-Tsubo Cardiomyopathy in Association with Ingestion of Serotonin/Noradrenaline Reuptake Inhibitors

Cited by 48 publications

References 25 publications

A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction

A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction

Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

Norepinephrine transporter function and human cardiovascular disease

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