One Patient, Three Variants, Four Episodes of Takotsubo Cardiomyopathy

Frankel, Eitan; Prior, Patrick; Mehta, Hetal H.; Rajagopalan, Priya; Wiener, David; Rose, Andrew; Marhefka, Gregary D.

doi:10.1016/j.case.2020.01.009

Cited by 2 publications

(2 citation statements)

References 13 publications

(21 reference statements)

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“…There have also been case reports of several variants of TTS in the same patient [ 78 , 79 ]. These cases contradict the hypothesis that the distribution of β receptors in the myocardium dictates the TTS variant.…”

Section: Discussionmentioning

confidence: 99%

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Nayar

John

Philip³

et al. 2022

Life

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Takotsubo cardiomyopathy or Takotsubo Syndrome (TTS) is a reversible left ventricular dysfunction syndrome that is increasingly being recognized. Recent advances in nuclear imaging have allowed us to study TTS in greater detail. We searched the PubMed and Medline databases and identified 53 publications with 221 patients reporting nuclear imaging findings in TTS. The age of the patients ranged from 17 to 87 years and were predominantly women (88.2%). The TTS variant was apical (typical) in 170 (76.9%), mid-ventricular in 23 (10.4%), and basal (reverse TTS) in 2 (0.9%). Cardiac perfusion was assessed using 99mTc sestamibi (MIBI) SPECT, 99mTc tetrofosmin SPECT, 201Tl SPECT, 82Rb PET, 201Tl SPECT, and 13N ammonia PET. Additional studies used were 123I MIBG SPECT, 123I BMIPP SPECT, 18F FDG PET, 67Ga citrate, and 11C hydroxy-ephedrine. A perfusion defect was seen in 69 (31.2%), and an inverse perfusion–metabolism mismatch (normal or near-normal perfusion with absent myocardial metabolic activity) was seen in 183 (82.8%) patients. Nuclear imaging has a significant role in evaluating, diagnosing, and prognosticating patients with TTS. As nuclear imaging technology evolves, we will surely gain more insights into this fascinating disorder.

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Section: Discussionmentioning

confidence: 99%

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Nayar

John

Philip³

et al. 2022

Life

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“…In humans, the blockade of the right ganglion stellatum has led to a significant prolongation of the QT interval, which is also found in patients with TTS ( 3 , 236 ). Recent case reports in a woman with four attacks and three variants of TTS and gastroparesis suggest that stunning could affect a larger neurovisceral area ( 237 ).…”

Section: Neurogenic Stunned Myocardiummentioning

confidence: 99%

Oxidative Stress in Takotsubo Syndrome—Is It Essential for an Acute Attack? Indirect Evidences Support Multisite Impact Including the Calcium Overload—Energy Failure Hypothesis

Maňoušek

Kala

Lokaj

et al. 2021

Front. Cardiovasc. Med.

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Indirect evidences in reviews and case reports on Takotsubo syndrome (TTS) support the fact that the existence of oxidative stress (OS) might be its common feature in the pre-acute stage. The sources of OS are exogenous (environmental factors including pharmacological and toxic influences) and endogenous, the combination of both may be present, and they are being discussed in detail. OS is associated with several pathological conditions representing TTS comorbidities and triggers. The dominant source of OS electrones are mitochondria. Our analysis of drug therapy related to acute TTS shows many interactions, e.g., cytostatics and glucocorticoids with mitochondrial cytochrome P450 and other enzymes important for OS. One of the most frequently discussed mechanisms in TTS is the effect of catecholamines on myocardium. Yet, their metabolic influence is neglected. OS is associated with the oxidation of catecholamines leading to the synthesis of their oxidized forms – aminochromes. Under pathological conditions, this pathway may dominate. There are evidences of interference between OS, catecholamine/aminochrome effects, their metabolism and antioxidant protection. The OS offensive may cause fast depletion of antioxidant protection including the homocystein-methionine system, whose activity decreases with age. The alteration of effector subcellular structures (mitochondria, sarco/endoplasmic reticulum) and subsequent changes in cellular energetics and calcium turnover may also occur and lead to the disruption of cellular function, including neurons and cardiomyocytes. On the organ level (nervous system and heart), neurocardiogenic stunning may occur. The effects of OS correspond to the effect of high doses of catecholamines in the experiment. Intensive OS might represent “conditio sine qua non” for this acute clinical condition. TTS might be significantly more complex pathology than currently perceived so far.

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One Patient, Three Variants, Four Episodes of Takotsubo Cardiomyopathy

Abstract: Graphical abstract

Cited by 2 publications

References 13 publications

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Oxidative Stress in Takotsubo Syndrome—Is It Essential for an Acute Attack? Indirect Evidences Support Multisite Impact Including the Calcium Overload—Energy Failure Hypothesis

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