Probable protective role of diabetes mellitus in takotsubo cardiomyopathy: a review

Abstract

Takotsubo cardiomyopathy (TC) is a syndrome that predominantly affects postmenopausal women and is characterized by transient regional systolic dysfunction of the left ventricle which occurs in the absence of angiographic evidence of significant obstructive coronary artery disease. It is often but not always triggered by emotional or physical stressful stimuli. In most cases, the regional ventricular dysfunction extends beyond a single epicardial coronary artery territory. It typically involves the apex, with rare atypical presentations involving the base and right ventricle. Although the pathophysiological underpinnings of TC have not been completely elucidated, possible mechanisms include catecholamine overactivity, diffuse multivessel coronary spasm, microvascular dysfunction and estrogen deficiency. The prevalence of diabetes mellitus has been noted to be low in multiple studies of patients with TC. In this review, the authors discuss the association between diabetes mellitus and TC, with a special emphasis on the possible protective effect of diabetes mellitus in development of TC. Key words:Diabetes mellitus, stress cardiomyopathy, takotsubo cardiomyopathy ABSTRACTArticle history:

Signaling Pathways Potentially Responsible for Foam Cell Formation: Cholesterol Accumulation or Inflammatory Response—What is First?

“…It was widely believed that it is the accumulation of intracellular lipids that stimulates the pro-inflammatory response [37][38][39][40][41][42][43][44]. However, it remains unknown whether intracellular lipid metabolism and the immune response are independently regulated by modified LDL or regulation of one process drives changes in the other.…”

Left Ventricular Dysfunction in the Setting of Takotsubo Cardiomyopathy: A Review of Clinical Patterns and Practical Implications

“…Within this Takotsubo Cardiomyopathy and Left Ventricular Dysfunction context, beta-blockers and sympathetic ganglion blockade, as well as psychological (and cognitive behavioural) treatment and certain yoga practices, may improve long-term prognosis in selected cases, possibly through prevention of future TTC recurrence and, correspondingly, abortion of cumulative myocardial changes, to some degree. 1,27,[51][52][53] These preventative implications appear to be based on the strong association between acute autonomic discharge and TTC, and may also be substantiated by the recent evidence of a lower prevalence of diabetes mellitus among TTC cases, potentially suggesting the Myocardial failure on exercise may also be verified with the use of certain tools, including diastolic stress testing 56 and dobutamine stress echocardiogram, in these patients.…”

Left Ventricular Dysfunction in the Setting of Takotsubo Cardiomyopathy: A Review of Clinical Patterns and Practical Implications

“…Within this practices, may improve long-term prognosis in selected cases, possibly through prevention of future TTC recurrence and, correspondingly, abortion of cumulative myocardial changes, to some degree. 1,27,[51][52][53] These preventative implications appear to be based on the strong association between acute autonomic discharge and TTC, and may also be substantiated by the recent evidence of a lower prevalence of diabetes mellitus among TTC cases, potentially suggesting the protective role of diabetes-induced sympathetic neuropathy against TTC evolution. [51][52][53] Subclinical Left Ventricular Dysfunction: A Subtle Phenomenon with Significant Impact on Quality of Life Among Takotsubo Cardiomyopathy Survivors Myocardial failure on exercise may also be verified with the use of certain tools, including diastolic stress testing 56 and dobutamine stress echocardiogram, in these patients.…”