Stress-Induced Cardiomyopathy in Sweden: Evidence for Different Ethnic Predisposition and Altered Cardio-Circulatory Status

Schultz, Tomas; Shao, Yangzhen; Redfors, Björn; Sverrisdóttir, Yrsa Bergmann; Råmunddal, Truls; Albertsson, Per; Matejka, Göran; Ömerovic, Elmir

doi:10.1159/000338814

Cited by 76 publications

(61 citation statements)

References 55 publications

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“…A meta-analysis published in 2014 has described that in a 2-year follow-up, 3-8% of TTC patients had recurring its symptoms; requiring particular attention for this fact (7,8,(69)(70)(71)(72). Different LV wall motion disorders in the same patient are also reported; that is, wall motion disorder patterns are not always the same (73,74).…”

Section: Recurrencementioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

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Section: Recurrencementioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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“…4 However a significant minority of patients have less favorable outcomes, with in-hospital mortality of approximately 0.5-1% from cardiogenic shock and multiorgan failure. 53 …”

Section: -7 Daysmentioning

confidence: 99%

Pathophysiology of Takotsubo Syndrome

Wright

Tranter

Morley-Smith

et al. 2014

Circ J

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Takotsubo syndrome (TTS), also known as takotsubo cardiomyopathy, stress cardiomyopathy and apical ballooning syndrome, is an acute, reversible heart failure (HF) syndrome that has increasingly come to medical attention over the past 24 years with wider access to early diagnostic coronary angiography for patients with acute chest pain and ECG abnormalities. 1 The typical case is a postmenopausal woman with an extremely stressful emotional or physical trigger, who presents with chest pain and breathlessness, ECG changes and acute hypokinesia of the apical and middle segments of the left ventricle (LV) in a circumferential pattern extending beyond a single coronary territory, and in the absence of culprit obstructive coronary artery disease (CAD). 2,3 Providing the patient survives the acute event, the dysfunctional segments recover, at least macroscopically, within days to weeks. 4 Many other variations on this "typical case" exist, including different demographics (men, younger women), different anatomical variants (basal/inverted, mid-LV, biventricular), spontaneous cases without a triggering stressor, cases triggered by other medical, surgical or psychiatric emergencies and permanent cardiac abnormalities (permanent "new" left bundle branch block, apical transmural necrosis).One common feature appears to be an extreme surge in catecholamines in response to the triggering stress or coexisting medical condition (eg, subarachnoid hemorrhage, pheochromocytoma, and thyrotoxicosis). 5-7 Animal models can replicate the features of this HF syndrome in order to dissect its mechanisms. 8-11 In contrast to the reductionist approach in most modern pathophysiological research, the more that is understood about TTS, the more it is apparent that a number of processes may result in the final common pathway of acute apical dysfunction. There are a number of mediators that may modify the severity and course of a particular episode. Defining the precise pathophysiology is challenging, and we suggest that an integrated approach to studying the cardiovascular responses to extreme surges in catecholamines is appropriate.Here we use a novel approach to reviewing the pathophysiology of TTS. Animal and clinical studies have reported findings at different phases through the development of this condition, and it is intuitive that the observed integrated cardiovascular responses to surges in serum catecholamines and sympathetic neural outflow would change over time. We discuss the pathophysiology in a sequential fashion describing effects as they occur at different time-points, integrating the observations and explaining the negative inotropic response and potential activation of cardioprotective mechanisms.Before discussing the temporal sequence of events, it is important to note a growing body of evidence that TTS is not a form of acute myocardial infarction (MI). Firstly, the epide- Takotsubo syndrome (TTS), also known as takotsubo cardiomyopathy, is an acute heart failure syndrome that typically occurs after a period of great emotion...

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“…In their article in this issue of Cardiology , entitled, ‘Stress-Induced Cardiomyopathy in Sweden: Evidence for Different Ethnic Predisposition and Altered CardioCirculatory Status’, Schultz et al [7] reported the clinical features and hemodynamic function in stress-induced cardiomyopathy (SIC) in Sweden. In their study, 115 patients were diagnosed with SIC from a large cohort studied over 5 years.…”

mentioning

confidence: 99%

“…Another study, published last year, investigated the differences in baseline characteristics between African-Americans and non-African-Americans [9], reporting no racial differences except electrocardiographic findings. Meanwhile, Schultz et al [7] reported that the recurrence rate of SIC was over 13%, which surpasses the previous highest rate of approximately 11% [10]. The recurrence rate of SIC in the largest Japanese cohort is 2% [11]; therefore, further genetic investigation is required to clarify the high predominance and recurrence rate in the Swedish cohort.…”

mentioning

confidence: 99%