Tako-Tsubo Cardiomyopathy: A Heart Stressed Out of Energy?

Dawson, Dana; Neil, Christopher; Henning, A; Cameron, Donnie; Jagpal, Baljit; Bruce, Margaret; Horowitz, John D.; Frenneaux, Michael

doi:10.1016/j.jcmg.2014.10.004

Cited by 66 publications

(64 citation statements)

References 2 publications

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“…There is extensive evidence that pre-contrast T1 mapping is reflective of edema, previously provided from our group 26 and by others [27][28][29] . Here we replicate our previous findings 7 showing that LV edema subsides in the previously well contracting segments. However, despite a significant decrease by 4 months post-acute presentation, edema persists to a mild degree in the previously dysfunctional segments, where pre-contrast T1 mapping values remain significantly elevated compared to a group of age, gender and hypertensive co-morbidity controls.…”

Section: Current Results In Context Of Previous Literaturesupporting

confidence: 92%

“…This is the first study to examine the architectural recovery of the LV myocardium after a takotsubo event, using contrast-enhanced CMR. The increased LV mass 24 is presumably a reflection of the significant myocardial edema seen in the myocardium during the acute stage, previously reported by us and others 7,21,25 . There is extensive evidence that pre-contrast T1 mapping is reflective of edema, previously provided from our group 26 and by others [27][28][29] .…”

Section: Current Results In Context Of Previous Literaturesupporting

confidence: 53%

“…However, in a separate, earlier cohort of patients, we documented reduced global longitudinal strain 3 months after the acute phase (a finding replicated by others at 21 days follow-up 19 ), associated with incomplete resolution of symptoms in a large proportion of takotsubo patients 20 . In further separate takotsubo cohorts, we previously described additional persistent abnormalities, such as elevated natriuretic peptide concentrations at 3 months, persistent myocardial edema at 3 months 21 and impaired myocardial energetic status (together with persistence of edema) at 4 months of follow-up 7 . These objective abnormalities indicate that complete recovery in these patients may not occur as rapidly as previously thought and together with the persistent symptoms that we consistently observed during the clinical followup of these patients prompted us to re-evaluate cardiac mechanics.…”

Section: Current Results In Context Of Previous Literaturementioning

confidence: 97%

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Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Schwarz

Ahearn

Srinivasan

et al. 2017

Journal of the American Society of Echocardiography

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105

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Background: Takotsubo syndrome is an increasingly recognized cause of chest pain and occasionally of cardiogenic shock. Despite rapid improvement of the Left Ventricular Ejection Fraction (LV EF), recent registry data raises concerns about long term prognosis. We hypothesized that restoration of normal EF after acute tako-tsubo is not equivalent to full functional recovery. Methods: We prospectively recruited 52 takotsubo patients [according to the Mayo criteria plus cardiac magnetic resonance imaging (CMR) to exclude myocardial infarction] and 44 healthy controls of the same age, gender and cardiovascular co-morbidity distribution. We focused the investigation on takotsubo patients presenting with ST-elevation type ECG or malignant arrhythmias and with LV apical ballooning variant and examined a 4 months recovery end-point. Patients underwent Echocardiography assessment of LV myocardial deformation (Global longitudinal, radial and circumferential strain, LV twist, torsion, untwist, time to peak twist and untwist) and assessment of LV myocardial structure by pre and post contrast-enhanced CMR by T1 mapping acutely and at 4 months follow-up. Controls had a single time-point investigation. Data were analyzed using paired or unpaired tests, as appropriate for their distribution and corrected for multiple comparisons. Results: The patients' mean age was 66 years (range 28-87) and 92% were women. All abnormal echocardiographic indices observed acutely in takotsubo patients improved (but not necessarily normalized) at followup. Significant mechano-temporal alterations characterizing both systole (global longitudinal strain, apical circumferential strain, both p<0.01; left ventricular twist, twist rate and torsion, all p<0.0001) and diastole (untwist rate and time to peak untwisting, all p<0.001) persisted at 4 months follow-up when compared with controls, despite normalization of LV ejection fraction and volumes. Whilst native T1 (which demonstrates edema) normalized at 4 months follow-up only in segments contracting normally during the acute phase [T1=1180± 40.6ms (normally contracting, p=0.2 vs control values of 1189±16 ms) and 1208± 60.3 ms (dysfunctional segments, p<0.05 vs control)], the extracellular volume fraction (ECV, which demonstrates diffuse fibrosis) remained significantly abnormal in all LV segments (whether normally contracting, 0.328±0.043, p<0.001 or ballooning during acute presentation, 0.320±0.044, p<0.001, both vs control values of 0.273±0.045). Conclusion: In patients with the most clinically severe spectrum of takotsubo cardiomyopathy, regional LV systolic and diastolic deformation abnormalities persist beyond the acute event, despite normalization of global LV EF and size. In addition, although myocardial edema partly subsides, a process of global microscopic fibrosis develops in its place, detected as early as 4 months.Suggested Reviewers:Opposed Reviewers: 1 24 th March, 2017 Dear Dr Pearlman, Thank you once again for your comments and those of the associate editors. I think it i...

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Section: Current Results In Context Of Previous Literaturesupporting

confidence: 92%

Section: Current Results In Context Of Previous Literaturesupporting

confidence: 53%

Section: Current Results In Context Of Previous Literaturementioning

confidence: 97%

See 1 more Smart Citation

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Schwarz

Ahearn

Srinivasan

et al. 2017

Journal of the American Society of Echocardiography

Self Cite

105

View full text Add to dashboard Cite

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“…Furthermore, quantitation of myocardial oedema via T2-weighted CMR imaging reveals the presence of slowly resolving global changes, with persistent oedema at 3 months 12 . We have recently demonstrated myocardial energetic impairment both during the acute phase of TTC and persistent for at least 4 months thereafter 18 : this may indicate that energetic impairment parallels with myocardial inflammation. As BNP/NT-proBNP release appear to be inflammatory activation (rather than distensive) in origin 13 , the correlation between NT-proBNP and GLS at 3 months suggests that residual inflammation may contribute to this subtle impairment.…”

Section: Discussionmentioning

confidence: 82%

“…On the other hand, most residual symptoms in this cohort of patients were of lassitude and exertional dyspnoea. Given the recent data show that TTC is associated with prolonged impairment of myocardial energetics 18 , it is certainly possible that contractile dysfunction may be accentuated during exercise. Furthermore, hypertension was marginally more common among TTC patients than controls, which could contribute to GLS differences.…”

Section: Discussionmentioning

confidence: 99%

Relation of Delayed Recovery of Myocardial Function After Takotsubo Cardiomyopathy to Subsequent Quality of Life

Neil

Nguyen

Singh

et al. 2015

The American Journal of Cardiology

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Takotsubo syndrome in Heart Failure and World Congress on Acute Heart Failure 2019: highlights from the experts

et al. 2020

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Takotsubo syndrome was featured in various sessions and posters at the recent Heart Failure Congress and World Congress on Acute Heart Failure 2019 held in Athens. The importance and increasing recognition of this acute heart failure syndrome is reflected by the growing activity at Heart Failure Association congresses over the last 8 years. Two dedicated sessions to Takotsubo syndrome with comprehensive lectures from experts in the field and several posters highlighted new scientific progress, important aspects of epidemiology, pathophysiology, risk stratification, and management of the syndrome and discussed gaps in knowledge of this intriguing entity. This paper will summarize the topics discussed in these sessions including the most recent data from large registries, clinical, and pre-clinical studies presented at the meeting.

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Tako-Tsubo Cardiomyopathy: A Heart Stressed Out of Energy?

Cited by 66 publications

References 2 publications

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Relation of Delayed Recovery of Myocardial Function After Takotsubo Cardiomyopathy to Subsequent Quality of Life

Takotsubo syndrome in Heart Failure and World Congress on Acute Heart Failure 2019: highlights from the experts

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