Takotsubo cardiomyopathy: A potentially serious trap (Data from the International Takotsubo Cardiomyopathy Registry)

BackgroundRecent studies have highlighted that Takotsubo syndrome (TTS), mimicking acute coronary syndrome (ACS), is associated with poor clinical outcome. TTS is associated with different repolarization disorders including ST-segment elevation. ST elevation myocardial infarction (STEMI) in ACS is associated with declined prognosis. However, the clinical and prognostic impact of ST-segment elevation on TTS remains lacking.AimThe aim of this study was to determine the short- and long-term prognostic impact of ST-segment elevation on TTS patients as compared with STEMI patients.Patients and methodsOur institutional database constituted a consecutive cohort of 138 TTS patients and 138 ACS patients matched for age and sex. TTS patients (n=41) with ST-segment elevation were compared with ACS patients with ST-segment elevation (n=64).ResultsChest pain was significantly more documented in STEMI patients as compared with TTS patients (48.8% vs 78.1%; P<0.01). Cardiovascular risk factors such as diabetes mellitus (12.2% vs 29.7%; P=0.02) were significantly more presented in STEMI patients. Although the initial left ventricular ejection fraction (LVEF) was more declined in TTS patients (39%±9% vs 45%±16%; P<0.01), the LVEF was more declined in STEMI patients at follow-up (54%±10% vs 45%±16%; P=0.04). Inhospital complications such as respiratory failure were significantly more presented in TTS patients (68.3% vs 20.3%; P<0.01). The short-term as well as the long-term morality was similar in both groups. In univariate analysis, male sex, ejection fraction (EF) <35%, glomerular filtration rate (GFR) <60 mL/min, cardiogenic shock, inotropic drugs, and history of cancer were predictors of 5-year mortality.ConclusionRates of the long-term mortality in TTS patients with ST elevations are comparable with STEMI patients.

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“…To date, TTS has been described as a benign disease with favorable prognosis. Recently, this has been disputed 11,14,16–18…”

Section: Discussionmentioning

confidence: 99%

<p>Impact of ST-segment elevation on the outcome of Takotsubo syndrome</p>

Gietzen¹,

El‐Battrawy

Lang

et al. 2019

TCRM

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“…Both systolic and diastolic cardiac functions is impaired [ 48 ]. Cardiogenic shock can occur in 7% -10% of patients with stress cardiomyopathy [ 26 , 49 , 50 ]. According to other investigators, the incidence of cardiogenic shock in cardiomyopathy stress is 20-27% [ 33 , 51 ].…”

Section: The Main Clinical Manifestations Of Takotsubo Syndromementioning

confidence: 99%

“…Daily administration of isoproterenol at a dose of 1.2 mg for 14 days has been shown to cause myocarditis in rats [ 154 ]. At the same time, some investigators have noted that at the time of diagnosis, many (33%) patients with TS took β-AR antagonists [ 26 ]. Among patients with recurrent TS, 51% took β-blockers [ 26 ], which contradicts the leading role of catecholamines in the pathogenesis of TS.…”

Section: Pathogenesis Of Stress Cardiomyopathymentioning

confidence: 99%

“…We would like to draw the reader’s attention to the fact that spontaneous vasospasm of the epicardial coronary arteries was detected in only 10% of patients, which does not exclude microvascular spasm. One of the causes of impaired coronary circulation may be attributed to the findings that the myocardial bridging of the left anterior descending artery was detected in 76% of TS [ 26 ].…”

Section: Pathogenesis Of Stress Cardiomyopathymentioning

confidence: 99%

“…Sometimes stress cardiomyopathy is called the “broken heart syndrome” [ 16 ] or “apical ballooning syndrome” [ 17 ]. Stress cardiomyopathy is a relatively rare disease, it occurs in 0.6 - 2.5% of patients with acute coronary syndrome [ 18 - 24 ] or 178 (0.018%) cases of TS per 1 million are registered annually in hospitalized patients [ 25 ], other authors cite a similar figure - 0.02% of the number of the hospitalized patients [ 26 ]. Today, the incidence of TTS is estimated at 2% in patients with an initial diagnosis of acute coronary syndrome (ACS) [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Прокудина

Kurbatov

Zavadovsky

et al. 2021

CCR

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: The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart, lack of coronary artery obstruction, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old , than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. In many patients with TS, but not in all, physical or emotional stress precedes the disease. Many patients with TS, but not all, have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with the excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I –MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.

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Commentary on 2 Cases of Takotsubo Cardiomyopathy Involving Psychotropic Medication

Verduin

2016

Journal of Psychiatric Practice

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Takotsubo cardiomyopathy, also known as Takotsubo syndrome (TTS), is a cardiac syndrome first described in Japan in 1990 that typically follows an acute physical or psychiatric stressor, hence its association with the terms "broken heart syndrome" and stress cardiomyopathy. Although it is relatively rare, occurring in only 0.02% of the general population and roughly 2% of patients with acute coronary syndrome, neurological or psychiatric disorders are present in over 50% of affected individuals. One of the major hypotheses regarding the pathophysiology of TTS involves a catecholamine surge, from stress directly, or in some cases from psychiatric medication used to relieve distress. Given the association of TTS with acute stress and psychiatric illness, psychiatrists may be involved in the care of patients with TTS either at the initial presentation of the condition or following recovery. The case reports presented in this issue exemplify these 2 scenarios: one case involves the development of TTS during treatment with atomoxetine, and the other case involves treatment of depression in a patient after recovery from TTS, as well as a TTS recurrence during treatment with fluoxetine.

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Takotsubo cardiomyopathy: A potentially serious trap (Data from the International Takotsubo Cardiomyopathy Registry)

Cited by 4 publications

References 29 publications

<p>Impact of ST-segment elevation on the outcome of Takotsubo syndrome</p>

<p>Impact of ST-segment elevation on the outcome of Takotsubo syndrome</p>

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Commentary on 2 Cases of Takotsubo Cardiomyopathy Involving Psychotropic Medication

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