Takotsubo cardiomyopathy: an integrated multi-imaging approach

Bossone, Eduardo; Lyon, Alexander R.; Citro, Rodolfo; Athanasiadis, Anastasios; Meimoun, Patrick; Parodi, Guido; Cimarelli, Sébastien; Ömerovic, Elmir; Ferrara, Francesco; Limongelli, Giuseppe; Cittadini, Antonio; Salerno‐Uriarte, Jorge A.; Filardi, Pasquale Perrone; Schneider, Barbara; Sechtem, Udo; Erbel, Raimund

doi:10.1093/ehjci/jet167

Cited by 79 publications

(73 citation statements)

References 48 publications

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“…Although invasive coronary angiography is indispensable to distinguish acute coronary syndrome from TTC, noninvasive imaging modalities are becoming useful for TTC assessment (14,(27)(28)(29). Even in emergent situations, echocardiography provides the accurate evaluation of TTC and contributes to the increased number of detection in daily clinical practice.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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“…Typical tako-tsubo cardiomyopathy (TTC) mimics acute myocardial infarction involving the left anterior descending territory (AMI), sharing similar presentation, electrocardiogram (ECG) findings, and wall motion abnormalities (WMA) at the left ventricular (LV) apex [1][2][3][4][5][6][7]. However, in TTC, where the coronary angiography demonstrates no significant coronary stenosis, there is a spontaneous total recovery of WMA within days or weeks, whereas in AMI the recovery is variable after reperfusion according to the surrounding viable myocardium [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…There is no data in TTC regarding the regional strain pattern and its relationship with recovery. By definition, TTC is a stunned myocardium which shows total recovery at follow-up [1][2][3]. However, It is unknown if TTC segments with WMA mimic viable AMI segments at the strain level.…”

Section: Introductionmentioning

confidence: 99%

“…Patients groups TTC was diagnosed according to the following criteria: acute chest pain or dyspnea, a stressful event when present, transient LV WMA at the apex of the LV, ECG changes (ST-segment elevation or T-wave inversion), no luminal narrowing [50 % and no evidence of plaque rupture in all epicardial coronary arteries on angiography, and a minimal troponine release despite extensive WMA [1][2][3]. Furthermore, no patient had a history of coronary artery disease, a febrile or acute neurologic disorder.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between acute strain pattern and recovery in tako-tsubo cardiomyopathy and acute anterior myocardial infarction: a comparative study using two-dimensional longitudinal strain

Meimoun

Abouth

Boulanger

et al. 2014

Int J Cardiovasc Imaging

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After acute-anterior myocardial infarction (AMI), left ventricular (LV) viable myocardial segments show some degree of active deformation (longitudinal shortening) despite wall motion abnormalities (WMA). Tako-tsubo cardiomyopathy (TTC) is characterized by myocardial stunning; however, it is unclear whether in TTC the strain pattern mimics AMI. To compare the strain-pattern in TTC and AMI using the 2D-longitudinal strain by speckle-tracking in segments with WMA, and its relationship with recovery of function at follow-up. 21 consecutive patients with typical TTC and 21 age-matched AMI patients treated by primary angioplasty had an analysis of LV-longitudinal strain at the acute-phase and at follow-up (1 and 6 months later for TTC and AMI respectively). The recovery of a segment was defined as normal wall motion at follow-up. Among the 706 analyzable LV-segments at the acute-phase, 406 had WMA (TTC 229, AMI 177). At follow-up, total recovery was observed for 45 % segments in AMI and 100 % in TTC, (p < 0.01). At the acute phase, systolic lengthening duration (47 ± 43 vs. 18 ± 33 %) and amplitude (0.25 ± 0.29 vs. 0.09 ± 0.19) and post systolic shortening (67 ± 53 vs. 39 ± 38 %) were higher in TTC, when compared to AMI-recovery (all, p < 0.01). In AMI, systolic lengthening duration was an independent predictor of poor recovery in multivariate analysis, linked to segmental longitudinal strain at follow-up (all, p ≤ 0.01). Furthermore, among the 57 % of segments exhibiting any systolic lengthening duration in AMI, only ¼ recovered, versus 62 % of such segments in TTC with 100 % recovery (p < 0.001). The systolic passive motion which is closely and inversely linked to recovery in AMI is paradoxically frequent and severe in TTC. This suggests that myocardial stunning in TTC and AMI is different according to longitudinal strain.

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“…63 Therefore, it remains much to learn regarding the underlying pathophysiology of this condition in order to improve diagnostic and treatment pathways. Further research is required to help clarify the hypotheses discussed and to increase our understanding of the cardiovascular responses to acute stress and the pathophysiology underpinning TTS.…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis of Takotsubo Syndrome

et al. 2017

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Takotsubo syndrome (TTS) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. Postulated mechanisms include catecholamine excess, coronary artery spasm, and microvascular dysfunction, however catecholamines seem to play a central role in the pathophysiology of TTS. In facts catecholamines have relevant effects on the vasculature and myocardium. Toxic direct effects of catecholamine on myocardium are mediated by multiple pathway including functional hypoxia, metabolic changes and changes in membrane permeability leading to various electrolytic imbalances. Recently report of familial cases has suggested a genetic component. Further research is required to help clarify the proposed hypotheses and to increase our understanding of the cardiovascular responses to acute stress and the pathophysiology underpinning TTS.

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Takotsubo cardiomyopathy: an integrated multi-imaging approach

Cited by 79 publications

References 48 publications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Relationship between acute strain pattern and recovery in tako-tsubo cardiomyopathy and acute anterior myocardial infarction: a comparative study using two-dimensional longitudinal strain

Pathogenesis of Takotsubo Syndrome

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