Takotsubo cardiomyopathy with concurrent multivessel obstructive coronary artery disease: proposition for a new clinical entity and first case surgical experience

Parker, Jack; Amerini, Andrea; Autschbach, Rüdiger; Spillner, J

doi:10.1093/icvts/ivr014

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…4–9 In patients with acute MI, pain and other stressors can stimulate central and autonomic nervous systems and increase bioavailability of cortisol and circulating catecholamines, 2 , 3 affecting the myocardium supported by both culprit and non-culprit coronary arteries. 18 , 19 Due to a higher density of β-adrenergic receptors and higher proportion of β2 receptors linked to Gi than Gs proteins in the ventricular apex, 20 , 21 wall motion impairment may predominantly present in apical and middle segments of the ventricle. This contractile dysfunction exceeds the factual ischemic myocardial territory and microvascular myocardial perfusion defect, forming a characteristic “apical ballooning” contractile pattern.…”

Section: Discussionmentioning

confidence: 99%

“Takotsubo effect” in patients with ST segment elevation myocardial infarction

Liu

Chen

Dogra

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background Myocardial infarction can be a trigger of Takotsubo syndrome. We recently characterized imaging features of acute myocardial infarction-induced Takotsubo syndrome (“Takotsubo effect”). In this study, we investigate diagnostic and prognostic implications of Takotsubo effect in patients with anterior wall ST-segment elevation myocardial infarction. Methods We enrolled 111 consecutive patients who developed anterior wall ST-segment elevation myocardial infarction and received percutaneous coronary intervention, and studied systolic/diastolic function, hemodynamic consequences, adverse cardiac events, as well as 30-day and five-year outcomes in patients with and without Takotsubo effect. Results Patients with Takotsubo effect showed significantly worse average peak systolic longitudinal strain (–9.5 ± 2.6% vs –11.1 ± 3.6%, p = 0.038), left ventricular ejection fraction (38.5 ± 6.8% vs 47.7 ± 8.7%, p = 0.000) and myocardial performance index (0.54 ± 0.17 vs 0.37 ± 0.15, p = 0.000) within 48 h of myocardial infarction. There was no significant difference between the two groups in diastolic ventricular filling pressures, hemodynamic consequences, and 30-day rehospitalization and mortality (Gehan-Breslow-Wilcoxon test: p = 0.157). However, patients with Takotsubo effect developed more major adverse cardiac events (log-rank test: p = 0.019) when tested at the five-year follow-up. Cox regression analysis revealed that age, hypotension, tricuspid annular plane systolic excursion, and Takotsubo effect were independent prediction factors for five-year major adverse cardiac events. The Doppler/tissue Doppler parameter E/e’ correlated with MACE only in patients without Takotsubo effect. Conclusion Takotsubo effect secondary to anterior ST-segment elevation myocardial infarction predicts a worse long-term prognosis.

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Section: Discussionmentioning

confidence: 99%

“Takotsubo effect” in patients with ST segment elevation myocardial infarction

Liu

Chen

Dogra

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…However, Templin et al observed that 15.3% of TC patients had evidence of concomitant coronary artery disease on coronary angiography. An association between coronary atherosclerosis and TC has been further described …”

Section: Discussionmentioning

confidence: 88%

Takotsubo Cardiomyopathy Following Cardiac Surgery

et al. 2015

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Background: Takotsubo cardiomyopathy syndrome, commonly occurring in postmenopausal women, is characterized by transient apical systolic dysfunction in absence of coronary lesions. The cardiomyopathy is often observed after intense stressful events such as a major surgical procedure. Methods: A 72-year-old woman symptomatic for dyspnea at rest, chest pain, and peripheral edema successfully underwent surgery for noncoronary sinus aneurysm-right atrium fistula repair. Two days after surgery the patient developed takotsubo syndrome, diagnosed according to the Mayo Clinic criteria. We reviewed the literature on takotsubo cardiomyopathy as a complication of major cardiac surgery procedures. Results: Takotsubo cardiomyopathy is confirmed as a possible early complication of cardiac surgery. Exaggerated sympathetic stimulation may cause massive endogenous catecholamine release. Hypoperfusion during cardiopulmonary bypass, inotropic drugs administration, and postoperative anxiety and pain are all factors generating stress, possible coronary artery spasm and transient cardiomyopathy, clinically simulating acute myocardial infarction. Several clinical features have been described such as acute mitral insufficiency, systolic anterior motion of the anterior mitral valve leaflet, left ventricular outflow tract obstruction, acute cardiac failure, and cardiogenic shock. Intraventricular thrombi and adverse cerebrovascular events may also be possible complications. Rare catastrophic events such as left ventricular free wall rupture and ventricular septal perforation have been also encountered. Conclusions: After cardiac surgery takotsubo cardiomyopathy should be suspected if clinical and instrumental criteria are met, and promptly differentiated from the more frequent acute myocardial infarction. Prognosis may be favorable if appropriate conservative medical treatment is promptly started.

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“…We do not exclude if she had had the inferior wall MI in the presence of intact coronary arteries. 4,12 Previous cases demonstrated inverted type with akinesia of antero-lateral diaphragmal, posterior and basal midportion walls without apical ballooning, 6,7 as well as myocardial rupture was described in the setting of TCM. 8,9 Our case is a rare reverse type of TCM with rupture of posterior, infero-lateral walls into pericardium.…”

Section: Discussionmentioning

confidence: 99%

“…3 Usually, hypo-akinesia of apical and midventricular LV segments and hyperkinesia of basal segments are observed; however, the reverse (inverted) types were also described. 1,[3][4][5][6][7] Reverse type accounted for 23.3% of all TCM cases and emotional stress was a leading triggering factor. The prognosis of TCM is usually benign; however, several cases of LV wall rupture were described.…”

Section: Introductionmentioning

confidence: 99%

“…The stress cardiomyopathy or Takotsubo cardiomyopathy (TCM), described by Sato et al, 1 is a transient left ventricular (LV) apical ballooning, accompanied by LV dysfunction. 2 Clinical manifestations of TCM resemble acute myocardial infarction (MI), although both may coexist, 3,4 and it usually develops in postmenopausal women with intact coronary arteries. Emotional stress with sympathetic activation and catecholamine’s cardiac toxicity is the underlying mechanism in most cases, though microvascular dysfunction, coronary spasm and inflammation contribute as well.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

Kudaiberdiev¹,

Akhmedova²,

Imanalieva³

et al. 2017

SAGE Open Medical Case Reports

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Objective:We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium.Methods:The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago.Results:Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function.Conclusion:Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

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Takotsubo cardiomyopathy with concurrent multivessel obstructive coronary artery disease: proposition for a new clinical entity and first case surgical experience

Cited by 7 publications

References 7 publications

“Takotsubo effect” in patients with ST segment elevation myocardial infarction

“Takotsubo effect” in patients with ST segment elevation myocardial infarction

Takotsubo Cardiomyopathy Following Cardiac Surgery

Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

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