Takotsubo Syndrome During the COVID-19 Pandemic: State-of-the-Art Review

Moady, Gassan; Atar, Shaul

doi:10.1016/j.cjco.2021.05.011

Cited by 23 publications

(47 citation statements)

References 83 publications

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“…2,3,14 It becomes compelling to study and validate these atypical clinical and imaging phenotypes of TTS during the COVID-19 pandemic across data sets from global health resources/registries in order to establish new reference criteria to improve diagnostic specificity and support goal-directed therapy. 2,5 The inpatient mortality of patients with COVID-19 and TTS is much higher than its prepandemic mortality. 10 Although the exact pathologic role of TTS in the adverse outcomes of patients with COVID-19 remains poorly understood, TTS in many patients with COVID-19 infection is likely a unique illness severity marker.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Evidence is mounting that increased mortality rates are associated with patients with TTS and COVID-19 infection. 4,5 In the present study, we completed a systematic review of published TTS cases during the COVID-19 pandemic and performed clustering and feature importance analysis on the demographic, clinical, and imaging parameters, aiming to characterize clinical/imaging features and identify mortality correlates.…”

mentioning

confidence: 99%

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Mortality Correlates in Patients With Takotsubo Syndrome During the COVID-19 Pandemic

Chang¹,

Wang²,

Jayanna³

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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We completed a systematic review of published Takotsubo syndrome (TTS) cases during COVID-19 pandemic and performed clustering and feature importance analysis, and statistical testing for independence on the demographic, clinical and imaging parameters. Compared with the data before the COVID-19 pandemic, TTS was increasingly diagnosed in physical stress (mostly COVID-19 pneumonia)-triggered male patients without psychiatric/neurologic disorders, warranting further investigation to establish new reference criteria to improve diagnostic specificity. In clustering analysis, the gender and in-patient mortality primarily contributed to the automated classification of the TTS. Both the gender and in-patient mortality showed significant correlations with COVID-19 infection/pneumonia. There is effect modification of gender on outcomes in patients with COVID-19 infection and TTS, with male patients having significantly worse inpatient mortality. Meanwhile, significantly more male TTS patients were classified as “high-risk” following InterTAK prognostic scores, suggestive of male COVID-19/TTS survivors will likely have worse long-term outcome.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mortality Correlates in Patients With Takotsubo Syndrome During the COVID-19 Pandemic

Chang¹,

Wang²,

Jayanna³

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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show abstract

“…104 Thus, TTS should be considered in the differential diagnosis of COVID-19 patients with cardiovascular complications, although the diagnosis is difficult because cardiac imaging modalities need to be modified to minimize patient contact. 105 Considering the severity of COVID-19, it is better that these patients are diagnosed in the acute phase. Thus, in patients with COVID-19 with cardiovascular complications, TTE evaluation may be useful to guide treatment and determine the need for further invasive workup.…”

Section: Optimizing Care With Other Approachesmentioning

confidence: 99%

Takotsubo Syndrome: Optimizing Care with a Multidisciplinary Approach

Kinno¹,

Ono²

2021

JMDH

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Symptoms of takotsubo syndrome (TTS) include acute and transient regional systolic dysfunction of the left ventricle, as well as a variety of wall-motion abnormalities. The clinical features of TTS, including initial symptoms, cardiac biomarkers, and electrocardiogram (ECG) changes, are similar to those of acute coronary syndrome, with the exception that TTS patients typically have no obstructive coronary artery disease. TTS primarily affects elderly women, and emotional or physical stress is a common cause of the disease. Exaggerated sympathetic stimulation associated with dysfunction of the limbic system has also been reported to be related to TTS occurrence. Cancer also induces emotional and physical stress. Therefore, optimization of TTS care should involve cardiac, neurological, psychiatric, and oncological approaches. The first step in optimizing TTS care is to diagnose it by cardiac means. Multimodality imaging, including ECG, echocardiogram, angiography, ventriculography, and cardiac magnetic resonance imaging, is indispensable for diagnosis, therapy management, and the evaluation of prognosis in the acute and chronic phases of TTS. The current cardiac approach during the acute phase is primarily supportive, with the goal of preventing life-threatening complications. As central nervous system diseases frequently trigger TTS, a neurological approach is also required. Appropriate psychiatric medication may reduce the risk of TTS recurrence, as not only psychiatric disorders themselves but also psychiatric medications can be the trigger for TTS. Several conditions are associated with TTS, including the novel coronavirus disease 2019. We present current knowledge of TTS in this review and describe how to optimize TTS care through a multidisciplinary approach.

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“…Precisely, it has been evidenced that the huge emotional stress evocated by the SARS-CoV-2 pandemic can act as a possible TSS trigger. However, it has been reported that TTS may also represent a direct complication of SARS-CoV-2 infection [3,4], and particularly in cancer patients. Cancer patients show different risk factors (i.e., active cancer, surgery, radiotherapy, anticancer drugs), that could determine a coagulation dysfunction, characterized by an increased coagulative activity, and reciprocally by an inhibition of fibrinolysis.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the type of cancer and related therapies, such as recent chemotherapy, radiotherapy, surgery, and other concomitant comorbidities (i.e., diabetes, cardiovascular diseases, metabolic syndrome) may increase the rate of vulnerability to the infection and its complications [4]. Furthermore, patients affected by sepsis, neurological disorders (i.e., subarachnoid hemorrhage, seizures, stroke/transient ischemic attack, cerebral tumors, head trauma), and pheochromocytoma, can also develop TTS [3,4]. Drugs, such as dopamine, dobutamine, epinephrine, norepinephrine, and anesthesia drugs, can also represent TTS triggers, evocating a TTS like disorder [5].…”

Section: Introductionmentioning

confidence: 99%

Genetic and Epigenetic Factors of Takotsubo Syndrome: A Systematic Review

Ferradini

Vacca

Belmonte

et al. 2021

IJMS

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Takotsubo syndrome (TTS), recognized as stress’s cardiomyopathy, or as left ventricular apical balloon syndrome in recent years, is a rare pathology, described for the first time by Japanese researchers in 1990. TTS is characterized by an interindividual heterogeneity in onset and progression, and by strong predominance in postmenopausal women. The clear causes of these TTS features are uncertain, given the limited understanding of this intriguing syndrome until now. However, the increasing frequency of TTS cases in recent years, and particularly correlated to the SARS-CoV-2 pandemic, leads us to the imperative necessity both of a complete knowledge of TTS pathophysiology for identifying biomarkers facilitating its management, and of targets for specific and effective treatments. The suspect of a genetic basis in TTS pathogenesis has been evidenced. Accordingly, familial forms of TTS have been described. However, a systematic and comprehensive characterization of the genetic or epigenetic factors significantly associated with TTS is lacking. Thus, we here conducted a systematic review of the literature before June 2021, to contribute to the identification of potential genetic and epigenetic factors associated with TTS. Interesting data were evidenced, but few in number and with diverse limitations. Consequently, we concluded that further work is needed to address the gaps discussed, and clear evidence may arrive by using multi-omics investigations.

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Takotsubo Syndrome During the COVID-19 Pandemic: State-of-the-Art Review

Abstract: Takotsubo syndrome during the COVID-19 pandemic, state-of -theart review.

Cited by 23 publications

References 83 publications

Mortality Correlates in Patients With Takotsubo Syndrome During the COVID-19 Pandemic

Mortality Correlates in Patients With Takotsubo Syndrome During the COVID-19 Pandemic

Takotsubo Syndrome: Optimizing Care with a Multidisciplinary Approach

Genetic and Epigenetic Factors of Takotsubo Syndrome: A Systematic Review

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