Takotsubo syndrome in a heart transplant recipient with poor cardiac sympathetic reinnervation

Miyake, Ryo; Ohtani, Kisho; Hashimoto, Toru; Yada, Ryoko; Sato, Tasuku; Shojima, Yoko; Hayashidani, Shunji; Higo, Taiki; Tsutsui, Hiroyuki

doi:10.1002/ehf2.12632

Cited by 6 publications

(12 citation statements)

References 13 publications

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“…It has been postulated that parasympathetic denervation may lead to upregulation of catecholamines and β-adrenoreceptors. 86 Combined with impaired neural innervation, this may result in an exaggerated response to catecholamines and susceptibility to takotsubo syndrome. The brain-heart axis is yet to be properly explored and possibly holds the answers to a number of questions that elude us regarding takotsubo syndrome and possibly other cardiac diseases.…”

Section: Brain-heart Axismentioning

confidence: 99%

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

et al. 2022

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Takotsubo syndrome is a condition characterized by acute transient left ventricular systolic dysfunction, which at presentation can be challenging to distinguish from acute myocardial infarction. Although previously thought to be a benign, self-limiting condition, recent studies have confirmed that patients with takotsubo syndrome have persistent subtle ongoing cardiac dysfunction, and many continue to have limiting symptoms despite restoration of left ventricular ejection fraction. Moreover, these patients have a substantial burden of morbidity and mortality, as well, with high rates of subsequent major adverse cardiovascular events that approach those of patients with acute coronary syndrome. The mechanisms behind this condition remain elusive. Despite substantial research, the medical community continues to have an incomplete understanding of its underlying pathogenesis and pathophysiology. Catecholamine-induced myocardial injury is the most established and well-known theory, but this does not explain all the clinical features and presentations of the condition, and numerous other pathways and abnormalities are emerging. Because of the poor understanding of its underlying pathophysiology, there is a lack of evidence-based interventions to treat the acute episode, to avoid recurrences, and to prevent major adverse cardiovascular events. This highlights the need for further research to gain a better understanding of the underlying pathophysiology to inform appropriate randomized controlled trials of interventions targeting the causative pathways. Only then can evidence-based management strategies be established to improve clinical outcomes of this potentially lethal condition.

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Section: Brain-heart Axismentioning

confidence: 99%

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

et al. 2022

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“…There are several case reports of patients with TTS whose nuclear imaging findings contradict our current pathogenesis model. One such case is a 67-year-old heart-transplant patient who developed TTS [ 76 ]. The patient, who had heart transplantation for ischemic cardiomyopathy ten years prior, presented with heart failure.…”

Section: Discussionmentioning

confidence: 99%

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Nayar

John

Philip³

et al. 2022

Life

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Takotsubo cardiomyopathy or Takotsubo Syndrome (TTS) is a reversible left ventricular dysfunction syndrome that is increasingly being recognized. Recent advances in nuclear imaging have allowed us to study TTS in greater detail. We searched the PubMed and Medline databases and identified 53 publications with 221 patients reporting nuclear imaging findings in TTS. The age of the patients ranged from 17 to 87 years and were predominantly women (88.2%). The TTS variant was apical (typical) in 170 (76.9%), mid-ventricular in 23 (10.4%), and basal (reverse TTS) in 2 (0.9%). Cardiac perfusion was assessed using 99mTc sestamibi (MIBI) SPECT, 99mTc tetrofosmin SPECT, 201Tl SPECT, 82Rb PET, 201Tl SPECT, and 13N ammonia PET. Additional studies used were 123I MIBG SPECT, 123I BMIPP SPECT, 18F FDG PET, 67Ga citrate, and 11C hydroxy-ephedrine. A perfusion defect was seen in 69 (31.2%), and an inverse perfusion–metabolism mismatch (normal or near-normal perfusion with absent myocardial metabolic activity) was seen in 183 (82.8%) patients. Nuclear imaging has a significant role in evaluating, diagnosing, and prognosticating patients with TTS. As nuclear imaging technology evolves, we will surely gain more insights into this fascinating disorder.

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“…This has been documented by the finding that TTS may take place in heart transplanted patients, i.e. in a clinical condition of cardiac denervation 38,39 …”

Section: The Role Of the Central And Peripheral Nervous System In The...mentioning

confidence: 96%

“…in a clinical condition of cardiac denervation. 38,39 There is a growing awareness that some TTS patients developed a new acquired anxiety disorder, with heightened awareness to endogenous catecholamines in scenarios of subsequent stress and sympathetic activation. Hence, potentially both chronic and acute alterations at the level of the brain appear to play a role in the pathogenesis of TTS.…”

Section: The Role Of the Central And Peripheral Nervous System In The...mentioning

confidence: 99%

Pathophysiology of Takotsubo syndrome – a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology – Part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications

Ömerovic

Citro

Bossone

et al. 2021

European J of Heart Fail

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While the first part of the scientific statement on the pathophysiology of Takotsubo syndrome was focused on catecholamines and the sympathetic nervous system, in the second part we focus on the vascular pathophysiology including coronary and systemic vascular responses, the role of the central and peripheral nervous systems during the acute phase and abnormalities in the subacute phase, the gender differences and integrated effects of sex hormones, genetics of Takotsubo syndrome including insights from microRNA studies and inducible pluripotent stem cell models of Takotsubo syndrome. We then discuss the chronic abnormalities of cardiovascular physiology in survivors, the limitations of current clinical and preclinical studies, the implications of the knowledge of pathophysiology for clinical management and future perspectives and directions of research.

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Takotsubo syndrome in a heart transplant recipient with poor cardiac sympathetic reinnervation

Cited by 6 publications

References 13 publications

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

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