Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases

Abstract

Takotsubo syndrome (TTS) is caused by catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed/Medline, SCOPUS, Web of Science, and Google Scholar databases to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, clinical attributes, and outcomes. There are 12 cases reported of TTS associated with COVID-19 infection with mean age of 70.8 ± 15.2 years (range 43–87 years) with elderly (66.6% > 60 years) female (66.6%) majority. The time interval from the first symptom to TTS was 8.3 ± 3.6 days (range 3–14 days). Out of 12 cases, 7 reported apical ballooning, 4 reported basal segment hypo/akinesia, and 1 reported median TTS. Out of 12 cases, during hospitalization, data on left ventricular ejection fraction (LVEF) was reported in only 9 of the cases. The mean LVEF was 40.6 ± 9.9% (male, 46.7 ± 5.7%, and female, 37.7 ± 10.6%). Troponin was measured in all 12 cases and was elevated in 11 (91.6%) without stenosis on coronary angiography except one. Out of 11 cases, 6 developed cardiac complications with 1 case each of cardiac tamponade, heart failure, myocarditis, hypertensive crisis, and cardiogenic shock in 2. Five patients required intubation, 1 patient required continuous positive airway pressure, and 1 patient required venovenous extracorporeal membrane oxygenation. The outcome was reported in terms of recovery in 11 (91.6%) out of 12 cases, and a successful recovery was noted in 10 (90.9%) cases. COVID-19-related TTS has a higher prevalence in older women. Despite a lower prevalence of cardiac comorbidities in COVID-19 patients, direct myocardial injury, inflammation, and stress may contribute to TTS with a high complication rate.

A case report on transient cardiomyopathy with cytokine storm in SARS-CoV-2

“…There are more reports of stress cardiomyopathy with SARS-CoV-2, with one systematic review of different case reports suggesting that cytokine storm is likely to play a role in the development of stress. 5 The other aetiology of cardiac involvement also includes direct myocardial involvement with SARS-CoV-2 infection as seen in a prospective study from Germany which showed myocardial inflammation in 60% of MRI studies in patients recovered from SARS-CoV-2. 6 …”

Reply to “Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases”

“…Dear authors, we greatly appreciated the systematic review and analysis of COVID-19 reported cases associated with the development of Takotsubo syndrome (TTS) [ 1 ]; however, we found two critical issues in reading your work.…”

Broken Heart (Takotsubo) Syndrome Triggered by SARS-CoV-2

“…The authors mention that their study is the first systematic review about COVID-19-related TSS [ 1 ], but in the results section, they indicate that 5 papers were excluded from the evaluation because they were review articles [ 1 ]. We should be told if these 5 articles were reviews about COVID-19-related TTS.…”

“…The authors mention that TTS in COVID-19 patients is caused by the cytokine storm [ 1 ]. They consider that the cytokine storm aroused by the infection could trigger TTS, particularly among patients without an evident trigger.…”

“…The authors propose myocarditis as a pathophysiological factor in the development of TTS [ 1 ]. It would be interesting to know if myocarditis in patients with COVID-19-related TTS was only suspected, confirmed upon cardiac MRI with contrast medium, or if myocarditis has been diagnosed in any of the included patients upon endomyocardial biopsy.…”