Takotsubo Syndrome—Is There a Need for CMR?

Jensch, Philipp-Johannes; Stiermaier, Thomas; Eitel, Ingo

doi:10.1007/s11897-021-00518-x

Cited by 17 publications

(14 citation statements)

References 70 publications

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“…In addition to detecting local abnormalities in the motion of the walls of the ventricles of the heart, MRI determines the functional characteristics of the ventricles, evaluates additional abnormalities and complications (pericardial/pleural effusion, blood clots), and characterizes myocardial tissues considering edema, inflammation, necrosis, fibrosis, if any. MRI allows differentiation between TTS and other pathologies, including myocarditis, myocardial infarction that is critical for prescribing appropriate medication [30]. Positive late gadolinium enhancement can determine segments with low perfusion, contraction bands in akinetic zones of the myocardium, small foci of fibrosis, accumulation of interstitial fluid in cardiomyocytes etc.…”

Section: Diagnostics Of Takotsubo Syndromementioning

confidence: 99%

The relevance of Takotsubo cardiomyopathy as a stress-induced disease

Ganych¹,

Oflidi²,

Zaitseva³

et al. 2023

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Takotsubo cardiomyopathy, or Takotsubo syndrome, can be quite rare found, but however the frequency of diagnosing with this disease among patients of cardiology departments is constantly growing. On the one hand, this may be due to improved diagnostics of this pathology, and on the other hand, to an increasing frequency of mental disorders in the human population and the spread of other risk factors, including drug-induced variants. The pathogenesis of the development of Takotsubo cardiomyopathy is associated with an increase in the level of catecholamines, which may be the result of a reactive sympathetic enhancement in response to external factors or be the result of taking antidepressants that can produce a similar effect. Although the diagnostics of this pathology has made significant progress, but however there is still no consensus on the strategy of treatment. This is due to the lack of large-scale randomized prospective studies that could justify one or another therapeutic approach. Basically, the efforts of medical doctors are aimed at maintaining cardiac activity, eliminating the trigger of the disease and at treating complications. The purpose of this review was to summarize the accumulated information related to the problems of etiology, pathogenesis, diagnosis and treatment of Takotsubo cardiomyopathy with an emphasis on the variants associated with the use of antidepressants.

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Section: Diagnostics Of Takotsubo Syndromementioning

confidence: 99%

The relevance of Takotsubo cardiomyopathy as a stress-induced disease

Ganych¹,

Oflidi²,

Zaitseva³

et al. 2023

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show abstract

“…48 It is also the gold standard in detecting biventricular ballooning and the detection of right ventricular TTS thus aiding the diagnosis and prognosis. 48,49 Treatment Angiotensin-converting enzyme inhibitors (ACEi) and beta blockers are commonly used in patients with left ventricle dysfunction due to their cardioprotective effects. 50 In their meta-analysis, Singh et al note that ACEi are superior to beta blockers in preventing recurrent TTS.…”

Section: Bnp:tnt >1272mentioning

confidence: 99%

“…This is recommended in the guidelines to rule out infective myocarditis 48 . It is also the gold standard in detecting biventricular ballooning and the detection of right ventricular TTS thus aiding the diagnosis and prognosis 48,49 …”

Section: Cardiac Imagingmentioning

confidence: 99%

“…47 Cardiac magnetic resonance CMR should be used in the acute setting whenever possible as it can visualize oedema in the absence of late gadolinium enhancement (LGE) of necrosis or enhancement in TTS. 48,49 This is recommended in the guidelines to rule out infective myocarditis. 48 It is also the gold standard in detecting biventricular ballooning and the detection of right ventricular TTS thus aiding the diagnosis and prognosis.…”

Section: Bnp:tnt >1272mentioning

confidence: 99%

“…48,49 This is recommended in the guidelines to rule out infective myocarditis. 48 It is also the gold standard in detecting biventricular ballooning and the detection of right ventricular TTS thus aiding the diagnosis and prognosis. 48,49 Treatment Angiotensin-converting enzyme inhibitors (ACEi) and beta blockers are commonly used in patients with left ventricle dysfunction due to their cardioprotective effects.…”

Section: Bnp:tnt >1272mentioning

confidence: 99%

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An update on takotsubo syndrome

Alim,

Shah,

Zahera

et al. 2023

Journal of Cardiovascular Medicine

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Takotsubo syndrome (TTS) can be described as an acute, transiently occurring form of heart failure. It typically causes systolic dysfunction of the left ventricle (LV). Perhaps what is of most significance is the reversible nature of TTS, with many patients achieving recovery within a few weeks to months. TTS can be referred to by other names, attributed to its various precipitants, as well as the structural manifestations of the syndrome. Physical and emotional stressors have been identified as the most common of causes, hence the terms ‘stress cardiomyopathy’ and ‘broken heart syndrome’. Precipitants can range from psychological, and hormonal, to molecular mechanisms. The symptoms of TTS can coalesce with other conditions and hence give rise to many differential diagnoses. Most patients present with dyspnoea and chest pain. The latter also presents in acute coronary syndrome (ACS); thus, ACS is a common differential diagnosis for TTS. The coronavirus disease 2019 (COVID-19) pandemic saw a drastic increase in mental health concerns which have persisted beyond this period. Further studies into personality disorders and their potential predisposition to COVID-19 and thus TTS would advance our understanding of the neuropsychiatric triggers of TTS. There is also a need for a single sensitive and specific diagnostic test for TTS as its diagnosis relies on the culmination of clinical presentation, echocardiography, cardiac catheterization, and cardiovascular magnetic resonance imaging (CMR).

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A novel and simple cardiac magnetic resonance score (PE2RT) predicts outcome in takotsubo syndrome

et al. 2023

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Objectives To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS). Methods Patients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PE2RT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PE2RT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan–Meier estimator. Results Seventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2–6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4–36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PE2RT score (median [IQR], 2 [2–3] vs 1 [0–1]; p < 0.001). PE2RT score was associated with MACE on Cox regression analysis (hazard ratio per PE2RT feature, 2.44; 95%CI: 1.62–3.68; p < 0.001). Two or more PE2RT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001). Conclusions The introduced PE2RT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR. Key Points • Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PE2RT features) are relatively common in takotsubo syndrome. • The proposed PE2RT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.

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Takotsubo Syndrome—Is There a Need for CMR?

Cited by 17 publications

References 70 publications

The relevance of Takotsubo cardiomyopathy as a stress-induced disease

The relevance of Takotsubo cardiomyopathy as a stress-induced disease

An update on takotsubo syndrome

A novel and simple cardiac magnetic resonance score (PE2RT) predicts outcome in takotsubo syndrome

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