A Case of Takotsubo Cardiomyopathy after Elective Mitral Valve Repair / 日本心臓血管外科学会雑誌

We describe Takotsubo syndrome, which developed after elective mitral valve repair and tricuspid annuloplasty in a 76-year-old woman. A preoperative echocardiogram confirmed severe mitral regurgitation due to posterior leaflet prolapse, moderate tricuspid regurgitation, and normal left ventricular function. Mitral valve repair and tricuspid annuloplasty were performed. After uneventful weaning off cardiopulmonary bypass, intraoperative transesophageal echocardiography revealed adequate mitral leaflet function and normal left ventricular contractions. After being transferred to the intensive care unit, the patient's hemodynamic parameters progressively deteriorated. Transthoracic echocardiography showed akinesis and ballooning of the apex and hyperkinesis of the base, and the ejection fraction was 20% on postoperative day 1. The serum aminotransferase and CPK-MB levels increased on postoperative day 2. The left ventricular function did not improve despite supportive therapy with vasopressors. She developed cardiogenic cerebral infarction due to obstruction of the right middle cerebral artery on postoperative day 8. Endovascular thrombectomy was performed within 2 h of the onset of cerebral infarction. Thereafter, the patient gradually recovered and was discharged without any sequelae on postoperative day 31. The ejection fraction was 65% with normal left ventricular motion at discharge. An electrocardiogram revealed a deep negative T wave in II, III, aVF, and V3-V6. After 2 months, the electrocardiogram findings were normalized. Coronary lesions were not observed on pre- or postoperative coronary angiographies; therefore, we diagnosed Takotsubo cardiomyopathy after mitral valve repair. Takotsubo cardiomyopathy should be considered as a possible complication of cardiac surgery, especially after mitral valve surgery.

Síndrome de Takotsubo: Actualización 2022 / Takotsubo Syndrome: 2022 Update

El síndrome de Takotsubo es una enfermedad cardíaca aguda que se presenta con un cuadro clínico similar al de un síndrome coronario agudo y se caracteriza por alteraciones segmentarias de la contracción ventricular transitorias, con un árbol coronario normal o con lesiones coronarias no significativas que las expliquen. Se observa, generalmente, en mujeres posmenopáusicas; el cual se desencadena principalmente por un estrés emocional o físico severo y su diagnóstico es un desafío clínico. Este artículo entrega una revisión de los factores desencadenantes y de riesgo y las principales hipótesis causales de esta enfermedad. Proporciona, además, una revisión actualizada de las pruebas diagnósticas que deben ser realizadas, el algoritmo para su diagnóstico, las complicaciones y el manejo terapéutico actual.

Takotsubo syndrome is an acute cardiomyopathy with a clinical presentation resembling an acute coronary syndrome. It is characterized by transient segmental ventricular dysfunction with a normal underlying coronary tree or coronary lesions that cannot explain the ventricular dysfunction. It is usually seen in postmenopausal women, triggered by severe emotional or physical stress, and is clinically challenging to diagnose. This article provides an exhaustive review of the risk factors, triggers, and main hypotheses to explain this disease. In addition, it provides an updated review of the diagnostic tests that must be performed, the diagnostic algorithms, their complications, and current therapeutic management.

Características clínicas del síndrome de takotsubo: una serie de casos / Clinical characteristics of takotsubo syndrome: a series of cases

Resumen Introducción: El síndrome de takotsubo (STT) es una entidad de reciente reconocimiento que asemeja un síndrome coronario agudo. Su epidemiologia ha sido estudiada en diversas poblaciones del mundo. El desencadenante más frecuente es un evento estresante emocional. Objetivo: Describir las características clínicas de una serie de casos con STT. Material y métodos: Se realizó un estudio descriptivo y retrospectivo. Se evaluaron las variables de edad, sexo, características clínicas, factores de riesgo cardiovascular, factores desencadenantes, biomarcadores, hallazgos electrocardiográficos, ecocardiográficos y angiográficos en los expedientes clínicos de un grupo de casos de pacientes con STT. Resultados: Se incluyeron 19 casos de STT. Fueron 16 mujeres y 3 hombres, promedio de edad 62 ± 14 años; el principal factor de riesgo cardiovascular fue el sedentarismo, en 13 casos. El desencadenante emocional estuvo presente en la mayoría de los casos. El síntoma más frecuente fue el dolor torácico, ocho casos presentaron datos de choque e insuficiencia cardiaca. La variante más común por ecocardiograma fue el balonamiento apical en un 79%, al igual que por ventriculografía. La complicación más común fue choque cardiogénico. Conclusiones: Las características clínicas de nuestra población son similares a las descritas previamente en la literatura. El STT es una miocardiopatía transitoria y reversible con buen pronóstico.

Abstract Introduction: takotsubo syndrome (TTS) is a recently recognized entity that resembles an acute coronary syndrome. Its epidemiology has been studied in various populations around the world. The most frequent trigger is an emotional stressful event. Objective: To describe the clinical characteristics of a series of cases with TTS. Material and methods: A descriptive and retrospective study was carried out. The variables of age, gender, clinical characteristics, cardiovascular risk factors, triggering factors, biomarkers, electrocardiographic, echocardiographic, and angiographic findings in the clinical records of a group of cases of patients with TTS were evaluated. Results: 19 cases of TTS were included. There were 16 women and 3 men, the average age was 62 ± 14 years; the main cardiovascular risk factor was sedentary lifestyle in 13 cases. The emotional trigger was present in most cases. The most frequent symptom was chest pain, eight cases presented data of shoCKP and heart failure. The most common variant by echocardiography was apical ballooning in 79%, as well as by ventriculography. The most common complication was cardiogenic shoCKP. Conclusions: The clinical characteristics of our population are like those previously described in the literature. TTS is a transient and reversible cardiomyopathy with a good prognosis.

Síndrome de tako-tsubo en una adolescente. Presentación de caso

El síndrome de tako-tsubo es una miocardiopatía aguda por estrés, caracterizada por una anormalidad regional del movimiento de la pared del ventrículo izquierdo, con un patrón circunferencial peculiar que resulta en un abultamiento notorio del ventrículo izquierdo durante la sístole. En Cuba, el síndrome de tako-tsubo ha sido publicado en pacientes adultos, pero se considera una entidad rara en niños, razón por la cual se decidió hacer este reporte. Se presenta el caso de una adolescente de 16 años, con antecedentes de haber dado a luz hacía 44 días al momento del ingreso, que fue recibida en el Servicio de Emergencias en estado grave, con disnea, dolor precordial y manifestaciones de choque, por lo que fue derivada inmediatamente a la Unidad de Cuidados Intensivos Pediátricos. Los antecedentes de haber tenido un factor desencadenante de estrés como el parto por cesárea, el electrocardiograma con signos de isquemia miocárdica y el ecocardiograma típico, con discinesia de segmentos apicales del ventrículo izquierdo, permitieron hacer el diagnóstico de síndrome de tako-tsubo y dirigir el tratamiento en ese sentido. Este síndrome es infrecuente en la edad pediátrica, por tanto, puede presentarse como una forma grave y no ser reconocido, trayendo implicaciones pronósticas.

Takotsubo syndrome is an acute stress cardiomyopathy, characterized by a regional abnormality of left ventricular wall motion, with a peculiar circumferential pattern that results in marked left ventricular bulging during systole. In Cuba, takotsubo syndrome has been published in adult patients, but it is considered a rare entity in children, so it was decided to make this report. The case of a 16-years-old adolescent, with a history of having given birth 44 days before at the time of admission, who was received at the Emergency Department in serious condition, with dyspnea, precordial pain, and manifestations of shock, for what she was immediately referred to the Pediatric Intensive Care Unit it is presented. The history of having had a stress trigger such as delivery by cesarean section, the electrocardiogram with signs of myocardial ischemia, and the typical echocardiogram, with dyskinesia of the apical segments of the left ventricle, allowed the diagnosis of takotsubo syndrome and direct treatment in that sense. This syndrome is rare in the pediatric age, therefore, it can present as a severe form and not be recognized, bringing prognostic implications.

Clinical features of pregnant associated Takotsubo cardiomyopathy: a literature review of 60 cases / 中华围产医学杂志

Objective:To investigate the clinical features of pregnant associated Takotsubo cardiomyopathy (PTCM).Methods:We reviewed reported PTCM cases published from January 2007 to June 2022 using the keywords "Tako-tsubo cardiomyopathy""Takotsubo cardiomyopathy" "stress cardiomyopathy" AND "parturition" "pregnancy" "cesarean delivery" "postpartum" "peripartum" "eclampsia" "abortion" in Pubmed and Web of Science databases and the corresponding Chinese words in Wanfang and Chinese Medical Journal Network. Age, obstetric history, mode of delivery, mode of anesthesia, etiological factors, clinical manifestations, treatment, and prognosis of PTCM were recorded. Descriptive statistical analysis was adopted.Results:A total of 55 articles were included, covering 60 patients with PTCM. (1) Age and time of onset: The age of onset was (32.4±6.0) years old. PTCM occurred most frequently during labor [42% (25/60)] and within one day postpartum [32% (19/60)] and during the gestational period [13%(8/60), 33.0 weeks (24.5-37.7 weeks)]. (2) Delivery-related factors: There were 38% (16/42) primiparas and 60% (25/42) multiparas. Among them, 67% (38/57) and 18% (10/57) were delivered by cesarean section and vaginal delivery, respectively. PCTM often lacks obvious triggers [40% (24/60)], with the most common inducing factor being pregnancy-related diseases [27% (16/60)]. (3) Clinical features: The initial symptoms of PTCM were dyspnea [44% (26/59)], followed by chest pain accompanied by dyspnea [17% (10/59)]. The most common subtype of PTCM was the apical type [45% (26/58)], followed by the basal type [24% (14/58)], while the biventricular type was the least common [3% (2/58)] in the PTCM classification. The left ventricular ejection fraction was (31.6±12.1) % at the onset of PTCM, which recovered to (58.2±7.6) % at discharge. PCTM was often complicated by pulmonary edema [67% (40/60)] and cardiogenic shock [55% (33/60)]. (4) Treatment and prognosis: Patients with PCTM usually require noninvasive or invasive ventilator-assisted ventilation [40% (23/58)]. One pregnant woman and five neonates died, while the remaining patients recovered well.Conclusions:PTCM should be considered in differential diagnosis of patients experiencing dyspnea and chest pain during labor and pregnancy. PTCM patients are younger and have more pulmonary edema and cardiogenic shock. Mechanical ventilation is often required, but the prognosis is favorable.

Risk Factors for in-Hospital Mortality in Patients with Takotsubo Syndrome / 中山大学学报(医学科学版)

ObjectiveTo analyze the risk factors for in-hospital mortality in patients with Takotsubo Syndrome （TTS）. MethodsHospitalization data of consecutive patients with TTS from February 2009 to January 2022 were retrospectively collected and analyzed. Patients were divided into survival group and death group according to outcomes. The basic clinical information， triggering factors， laboratory examinations， electrocardiogram， echocardiography， complications and treatments of the two groups were compared. Univariable logistic regression analysis was used to screen the possible risk factors for in-hospital mortality in TTS patients， and multivariable logistic regression analysis was used to determine the independent risk factors for in-hospital mortality in TTS patients. ResultsA total of 62 TTS patients were included in our study， including 21 males （33.9%）， 41 females （66.1%） and 26 postmenopausal women （41.9%）， with the mean age of （55.6±16.2） years， and physical triggers were found in 50 patients （80.6%）. 17 patients （27.4%） died while 45 patients （72.6%） survived during hospitalization. The death group had lower systolic blood pressure and left ventricular ejection fraction （LVEF）， higher incidence rate of syncope， higher level of N-terminal pro-B natriuretic peptide （NT-proBNP） and hypersensitive troponin T （hs TnT） when compared with survival group （all P value <0.05）. As for the triggering factors， the proportion of TTS induced by neurologic disorders in the death group was higher than that in the survival group （P<0.05）. The death group had higher rates of cardiogenic shock， malignant ventricular arrhythmia， atrial fibrillation， and respiratory failure （all P value <0.05）. Compared with the survival group， therapeutic dopamine， therapeutic norepinephrine， hemodialysis and mechanical ventilation were higher in the death group （all P value <0.05）. Univariable logistic regression analysis suggested that syncope， NT-proBNP， LVEF， neurologic disorders， cardiogenic shock， malignant ventricular arrhythmia， atrial fibrillation， respiratory failure， therapeutic dopamine， therapeutic norepinephrine， hemodialysis and mechanical ventilation were potential risk factors for in-hospital mortality in TTS patients （all P value <0.05）. Multivariable logistic regression analysis indicated that neurologic disorders ［OR（95%CI）=5.651（1.195，26.715），P=0.029］， atrial fibrillation ［OR（95%CI）=6.217（1.276，30.298）， P=0.024）］ and therapeutic norepinephrin ［OR（95%CI）=8.847（1.912，40.949）， P=0.005］ were independent risk factors for in-hospital mortality in TTS patients. ConclusionsNeurologic disorders， atrial fibrillation and therapeutic norepinephrin are independent risk factors for in-hospital mortality in patients with Takotsubo Syndrome. Clinically， attention should be paid to the prevention and treatment of neurologic disorders and atrial fibrillation； norepinephrine should be carefully used in patients with diagnosed TTS complicated with hemodynamic instability.

Cardiomiopatía por estrés con membrana de oxigenación extracorpórea V-A durante el puerperio. Reporte de un caso y revisión de la literatura / Stress cardiomyopathy with extracorporeal oxygenation membrane V-A during the puerperium. Case report and literature review / Cardiomiopatia de estresse com oxigenação por membrana extracorpórea V-A durante o puerpério. Relato de caso e análise literária

Resumen: Se presenta un caso de una mujer de 28 años, primera gesta, embarazo normoevolutivo, quien acudió a atención de parto, se realizó cesárea por falta de progresión. Durante el perioperatorio desarrolló atonía uterina y sangrado (2,000 mL), por lo que se le realizó histerectomía subtotal abdominal, embolización selectiva de vasos pélvicos, transfusión masiva y empaquetamiento pélvico. Evolucionó con vasoplejía y perfil hemodinámico compatible con choque cardiogénico, ecocardiograma transtorácico con disfunción sistólica severa, fracción de eyección de ventrículo izquierdo (FEVI) 18%, contractilidad normal en los tercios basales de la pared lateral. El resto de los segmentos con hipocinesia severa, NT-pro BNP 9,226 pg/mL, troponina de alta sensibilidad 490 pg/mL, electrocardiograma con taquicardia sinusal sin datos de lesión. Se estableció el diagnóstico de Takotsubo (miocardiopatía por estrés). Se colocó membrana de oxigenación extracorpórea (ECMO) V-A y balón de contrapulsación intraaórtica. Desarrolló lesión renal aguda y sobrecarga hídrica, por lo que se inició terapia de sustitución renal. La terapia ECMO se mantuvo durante nueve días, y se egresó a domicilio a los 18 días. El ECMO es una estrategia terapéutica para el soporte hemodinámico del choque cardiogénico incluyendo la cardiomiopatía por estrés; este caso ilustra su utilidad en el puerperio.

Abstract: We present a case of a 28-year-old woman currently in her first pregnancy, normal evolution, who attended delivery care, a cesarean section was performed due to lack of progression. During the perioperative period, she developed uterine atony and bleeding of 2,000 mL, for which she underwent a subtotal abdominal hysterectomy, selective embolization of the pelvic vessels, massive transfusion, and pelvic packing. She evolved with vasoplegia and hemodynamic profile compatible with cardiogenic shock, transthoracic echocardiogram exposes severe systolic dysfunction, LVEF 18%, normal contractility in the basal thirds of the lateral wall, the rest of the segments with severe hypokinesia, NT-pro BNP 9,226 pg/mL, high-sensitivity troponin 490 pg/mL, electrocardiogram whit sinus tachycardia with no evidence of injury, the diagnosis of Takotsubo (stress cardiomyopathy) was established. Extracorporeal membrane oxygenation (ECMO) V-A and intra-aortic balloon counterpulsation were placed. Acute kidney injury developed, and fluid overload, for which renal replacement therapy was started. ECMO therapy was maintained for nine days, and she was discharged home after 18 days. ECMO is an innovative therapeutic strategy for hemodynamic support of cardiogenic shock, including stress cardiomyopathy, and this case illustrates its potential utility in the postpartum period.

Resumo: Apresenta-se o caso de uma mulher de 28 anos, primigesta, gravidez evolução normal, que assistiu ao parto, tendo sido submetida a cesariana por falta de evolução. No período perioperatório, apresentou atonia uterina e sangramento (2,000 mL), sendo submetida a histerectomia abdominal subtotal, embolização seletiva de vasos pélvicos, transfusão maciça e tamponamento pélvico. Evoluiu com vasoplegia e quadro hemodinâmico compatível com choque cardiogênico, ecocardiograma transtorácico com disfunção sistólica grave, FEVE 18%, contratilidade normal nos terços basais da parede lateral, restante dos segmentos com hipocinesia grave, NT-pro BNP 9,226 pg/mL, troponina de alta sensibilidade 490 pg/mL, eletrocardiograma com taquicardia sinusal sem evidência de lesão, foi estabelecido o diagnóstico de Takotsubo (cardiomiopatia de estresse). Colocou-se uma oxigenação por membrana extracorpórea (ECMO) V-A e um balão de contrapulsação intra-aórtico. Evoluiu com lesão renal aguda e sobrecarga hídrica, sendo iniciada terapia renal substitutiva. A terapia com ECMO foi mantida por 9 dias e ele recebeu alta após 18 dias. A ECMO é uma estratégia terapêutica para suporte hemodinâmico do choque cardiogênico, incluindo a cardiomiopatia de estresse, e este caso ilustra sua utilidade no puerpério.

Cardiac Manifestations Associated With Coronavirus Disease: A Case Report

Abstract This study presents a 47-year-old female patient, with a history of diabetes, who contracted SARS-CoV-2 and exhibited cardiovascular complications.

Síndrome de takotsubo relacionado con COVID-19: primer caso reportado en Latinoamérica / Takotsubo syndrome related to COVID-19: first reported case in Latin America

Resumen Se presenta el caso de una mujer de 67 años, con antecedentes de hipertensión arterial y obesidad, que acudió a urgencias por tos, fatiga, fiebre y disnea. Durante la monitorización se documentó elevación del segmento ST anterolateral e inferior y elevación de troponina; la arteriografía coronaria no evidenció lesiones significativas; en el ventriculograma y en el ecocardiograma transtorácico se documentó acinesia apical. Se confirmó RT-PCR positiva para SARS-CoV-2; se consideró como diagnóstico síndrome de takotsubo.

Abstract A 67-years-old woman with hypertension, obesity as previous diseases, presented to the emergency department due to cough, fatigue, fever, and dyspnea. ST-segment elevation was visualized during monitoring, troponin was positive, the coronary angiography was negative; the ventriculogram and transthoracic echocardiogram documented apical akinesia. The RT-PCR was positive for SARS CoV-2; the diagnosis was takotsubo-syndrome.

Recurrent takotsubo syndrome: case report and literature review

Introduction: Takotsubo syndrome is a cardiomyopathy that can lead to severe myocardial involvement. It is characterized by the presence of signs and symptoms suggestive of ventricular dysfunction associated with an adrenergic discharge during a stressful event. This case report presents a literature review, as well as a comparison with other similar cases. Case presentation. A 56-year-old female with a previous episode of Takotsubo was admitted to the emergency department due to symptoms of acute coronary syndrome and a history of Takotsubo syndrome. Her electrocardiogram showed T-wave inversion in leads V1-V4 and a raise in troponins. Percutaneous coronary angiography revealed no coronary lesions, and an echocardiogram revealed segmental alterations compatible with Takotsubo syndrome, requiring medical therapy with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, with subsequent improvement in ventricular function. Conclusions. Recurrence in Takotsubo cardiomyopathy is a rare complication that should be suspected. The risk factors associated with recurrence are not known. Although therapy with ACE inhibitors and beta-blockers seems to have an impact on the recovery of ventricular function in patients with this condition, further studies are necessary to establish the best pharmacological treatment.

Introducción. La miocardiopatía de Takotsubo (MT) es una afección cardiaca que puede generar compromiso miocárdico severo y se caracteriza por la presencia de signos y síntomas sugestivos de disfunción ventricular que se asocian a una descarga adrenérgica durante un evento estresor. En este reporte de caso se realizó una revisión de la literatura y se hizo una comparación con otros casos similares al presentado. Presentación del caso. Mujer de 56 años, quien asistió al servicio de urgencias por síntomas sugestivos de un síndrome coronario agudo. A la paciente, que tenía antecedente de MT, se le realizó un electrocardiograma que mostró inversión de la onda T en las derivaciones V1-V4 y elevación de troponinas, una angiografía coronaria que evidenció arterias epicárdicas sin lesiones y un ecocardiograma que reveló alteraciones segmentarias compatibles con MT, por lo que se estableció manejo con betabloqueadores e inhibidores de la enzima convertidora de angiotensina (IECA), con lo cual se logró mejoría de la función ventricular. Conclusiones. La MT es una afección poco frecuente de la cual no se conocen los factores de riesgo asociados a su recurrencia. Aunque la terapia con IECA y betabloqueadores parece tener un impacto en la recuperación de la función ventricular en pacientes con esta condición, se requieren estudios adicionales para establecer el mejor manejo farmacológico.

Síndrome de takotsubo secundario a trastorno emocional adaptativo / Takotsubo syndrome secondary to adaptative emotional disorder

Introducción: El síndrome de takotsubo o cardiomiopatía por stress, se caracteriza por una disfunción sistólica regional transitoria, principalmente del ventrículo izquierdo que simula un infarto agudo de miocardio, pero en ausencia de evidencia angiográfica de enfermedad arterial coronaria obstructiva o rotura aguda de placa. Es la causa del 1-2 % de todos los síndromes coronarios agudos, se requiere de un diagnóstico oportuno y un tratamiento adecuado para evitar la morbimortalidad por esta patología. Objetivo: destacar la importancia de tener en cuenta el síndrome de takotsubo o cardiomiopatía por estrés como diagnóstico diferencial de los pacientes con dolor torácico según la historia clínica y los desencadenantes del dolor. Presentación de caso: Paciente de 50 años de edad con dolor torácico de características típicas posterior a episodio emocional; reporte de electrocardiograma inicial isquemia anterolateral con troponina positiva y falla cardiaca sistólica, angiografía sin alteración en los vasos coronarios, se diagnosticó síndrome de takotsubo. Conclusión: Es importante considerar el síndrome de takotsubo en el diagnóstico diferencial de los pacientes con dolor torácico, evaluando las circunstancias por las cuales se origina el dolor, ya que requiere un manejo médico multidisciplinario.

Introduction: Takotsubo syndrome or stress cardiomyopathy is characterized by a transient regional systolic dysfunction, mainly of the left ventricle that simulates an acute myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. It is the cause of 1-2 % of all acute coronary syndromes, which requires a timely diagnosis and an adequate treatment to avoid morbidity and mortality from this pathology. Objective: to highlight the importance of taking into account takotsubo syndrome or stress cardiomyopathy as a differential diagnosis in patients with chest pain according to the clinical history and pain triggers. Case presentation: Fifty-year-old patient with typical chest pain after an emotional episode; the initial electrocardiogram reported anterolateral ischemia with positive troponin and systolic heart failure, and the angiography showed no alteration in the coronary vessels, concluding with the diagnosis of Takotsubo syndrome. Conclusion: It is important to consider takotsubo syndrome in the differential diagnosis of patients with chest pain, evaluating the circumstances by which the pain originates since it requires multidisciplinary medical management.

Síndrome de takotsubo atípico o invertido / Atypical or inverted takotsubo syndrome

Resumen El síndrome de takotsubo es una enfermedad cardíaca subregistrada, que inicialmente fue enfocada como una condición benigna. Su presentación clínica típica con abalonamiento apical es la más reconocida; sin embargo, su fenotipo atípico con alteración para la motilidad focal de las paredes miocárdicas con variante ventricular media y escaso compromiso apical se ha demostrado hasta en un 40% de los pacientes con miocardiopatía de takotsubo. Dado que recientemente se ha demostrado que este síndrome puede estar asociado con complicaciones graves, incluida la muerte, y que el pronóstico a largo plazo es similar al de los pacientes con síndromes coronarios, se hace imperativo reconocer sus formas atípicas para mejorar su diagnóstico, tratamiento y pronóstico.

Abstract Takotsubo syndrome is a poorly registered heart disease that was initially approached as a benign condition. Its typical clinical presentation with apical abalonation is the most recognized, however, its atypical phenotype with alteration for focal motility of the myocardial walls with a medium ventricular variant and little apical compromise has been demonstrated in up to 40% of patients with cardiomyopathy of takotsubo. Given that, it has recently been shown that takotsubo syndrome can be associated with severe complications, including death, and that the long-term prognosis is similar to that of patients with coronary syndromes, it is imperative to recognize its atypical forms in order to improve its diagnosis, treatment and prognosis.

Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies / Conectividad funcional cerebral en pacientes con miocardiopatía de takotsubo: Revisión sistemática de estudios de imagen por resonancia magnética

Abstract Background: Functional neuroimaging studies may aid to our understanding of the pathophysiology of the takotsubo cardiomyopathy. Objective: The aim of the study was to review the available evidence of brain functional connectivity in takotsubo cardiomyopathy patients. Methods: This was a systematic review. We searched MEDLINE, LILACS, Ovid (Cochrane), Scopus, and Science Direct for studies conducting functional magnetic resonance imaging (fMRI) in takotsubo patients. After reviewing title/abstract and full text, we selected relevant studies, extracted methodological characteristics, and their main findings, and assessed their risk of bias with the Newcastle-Ottawa scale. We present a narrative review. Results: We included five case-control studies from 600 registries. The risk of bias was low; comparability was the main issue. Resting-state fMRI findings suggest significant differences for the hippocampus, the Insula, the amygdala, and the para-hippocampal gyrus. Task fMRI findings suggest significant differences for the Insula, the superior occipital gyrus, and the amygdala. Studies were heterogeneous about the laterality and directionality of these differences. Conclusion: Brain connectivity alterations involving elements relevant for autonomic control like the Insula and the Amygdala provide evidence in favor of the role of functional networks in the neurocardiology of stress-related cardiomyopathies. However, it is not possible to determine if this role is causal or consequential.

Resumen Antecedentes: Los estudios de neuroimagen funcional podrían ayudar a clarificar la fisiopatología de la miocardiopatía de takotsubo. Objetivo: Revisar la evidencia disponible sobre conectividad funcional cerebral en pacientes con cardiomiopatía de takotsubo. Métodos: Revisión sistemática. Se buscaron en MEDLINE, LILACS, Ovid (Cochrane), Scopus, y ScienceDirect estudios de imagen por resonancia magnética funcional (IRMf) en pacientes con cardiomiopatía de takotsubo. Tras revisar títulos, resúmenes y textos completos se seleccionaron los estudios relevantes, se extrajeron sus características metodológicas y resultados principales, y se valoró su riesgo de sesgo mediante la escala Newcastle-Ottawa. Se presenta revisión narrativa de los resultados. Resultados: Se incluyeron cinco estudios de casos y controles de entre 600 registros. El riesgo de sesgo fue bajo, la comparabilidad fue la principal limitante. Los estudios de IRMf en estado de reposo sugieren diferencias significativas en el Hipocampo, la Ínsula, la Amígdala y el Giro parahipocampal. Los estudios de IRMf bajo paradigma sugieren diferencias en la Ínsula, el Giro occipital superior y en la Amígdala. Los estudios fueron heterogéneos respecto a la lateralización y direccion de estas diferencias. Conclusión: Alteraciones en la conectividad cerebral de zonas relevantes para el control autonómico como la ínsula y la Amígdala provén evidencia a favor del rol de redes funcionales en la neurocardiología de miocardiopatías relacionadas con el estrés. Sin embargo, aún no es posible determinar si esto obedece a un rol causal o consecuencial.

Meta-analysis of incidence and outcomes of life-threatening arrhythmias in takotsubo cardiomyopathy

Background: Takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy is a transient heart condition that clinically resembles an acute coronary syndrome. This study aims to assess the incidence of life-threatening arrhythmias in patients with Takotsubo cardiomyopathy and evaluate the outcomes of patients with life-threatening arrhythmias (LTAs) in Takotsubo cardiomyopathy compared with those without LTA. Methods: We comprehensively searched the PubMed, Google Scholar, and Embase databases from inception to February 2021. The primary aim of the study was to determine the incidence of LTAs in TC patients. Other outcomes of interest were the odds of in-hospital, long-term mortality, and cardiogenic shock (CS) in TC patients with LTAs versus those without LTAs. For all statistical analyses, ReviewManager and MedCalc were used. Results: Eighteen studies were included in this study involving 55,557 participants (2,185 with LTAs and 53,372 without LTAs). The pooled incidence of LTAs in the patients of TC was found to be 6.29% (CI: 4.70 e8.08%; I2 ¼ 94.67%). There was a statistically significant increased risk of in-hospital mortality (OR ¼ 4.74; CI: 2.24e10.04; I2 ¼ 77%, p < 0.0001) and cardiogenic shock (OR ¼ 5.60; CI: 3.51e8.95; I2 ¼ 0%, p < 0.00001) in the LTA group versus the non-LTA group. LTA was not associated with long-term mortality (OR ¼ 2.23; CI: 0.94e5.28; I2 ¼ 53%, p ¼ 0.07). Conclusion: The pooled incidence of life-threatening arrhythmias in the patients of TC was found to be 6.29%. In the group of TC patients with LTAs, the odds of in-hospital mortality and CS, was higher than in the TC patients without LTAs.

Arritmias ventriculares en el síndrome de takotsubo: cuestión de sexo / Sex-related risk of arrhythmia in takotsubo syndrome

Resumen El síndrome de takotsubo, también conocido como miocardiopatía de estrés, representa un difícil reto diagnóstico, pues en muchos casos su presentación es superponible al infarto de miocardio por ruptura de placa; el diagnóstico definitivo se basa en la ausencia de lesiones culpables en la coronariografía. La fisiopatología de la enfermedad no está por completo establecida, y tiene un pronóstico generalmente benigno. Sin embargo, existe un porcentaje no despreciable de pacientes que sufren complicaciones graves, entre las que destacan las arritmias malignas tipo taquicardia ventricular polimórfica por prolongación del intervalo QT. A pesar de que el síndrome de takotsubo afecta principalmente a las mujeres, quienes por otra parte también suelen tener intervalos QT más prolongados en condiciones basales, la muerte súbita de origen arrítmico aparece con mayor frecuencia en los hombres que sufren esta enfermedad. Se presentan dos casos de ensanchamiento extremo del intervalo QT corregido en pacientes con takotsubo que tuvieron desenlaces diferentes. El propósito de este trabajo es destacar y revisar las diferencias electrocardiográficas y pronósticas relacionadas con el sexo de los sujetos que desarrollan esta controvertida enfermedad.

Abstract Takotsubo syndrome, also known as stress cardiomyopathy, is a difficult diagnostic challenge as, in many cases, its presentation can overlap with that of myocardial infarction due to plaque rupture. The definitive diagnosis is based on the lack of culprit lesions on coronariography. The pathophysiology of the disease has not been completely ascertained, and it has a generally benign prognosis. However, a not inconsiderable percentage of patients experience serious complications, notably malignant arrhythmias like polymorphic ventricular tachycardia due to a prolonged QT interval. Despite takotsubo syndrome affecting mainly women who, furthermore, generally have longer basal QT intervals, sudden death due to arrhythmias is more common in men with this disease. Two cases are presented of extremely prolonged corrected QT intervals in patients with takotsubo, with different outcomes. The purpose of this paper is to highlight and review the electrocardiographic and prognostic differences related to the gender of the individuals who develop this controversial disease.

Takotsubo syndrome in children / 中国小儿急救医学

Takotsubo syndrome (TTS) is an acute and mostly reversible cardiomyopathy that mimics an acute coronary syndrome with systolic dysfunction of left ventricular.Although supraphysiological epinephrine levels have been associated with TTS, the detailed pathophysiology is incompletely understood.According to the distribution of left ventricular wall motion abnormalities, various morphological subtypes have been identified.The ultimate diagnosis depends on cardiac imaging with left ventricular angiography during acute heart catheterization, as well as echocardiography and cardiac magnetic resonance.Management is based on observational data, while randomized multicenter studies are still lacking.Mechanical circulatory support is an emerging strategy for patients with TTS and shock, in order to avoid catecholamines and inotropes in particular.This review provides a general overview of TTS.However, the demographic characteristics, diagnosis, treatment and prognosis of TTS have not been well studied in children.

Risk factors and prognosis in critical patients with sepsis-related cardiomyopathy / 中华内科杂志

Objective:To explore the risk factors and prognosis of sepsis-related cardiomyopathy.Methods:Patients with sepsis and septic shock admitted to the Critical Care Medicine Department at Peking Union Medical College Hospital from October 2017 to February 2021 were enrolled. Echocardiographic parameters including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and cardiac index (CI) were obtained within 24 h after admission. Hemodynamic parameters including heart rate, mean arterial pressure and central venous pressure were also collected. The risk factors of 45-day mortality were analyzed using Cox regression analysis. Kaplan-Meier survival analysis was performed to compare 45-day mortality among patients with normal left ventricle (LV) systolic function group, sepsis-related takotsubo cardiomyopathy (ST) and septic cardiomyopathy (SC) group as well as between patients with normal right ventricular (RV) function and patients with RV dysfunction.Results:According to LV systolic function, patients were categorized into three groups: normal group [174 (66.9%)], SC group [66 (25.4%)] and ST group [66 (25.4%)]. In comparison with those in normal group, patients in SC group and ST group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score ( P<0.05). No difference was found between SC group and ST group regarding APACHE Ⅱ score and SOFA score( P>0.05). ST group had lower LVEF [33(28, 41)% vs. 45(38, 48)%, P<0.05], CI [2.29 (1.99, 2.53)L·min -1·m -2 vs. 3.04(2.61, 3.61) L·min -1·m -2, P<0.05] higher TAPSE [18.6(16.0, 21.2)mm vs. 15.1(12.5, 19.0)mm, P<0.05] than SC group. A Cox regression survival analysis showed that right ventricular dysfunction (RVD) was an independent predictor of 45-day mortality ( HR=1.992, 95% CI 1.088-3.647, P=0.025). A Kaplan-Meier analysis revealed no significant difference regarding 45-day mortality among ST group [25.0%(5/20)], SC group [30.3%(20/66)] and normal group 18.4%(32/174)( P=0.158). RVD patients [38.0%(30/79)] had significantly higher 45-day mortality than patients with normal RV function [14.9%(27/181), P<0.001]. Conclusions:In comparison with SC patients, ST patients tend to have worse LV systolic function, lower cardiac output and better RV function. However, neither ST nor SC is associated with 45-day mortality. RVD is a risk predictor of 45-day mortality, which should be monitored in septic patients.

Progress of takotsubo mediated by sympathetic nervous in children with intensive nervous system disease / 中国小儿急救医学

The incidence of intensive nervous system disease in children is high, and there will be more or less long-term sequelae.In addition, due to age, long-term treatment costs are high, causing a great burden to society.When intensive nervous system disease occurs, the body can show an increase in sympathetic activity and catecholamine, which leads to the occurrence of takotsubo.After the occurrence of takotsubo, it can reduce the supplement of intracranial oxygen, thus aggravate the intensive nervous system disease and aggravate the adverse clinical outcome of children.Sedation and analgesia to reduce sympathetic activity can achieve the purpose of treating intensive nervous system diseases and takotsubo.