1
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Li M, Nguyen CN, Toleva O, Mehta PK. Takotsubo syndrome: A current review of presentation, diagnosis, and management. Maturitas 2022; 166:96-103. [PMID: 36108540 DOI: 10.1016/j.maturitas.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome is a syndrome of acute heart failure due to left ventricular systolic dysfunction that is associated with increased cardiovascular morbidity and mortality. It occurs in both sexes and at all ages, but predominates in post-menopausal women for reasons that are unclear. In a patient who presents with cardiac symptoms, electrocardiographic changes, and/or biomarker elevation indicating myocardial stress (i.e. troponin elevation), this condition should be considered in the differential diagnosis. Cardiac imaging is critical for a timely diagnosis of this condition and has management implications. This syndrome can occur with or without underlying coronary artery disease, and while there are various characteristic myocardial patterns described on imaging, the most common one is left ventricular dysfunction due to apical stunning with basal hyperkinesis. In the acute phase, Takotsubo syndrome can lead to life-threatening sequelae, including cardiogenic shock, pulmonary edema, thromboembolism, and arrhythmias. Multiple pathophysiologic mechanisms are implicated, including an acute increase in left ventricular afterload in the setting of sympathetic activation with a catecholamine storm, multi-vessel coronary vasospasm, coronary endothelial microvascular dysfunction, and inflammation. In this review, we discuss the current knowledge surrounding presentation, diagnosis, and treatment of this under-diagnosed condition.
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Affiliation(s)
- Monica Li
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Christopher N Nguyen
- Northside Hospital Gwinnett Internal Medicine Residency Program, Lawrenceville, GA, United States of America
| | - Olga Toleva
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, United States of America; Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
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2
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Couch LS, Channon K, Thum T. Molecular Mechanisms of Takotsubo Syndrome. Int J Mol Sci 2022; 23:12262. [PMID: 36293121 PMCID: PMC9603071 DOI: 10.3390/ijms232012262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Takotsubo syndrome (TTS) is a severe but reversible acute heart failure syndrome that occurs following high catecholaminergic stress. TTS patients are similar to those with acute coronary syndrome, with chest pain, dyspnoea and ST segment changes on electrocardiogram, but are characterised by apical akinesia of the left ventricle, with basal hyperkinesia in the absence of culprit coronary artery stenosis. The pathophysiology of TTS is not completely understood and there is a paucity of evidence to guide treatment. The mechanisms of TTS are thought to involve catecholaminergic myocardial stunning, microvascular dysfunction, increased inflammation and changes in cardiomyocyte metabolism. Here, we summarise the available literature to focus on the molecular basis for the pathophysiology of TTS to advance the understanding of the condition.
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Affiliation(s)
- Liam S. Couch
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Keith Channon
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, 30625 Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, 30625 Hannover, Germany
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3
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A Review of Nuclear Imaging in Takotsubo Cardiomyopathy. Life (Basel) 2022; 12:life12101476. [PMID: 36294911 PMCID: PMC9604781 DOI: 10.3390/life12101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
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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4
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Li P, Jin C, Cui C, Cai P, Manohar SA, Jin L, Wei X, Pan S, Dixon RAF, Liu Q. Impact of family history of coronary artery disease on clinical outcomes in Takotsubo cardiomyopathy. J Investig Med 2022; 70:jim-2021-002186. [PMID: 35850971 DOI: 10.1136/jim-2021-002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
Family history of coronary artery disease (FHxCAD) is a critical risk factor for CAD, underscoring the contribution of genetic factors to disease pathogenesis and susceptibility. Takotsubo cardiomyopathy (TCM) simulates the clinical features of and frequently coexists with CAD. However, the association between FHxCAD and TCM is unclear. Here, we retrospectively examined the impact of FHxCAD on in-hospital outcomes of patients with TCM. Using the National Inpatient Sample database (2016-2018), we identified 4733 patients admitted to hospital with a primary diagnosis of TCM. We compared in-hospital outcomes and complications between TCM patients with (n=646, 13.7%) and without FHxCAD (n=646) in the unmatched and in a propensity-score matched cohort (1:1 ratio). TCM with FHxCAD patients had a reduced incidence of cardiogenic shock, acute kidney injury (AKI), and acute respiratory failure (ARF); lower mortality rates; shorter length of stay (LOS); and decreased total charge compared with TCM without FHxCAD patients (p<0.05). In the matched cohort, TCM with FHxCAD patients (vs TCM without FHxCAD patients) had a lower incidence of cardiogenic shock (2.2% vs 6.3%, p<0.001; OR 0.33, 95% CI 0.18 to 0.61), AKI (5.1% vs 8.7%, p=0.016; OR 0.57, 95% CI 0.36 to 0.88), and ARF (5.7% vs 12.7%, p<0.001; OR 0.42, 95% CI 0.28 to 0.63); decreased in-hospital mortality (<11% vs 3.1%, p=0.002; OR 0.2, 95% CI 0.07 to 0.57); shorter LOS (2.66±1.96 days vs 3.40±3.05 days, p<0.001); and a reduced total charge (p=0.001), respectively. FHxCAD was associated with favorable outcomes in both unmatched and propensity-matched cohorts.
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Affiliation(s)
- Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Chengyue Jin
- Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Can Cui
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Shamita Alisa Manohar
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ling Jin
- Department of Medicine, Metrowest Medical Center, Framingham, Massachusetts, USA
| | - Xin Wei
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Su Pan
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, Houston, Texas, USA
| | - Richard A F Dixon
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, Houston, Texas, USA
| | - Qi Liu
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, Houston, Texas, USA
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5
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Ferradini V, Vacca D, Belmonte B, Mango R, Scola L, Novelli G, Balistreri CR, Sangiuolo F. Genetic and Epigenetic Factors of Takotsubo Syndrome: A Systematic Review. Int J Mol Sci 2021; 22:9875. [PMID: 34576040 PMCID: PMC8471495 DOI: 10.3390/ijms22189875] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 01/05/2023] Open
Abstract
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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Affiliation(s)
- Valentina Ferradini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Davide Vacca
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, 90134 Palermo, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, 90134 Palermo, Italy
| | - Ruggiero Mango
- Cardiology Unit, Department of Emergency and Critical Care, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Letizia Scola
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy
| | - Federica Sangiuolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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6
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Budnik M, Piątkowski R, Ochijewicz D, Zaleska M, Grabowski M, Opolski G. Pathophysiology of Takotsubo Syndrome as A Bridge to Personalized Treatment. J Pers Med 2021; 11:jpm11090879. [PMID: 34575656 PMCID: PMC8466771 DOI: 10.3390/jpm11090879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 01/17/2023] Open
Abstract
Takotsubo syndrome (TTS) consists of transient dysfunction of the left and/or right ventricle in the absence of ruptured plaque; thrombus or vessel dissection. TTS may be divided into two categories. Primary TTS occurs when the cause of hospitalization is the symptoms resulting from damage to the myocardium usually preceded by emotional stress. Secondary TTS occurs in patients hospitalized for other medical; surgical; anesthetic; obstetric or psychiatric conditions who have activation of their sympathetic nervous system and catecholamines release- they develop TTS as a complication of their primary condition or its treatment. There are several hypotheses concerning the cause of the disease. They include a decrease in estrogen levels; microcirculation dysfunction; endothelial dysfunction and the hypothesis based on the importance of the brain-heart axis. More and more research concerns the importance of genetic factors in the development of the disease. To date; no effective treatment or prevention of recurrent TTS has been found. Only when the pathophysiology of the disease is fully known; then personalized treatment will be possible.
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7
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Agarwal S, Sanghvi C, Odo N, Castresana MR. Perioperative takotsubo cardiomyopathy: Implications for anesthesiologist. Ann Card Anaesth 2020; 22:309-315. [PMID: 31274495 PMCID: PMC6639891 DOI: 10.4103/aca.aca_71_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease that may be triggered by an acute medical illness or intense physical or emotional stress. TCM is often confused with acute myocardial infarction given the similar electrocardiographic changes, cardiac enzymes, hemodynamic perturbations, and myocardial wall motion abnormalities. In the perioperative setting, the clinical picture may be more confusing because of the effect of anesthesia as well as hemodynamic changes related to the surgery itself. However, awareness of various other diagnostic modalities may enable clinicians to distinguish between the two, more systematically and with greater certainty. Despite the large body of literature, there still seems to be an overall paucity in our understanding of the etiopathogenesis, clinical characteristics, natural history, and management of this syndrome, especially in the perioperative setting. This narrative review seeks to present and synthesize the most recent literature on TCM and to identify gaps in current knowledge which can become the basis for future research.
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Affiliation(s)
- Shvetank Agarwal
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Chinar Sanghvi
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nadine Odo
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Manuel R Castresana
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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8
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Vijiiac A, Ploscaru V, Vatasescu RG. The Great Myocardial Mimic - Takotsubo Syndrome. MÆDICA 2020; 15:111-121. [PMID: 32419871 DOI: 10.26574/maedica.2020.15.1.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Takotsubo syndrome has been traditionally considered a reversible form of acute heart failure triggered by an emotional or physical stressor, mainly occurring in women of post-menopausal age and often mimicking an acute coronary syndrome. While its pathophysiology is still incompletely understood, sympathetic overstimulation is known to play a central role in the disease. The classical hallmark of the condition was the presence of wall motion abnormalities limited to the apical segments of the ventricle, leading to the so-called apical ballooning, but different patterns of wall motion abnormalities are nowadays recognised. Different definitions and diagnostic criteria for takotsubo syndrome were proposed during the last decades, reflecting the heterogeneity of the condition and the gaps in the thorough understanding of the disease. While initially it was believed to be a benign entity, takotsubo syndrome has in fact similar morbidity and mortality with acute coronary syndromes, both on short- and long-term, highlighting the importance of proper risk stratification. Many questions still remain unanswered concerning the pathophysiology of the syndrome and the optimal therapeutic strategy for these patients.
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Affiliation(s)
- Aura Vijiiac
- Cardiology Department, Emergency Clinical Hospital Bucharest, Romania
| | - Vlad Ploscaru
- Cardiology Department, Emergency Clinical Hospital Bucharest, Romania
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9
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Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, Yoshida T, Manfredini R, Eitel I, Kosuge M, Nef HM, Deshmukh A, Lerman A, Bossone E, Citro R, Ueyama T, Corrado D, Kurisu S, Ruschitzka F, Winchester D, Lyon AR, Omerovic E, Bax JJ, Meimoun P, Tarantini G, Rihal C, Y-Hassan S, Migliore F, Horowitz JD, Shimokawa H, Lüscher TF, Templin C. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J 2019; 39:2032-2046. [PMID: 29850871 PMCID: PMC5991216 DOI: 10.1093/eurheartj/ehy076] [Citation(s) in RCA: 832] [Impact Index Per Article: 166.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 04/17/2018] [Indexed: 12/11/2022] Open
Abstract
Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.
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Affiliation(s)
- Jelena-Rima Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ilan Shor Wittstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA
| | - Scott Sharkey
- Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yoshihiro John Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Victoria Lucia Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tetsuro Yoshida
- Department of Cardiovascular Medicine, Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ingo Eitel
- University Heart Center Luebeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Luebeck, Luebeck, Germany
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Holger M Nef
- Department of Cardiology, University Hospital Giessen, Giessen, Germany
| | | | - Amir Lerman
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Takashi Ueyama
- Department of Anatomy and Cell Biology, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - David Winchester
- Division of Cardiovascular Disease, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Guiseppe Tarantini
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - Charanjit Rihal
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA
| | - Shams Y-Hassan
- Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Thomas Felix Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Department of Cardiology, Royal Brompton & Harefield Hospital and Imperial College, London, UK
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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10
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Manabe O, Naya M, Oyama-Manabe N, Koyanagawa K, Tamaki N. The role of multimodality imaging in takotsubo cardiomyopathy. J Nucl Cardiol 2019; 26:1602-1616. [PMID: 29858766 DOI: 10.1007/s12350-018-1312-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022]
Abstract
Takotsubo cardiomyopathy (TC) is a syndrome of transient left ventricular (LV) dysfunction mimicking acute coronary syndrome. Although the mechanisms underlying the occurrence of TC are unknown, several imaging techniques contribute to its diagnosis. Here we review the current knowledge about TC, in particular, the pathophysiology and the role of imaging including nuclear cardiovascular medicine.
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Affiliation(s)
- Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University of Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University of Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazuhiro Koyanagawa
- Department of Cardiovascular Medicine, Hokkaido University of Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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11
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Abstract
Takotsubo syndrome is an intriguing condition of often stress induced reversible cardiac dysfunction mimicking myocardial infarction, but without explanatory coronary obstructions. The pathogenesis of the syndrome is not yet fully understood, though altered sympathetic regulation or response to cardiac sympathetic stimuli is likely to be involved. We present a unique and clinically detailed report of identical twin sisters, who both developed Takotsubo syndrome in association to mental stress shortly after menopause, also covering a potential relapse of disease in one of the twins, supporting the theory of a genetic contribution to the development of the syndrome proposed by previous case reports and small genetic studies.
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Affiliation(s)
- Christina Ekenbäck
- Cardiology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Cardiology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden
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12
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Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, Yoshida T, Manfredini R, Eitel I, Kosuge M, Nef HM, Deshmukh A, Lerman A, Bossone E, Citro R, Ueyama T, Corrado D, Kurisu S, Ruschitzka F, Winchester D, Lyon AR, Omerovic E, Bax JJ, Meimoun P, Tarantini G, Rihal C, Y.-Hassan S, Migliore F, Horowitz JD, Shimokawa H, Lüscher TF, Templin C. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J 2018; 39. [PMID: 29850871 PMCID: PMC5991216 DOI: 10.1093/eurheartj/ehy076 10.1093/cid/ciaa1466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.
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Affiliation(s)
- Jelena-Rima Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ilan Shor Wittstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA
| | - Scott Sharkey
- Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Yoshihiro John Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Victoria Lucia Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tetsuro Yoshida
- Department of Cardiovascular Medicine, Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ingo Eitel
- University Heart Center Luebeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Luebeck, Luebeck, Germany
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Holger M Nef
- Department of Cardiology, University Hospital Giessen, Giessen, Germany
| | | | - Amir Lerman
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA
| | - Eduardo Bossone
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy
| | - Takashi Ueyama
- Department of Anatomy and Cell Biology, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - David Winchester
- Division of Cardiovascular Disease, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Alexander R Lyon
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College, London, UK
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Guiseppe Tarantini
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - Charanjit Rihal
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA
| | - Shams Y.-Hassan
- Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Thomas Felix Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland,Department of Cardiology, Royal Brompton & Harefield Hospital and Imperial College, London, UK
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland,Corresponding author. Tel: +41 44 255 9585, Fax: +41 44 255 4401,
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Lacey CJ, Doudney K, Bridgman PG, George PM, Mulder RT, Zarifeh JJ, Kimber B, Cadzow MJ, Black MA, Merriman TR, Lehnert K, Bickley VM, Pearson JF, Cameron VA, Kennedy MA. Copy number variants implicate cardiac function and development pathways in earthquake-induced stress cardiomyopathy. Sci Rep 2018; 8:7548. [PMID: 29765130 PMCID: PMC5954162 DOI: 10.1038/s41598-018-25827-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 04/25/2018] [Indexed: 02/07/2023] Open
Abstract
The pathophysiology of stress cardiomyopathy (SCM), also known as takotsubo syndrome, is poorly understood. SCM usually occurs sporadically, often in association with a stressful event, but clusters of cases are reported after major natural disasters. There is some evidence that this is a familial condition. We have examined three possible models for an underlying genetic predisposition to SCM. Our primary study cohort consists of 28 women who suffered SCM as a result of two devastating earthquakes that struck the city of Christchurch, New Zealand, in 2010 and 2011. To seek possible underlying genetic factors we carried out exome analysis, genotyping array analysis, and array comparative genomic hybridization on these subjects. The most striking finding was the observation of a markedly elevated rate of rare, heterogeneous copy number variants (CNV) of uncertain clinical significance (in 12/28 subjects). Several of these CNVs impacted on genes of cardiac relevance including RBFOX1, GPC5, KCNRG, CHODL, and GPBP1L1. There is no physical overlap between the CNVs, and the genes they impact do not appear to be functionally related. The recognition that SCM predisposition may be associated with a high rate of rare CNVs offers a novel perspective on this enigmatic condition.
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Affiliation(s)
- Cameron J Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
| | - Kit Doudney
- Molecular Pathology Laboratory, Canterbury Health Laboratories, Canterbury District Health Board, Christchurch, New Zealand
| | - Paul G Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Peter M George
- Molecular Pathology Laboratory, Canterbury Health Laboratories, Canterbury District Health Board, Christchurch, New Zealand
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Julie J Zarifeh
- Psychiatric Consultation Service, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Bridget Kimber
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Murray J Cadzow
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Michael A Black
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Klaus Lehnert
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Vivienne M Bickley
- Molecular Pathology Laboratory, Canterbury Health Laboratories, Canterbury District Health Board, Christchurch, New Zealand
| | - John F Pearson
- Biostatistics and Computational Biology Unit, University of Otago, Christchurch, New Zealand
| | - Vicky A Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
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14
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Correlation between endothelial dysfunction and myocardial damage in acute phase of Tako-Tsubo cardiomyopathy: brachial flow mediated dilation as a potential marker for assessment of patient with Tako-Tsubo. Heart Vessels 2017; 33:291-298. [DOI: 10.1007/s00380-017-1062-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
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15
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Gupta S, Gupta MM. Takotsubo syndrome. Indian Heart J 2017; 70:165-174. [PMID: 29455773 PMCID: PMC5902911 DOI: 10.1016/j.ihj.2017.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 01/01/2023] Open
Abstract
Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6-12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1-4.5% and recurrence rate of 5-10% during five year follow-up.
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Affiliation(s)
- Sanjiv Gupta
- NH Narayana Multispeciality Hospital, Jaipur, India.
| | - Madan Mohan Gupta
- Heart and Diabetic Clinic, B-19, Rajender Marg, Bapu Nagar, Jaipur, India
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16
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Longobardo L, Zito C, Carerj S, Caracciolo G, Khandheria BK. Influence of Genetics and Gender in Takotsubo Syndrome: Unexplored Areas of an Incompletely Understood Disease. GENDER AND THE GENOME 2017. [DOI: 10.1089/gg.2017.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Stress cardiomyopathy, also known as “Takotsubo syndrome” (TS), is a complex disease that typically affects postmenopausal women. The pathophysiology is still largely unknown, but evidence of a frequent association between TS and stressful events has evoked the hypothesis of a pathophysiologic role of sympathetic overdrive in the myocardial dysfunction. However, despite several studies, the role gender plays in TS onset remains unclear because stress cardiomyopathy also has been described in young women and in men. Moreover, although several cases of a familial cluster of TS have been reported, no responsible gene mutations or polymorphisms have been clearly identified so far, and neither the modality of transmission or the true impact of genetic background. In this review, we discuss the role of gender in the onset, course, and outcomes of TS and we report the available data about polymorphisms and gene mutations so far investigated, trying to critically analyze the evidence reported in the literature.
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Affiliation(s)
- Luca Longobardo
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Giuseppe Caracciolo
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K. Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
- Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin
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17
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Bergami M, Amaduzzi PL, Bugiardini R. Takotsubo Syndrome: Does the Octopus Trap Hide Dangers? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Takotsubo Cardiomyopathy vs. Acute Coronary Syndrome in the Emergency Department Setting: a Review of Diagnostic Criteria and Outcomes. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0129-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Limongelli G, Masarone D, Maddaloni V, Rubino M, Fratta F, Cirillo A, Ludovica SB, Pacileo R, Fusco A, Coppola GR, Pisacane F, Bossone E, Calabrò P, Calabrò R, Russo MG, Pacileo G. Genetics of Takotsubo Syndrome. Heart Fail Clin 2017; 12:499-506. [PMID: 27638020 DOI: 10.1016/j.hfc.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Takotsubo syndrome (TTS) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. A genetic predisposition has been suggested based on the few familial TTS cases. Conflicting results have been published regarding the role of functional polymorphisms in relevant candidate genes, such as α1-, β1-, and β2-adrenergic receptors; G protein-coupled receptor kinase 5; and estrogen receptors. Further research is required to help clarify the role of genetic susceptibility in TTS.
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Affiliation(s)
- Giuseppe Limongelli
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy.
| | - Daniele Masarone
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Valeria Maddaloni
- Genomic and Cellular Lab, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Marta Rubino
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Fiorella Fratta
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Annapaola Cirillo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Spinelli Barrile Ludovica
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Roberta Pacileo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Adelaide Fusco
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Guido Ronald Coppola
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Francesca Pisacane
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Cardiology Division, Heart Department, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, via De Marinis, Cava de" Tirreni (SA) 84013, Italy
| | - Paolo Calabrò
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Raffaele Calabrò
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Maria Giovanna Russo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
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20
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Like mother like daughter: A case report of simultaneous mother-daughter Takotsubo cardiomyopathy triggered by a house fire. Int J Cardiol 2016; 220:312-3. [DOI: 10.1016/j.ijcard.2016.06.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
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21
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Alkhoury J, Lundgren J, Ali A, Mesinovic D, Redfors B, Omerovic E. Updates on publication trends in Takotsubo syndrome. Int J Cardiol 2016; 221:283-6. [PMID: 27404691 DOI: 10.1016/j.ijcard.2016.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jessica Alkhoury
- Department for Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Sweden.
| | - Joel Lundgren
- Department for Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Sweden
| | - Anwar Ali
- Department for Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Sweden
| | - Denis Mesinovic
- Department for Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Sweden
| | - Björn Redfors
- Department for Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Elmir Omerovic
- Department for Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Sweden
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22
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Kalani MYS, Siniard AL, Corneveaux JJ, Bruhns R, Richholt R, Forseth J, Zabramski JM, Nakaji P, Spetzler RF, Huentelman MJ. Rare Variants in Cardiomyopathy Genes Associated With Stress-Induced Cardiomyopathy. Neurosurgery 2015; 78:835-43. [PMID: 26606670 DOI: 10.1227/neu.0000000000001152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stress-induced cardiomyopathy (SIC) is a poorly understood condition associated with periods of emotional and physical stress. The clinical approaches for management of SIC are supportive and reactive to patient symptoms. OBJECTIVE To utilize next-generation exome sequencing to define genetic variation associated with, and potentially responsible for, this disease. METHODS We performed exome sequencing of 7 white female patients with SIC. Filtering of the identified variants was performed to limit our investigation to those sequences that passed quality control criteria, were rare or novel, were determined algorithmically to have high impact on the associated protein, and were within regions of high species conservation. All variants were verified by using Sanger sequencing. RESULTS Exome-sequencing analysis revealed that each patient carried predicted deleterious variants affecting known cardiomyopathy genes. In each case, the identified variant was either not previously found in public human genome data or was previously annotated in a database of clinical variants associated with cardiac dysfunction. CONCLUSION Patients with SIC harbor deleterious mutations in established cardiomyopathy genes at a level higher than healthy controls. We hypothesize that patients at highest risk for SIC likely live in a compensated state of cardiac dysfunction that manifests clinically only after the myocardium is stressed. In short, we propose that SIC is another example of an occult cardiomyopathy with a distinct physiological trigger and suggest that alternative clinical approaches to these patients may be warranted. ABBREVIATIONS CADD, Combined Annotation Dependent DepletionFPKM, fragments per kilobase pair of exon per million fragments mappedNHLBI GO ESP, National Heart, Lung, and Blood Institute Grand Opportunity Exome Sequencing ProjectPCR, polymerase chain reactionSIC, stress-induced cardiomyopathy.
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Affiliation(s)
- M Yashar S Kalani
- *Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; ‡Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona; §Division of Internal Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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23
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Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ, Ruschitzka F, Filippatos G, Mebazaa A, Omerovic E. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2015; 18:8-27. [PMID: 26548803 DOI: 10.1002/ejhf.424] [Citation(s) in RCA: 710] [Impact Index Per Article: 78.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/25/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022] Open
Abstract
Takotsubo syndrome is an acute reversible heart failure syndrome that is increasingly recognized in modern cardiology practice. This Position Statement from the European Society of Cardiology Heart Failure Association provides a comprehensive review of the various clinical and pathophysiological facets of Takotsubo syndrome, including nomenclature, definition, and diagnosis, primary and secondary clinical subtypes, anatomical variants, triggers, epidemiology, pathophysiology, clinical presentation, complications, prognosis, clinical investigations, and treatment approaches. Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision-making by practising clinicians. These also cover more complex areas (e.g. uncertain diagnosis and delayed presentation) and the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation. The unmet needs and future directions for research in this syndrome are also discussed.
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Affiliation(s)
- Alexander R Lyon
- National Heart and Lung Institute, Imperial College, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Eduardo Bossone
- Cardiology Division, 'Cava de Tirreni and Amalfi Coast' Hospital, Heart Department, University of Salerno, Italy
| | | | - Udo Sechtem
- Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Rodolfo Citro
- University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Heart Department, Largo Città di Ippocrate, Salerno, Italy
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Mary N Sheppard
- Department of Cardiovascular Pathology, St George's University Medical School, London, UK
| | - Gemma A Figtree
- North Shore Heart Research, Kolling Institute, University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Guido Parodi
- Invasive Cardiology, Careggi Hospital, Florence, Italy
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Attikon University Hospital, University of Athens Medical School, Athens, Greece
| | - Alexandre Mebazaa
- Université Paris Diderot; U942 Inserm, Département d'Anestéhsie-Réanimation Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Electrocardiographic changes associated with takotsubo cardiomyopathy in a patient with pre-existing left bundle branch block. Heart Vessels 2015; 31:1393-6. [PMID: 26498941 DOI: 10.1007/s00380-015-0766-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
An 81-year-old man was referred to our emergency department with severe persistent chest pain. One year before presentation at our department, his 12-lead electrocardiogram (ECG) revealed a normal QRS pattern during the period of normal conduction with intermittent left bundle branch block (LBBB). His ECG immediately after arrival showed deep T-wave inversion in the precordial leads during normal conduction. During LBBB, there was mild ST-segment elevation with poor R-wave progression across the precordial leads. Emergent cardiac catheterization was performed to rule out acute coronary syndrome. Coronary angiography showed no significant stenosis, and coronary spasm was not provoked by the administration of intracoronary ergonovine. Left ventriculography demonstrated persistent left ventricular apical akinesis with systolic ballooning. Based on these findings, the patient was diagnosed to have takotsubo cardiomyopathy (TCM). After 6 months, echocardiography demonstrated the recovery of the left ventricular regional wall motion abnormality. An ECG performed 6 months after the presentation showed incomplete resolution of T-wave inversion in the periods of normal conduction. ST elevation and poor R-wave progression were improved during LBBB. In a case with acute chest pain and an ECG changes incompatible with acute ischemia superimposed on a pattern of LBBB, TCM should be considered as a differential diagnosis.
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25
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Ouchi K, Nakamura F, Ikutomi M, Oshima T, Ishiwata J, Shinohara H, Kouzaki T, Amaki T. Usefulness of contrast computed tomography to detect left ventricular apical thrombus associated with takotsubo cardiomyopathy. Heart Vessels 2015; 31:822-7. [PMID: 25630714 DOI: 10.1007/s00380-015-0637-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/16/2015] [Indexed: 12/01/2022]
Abstract
Left ventricular (LV) apical thrombus can rarely occur during the early phase of takotsubo cardiomyopathy. We report such a case that was depicted clearly in contrast computed tomography (CT) but not in initial echocardiography. Because LV thrombus may lead to thromboembolic events, we should evaluate all patients with takotsubo cardiomyopathy for the presence of a LV thrombus. LV thrombus is generally recognized with echocardiography in the course of follow-up, but limited depiction of the LV apex with echocardiography can make evaluation of LV thrombus difficult. Contrast CT is useful to detect LV apical thrombus associated with takotsubo cardiomyopathy.
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Affiliation(s)
- Kotaro Ouchi
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
| | - Fumitaka Nakamura
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan.
| | - Masayasu Ikutomi
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
| | - Tsukasa Oshima
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
| | - Jumpei Ishiwata
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
| | - Hiroki Shinohara
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
| | - Tsunashi Kouzaki
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
| | - Toshihiro Amaki
- Department of Cardiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Chiba, Ichihara, 299-0111, Japan
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26
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Goodloe AH, Evans JM, Middha S, Prasad A, Olson TM. Characterizing genetic variation of adrenergic signalling pathways in Takotsubo (stress) cardiomyopathy exomes. Eur J Heart Fail 2014; 16:942-9. [PMID: 25132214 DOI: 10.1002/ejhf.145] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/20/2014] [Accepted: 06/27/2014] [Indexed: 01/21/2023] Open
Abstract
AIMS Exome sequencing was used to genotype comprehensively a Takotsubo (stress) cardiomyopathy (TC) cohort, enabling investigation of a vast 486 gene network for adrenergic signalling. METHODS AND RESULTS Twenty-eight TC subjects, including a mother-daughter pair and five recurrent cases, underwent whole-exome sequencing. Frequencies of 17 common, functional adrenergic polymorphisms were statistically similar to those of population controls. Filtering for rare, predicted-deleterious, catecholamine/adrenergic signalling variants revealed heterozygosity in 55 genes in TC cases and 59 genes in healthy controls. Overall allele burden was similar and did not discriminate clinical variables among TC subjects, but gene identities were largely cohort specific, and TC cases were enriched for variants within functional domains (68% vs. 48%, P = 0.031). Two-thirds of TC cases carried more than one filtered adrenergic pathway variant, and 11 genes harboured a variant in ≥ 2 cases. The mother-daughter pair shared missense variants in highly conserved functional domains of ADH5, CACNG1, EPHA4, and PRKCA. An adrenergic pathway-independent analysis of the cohort exposed no common gene for TC. CONCLUSIONS Overall, these data support genetic heterogeneity in TC susceptibility and a likely polygenic basis, conferring a cumulative effect on adrenergic pathway dysregulation in a subset of individual subjects. Study of larger cohorts and non-coding regulatory regions is warranted to define genetic risk factors for TC further.
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