1
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Wang T, Xiong T, Yang Y, Zuo B, Chen X, Wang D. Metabolic remodeling in takotsubo syndrome. Front Cardiovasc Med 2022; 9:1060070. [PMID: 36505375 PMCID: PMC9729286 DOI: 10.3389/fcvm.2022.1060070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
The heart requires a large and constant supply of energy that is mainly the result of an efficient metabolic machinery that converges on mitochondrial oxidative metabolism to maintain its continuous mechanical work. Perturbations in these metabolic processes may therefore affect energy generation and contractile function directly. Metabolism characteristics in takotsubo syndrome (TTS) reveals several metabolic alterations called metabolic remodeling, including the hyperactivity of sympathetic metabolism, derangements of substrate utilization, effector subcellular dysfunction and systemic metabolic disorders, ultimately contributing to the progression of the disease and the development of a persistent and long-term heart failure (HF) phenotype. In this review, we explore the current literature investigating the pathological metabolic alterations in TTS. Although the metabolic dysfunction in takotsubo hearts is initially recognized as a myocardial metabolic inflexibility, we suggest that the widespread alterations of systemic metabolism with complex interplay between the heart and peripheral tissues rather than just cardiometabolic disorders per se account for long-term maladaptive metabolic, functional and structural impairment under this condition. Therapeutic strategies with the recent evidence from small clinical and animal researches, especially for targeting substrate utilization and/or oxidative stress, might be promising tools to improve the outcome of patients with TTS beyond that achieved with traditional sympathetic inhibition and symptomatic therapies.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Ting Xiong
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China,*Correspondence: Daxin Wang, ,
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2
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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: 897] [Impact Index Per Article: 179.4] [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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3
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Abstract
Stress-induced cardiomyopathy (SCM), is a reversible cardiomyopathy characterized by transient systolic dysfunction following an acute physiologic stress. Thromboembolism occurs at a high frequency in patients with intracardiac thrombus secondary to SCM, with one systematic review reporting a rate of 33.3%. The risk of thrombus formation following SCM has been associated with left-ventricular (LV) contraction abnormalities, catecholaminergic surge, and other associated comorbidities. However, established guidelines for screening and management of intracardiac thrombus in the setting of SCM do not exist at present due to a lack of sufficient clinical trial data. The purpose of this article is to discuss the pathophysiological theory and previously documented evidence from cases of LV thrombus secondary to SCM, and to present our recommendations for management of intracardiac thrombus secondary to SCM.
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Affiliation(s)
- Saagar K Sanghvi
- Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way, ML 0542, Cincinnati, OH, 45267-0542, USA.
| | - David M Harris
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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4
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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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5
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Abstract
Originally described by Japanese authors in the 1990s, Takotsubo syndrome (TTS) generally presents as an acute myocardial infarction characterized by severe left ventricular dysfunction. TTS, however, differs from an acute coronary syndrome because patients have generally a normal coronary angiogram and left ventricular dysfunction, which extends beyond the territory subtended by a single coronary artery and recovers within days or weeks. The prognosis was initially thought to be benign, but subsequent studies have demonstrated that both short-term mortality and long-term mortality are higher than previously recognized. Indeed, mortality reported during the acute phase in hospitalized patients is ≈4% to 5%, a figure comparable to that of ST-segment-elevation myocardial infarction in the era of primary percutaneous coronary interventions. Despite extensive research, the cause and pathogenesis of TTS remain incompletely understood. The aim of the present review is to discuss the pathophysiology of TTS with particular emphasis on the role of the central and autonomic nervous systems. Different emotional or psychological stressors have been identified to precede the onset of TTS. The anatomic structures that mediate the stress response are found in both the central and autonomic nervous systems. Acute stressors induce brain activation, increasing bioavailability of cortisol and catecholamine. Both circulating epinephrine and norepinephrine released from adrenal medullary chromaffin cells and norepinephrine released locally from sympathetic nerve terminals are significantly increased in the acute phase of TTS. This catecholamine surge leads, through multiple mechanisms, that is, direct catecholamine toxicity, adrenoceptor-mediated damage, epicardial and microvascular coronary vasoconstriction and/or spasm, and increased cardiac workload, to myocardial damage, which has a functional counterpart of transient apical left ventricular ballooning. The relative preponderance among postmenopausal women suggests that estrogen deprivation may play a facilitating role, probably mediated by endothelial dysfunction. Despite the substantial improvement in our understanding of the pathophysiology of TTS, a number of knowledge gaps remain.
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Affiliation(s)
- Francesco Pelliccia
- From Department of Cardiovascular Sciences, Sapienza University, Rome, Italy (F.P.); Molecular and Clinical Sciences Research Institute, St George's, University of London, UK (J.C.K.); Institute of Cardiology, Catholic University, Rome, Italy (F.C.); and Vita-Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.)
| | - Juan Carlos Kaski
- From Department of Cardiovascular Sciences, Sapienza University, Rome, Italy (F.P.); Molecular and Clinical Sciences Research Institute, St George's, University of London, UK (J.C.K.); Institute of Cardiology, Catholic University, Rome, Italy (F.C.); and Vita-Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.)
| | - Filippo Crea
- From Department of Cardiovascular Sciences, Sapienza University, Rome, Italy (F.P.); Molecular and Clinical Sciences Research Institute, St George's, University of London, UK (J.C.K.); Institute of Cardiology, Catholic University, Rome, Italy (F.C.); and Vita-Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.)
| | - Paolo G Camici
- From Department of Cardiovascular Sciences, Sapienza University, Rome, Italy (F.P.); Molecular and Clinical Sciences Research Institute, St George's, University of London, UK (J.C.K.); Institute of Cardiology, Catholic University, Rome, Italy (F.C.); and Vita-Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.).
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6
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Citro R, Pontone G, Pace L, Zito C, Silverio A, Bossone E, Piscione F. Contemporary Imaging in Takotsubo Syndrome. Heart Fail Clin 2017; 12:559-75. [PMID: 27638026 DOI: 10.1016/j.hfc.2016.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transthoracic echocardiography is the first-line imaging modality for evaluating patients with Takotsubo syndrome (TTS). Beyond diagnosis, TTE enables detection of peculiar complications and is useful for risk stratification and management of patients with cardiogenic shock. Cardiac magnetic resonance can be used to detect myocardial edema typically associated with TTS and is helpful in the differential diagnosis with other disease states. Coronary computed tomography angiography can be performed as an alternative to coronary angiography to confirm coronary artery patency. Molecular imaging is a promising approach for identifying patients at increased risk of recurrence.
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Affiliation(s)
- Rodolfo Citro
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy.
| | - Gianluca Pontone
- Centro Cardiolgico Monzino, IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Leonardo Pace
- Department of Medicine and Surgery, Schola Medica Salernitana, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
| | - Concetta Zito
- Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti 1, 98122 Messina, Italy
| | - Angelo Silverio
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Eduardo Bossone
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy
| | - Federico Piscione
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Heart Tower Room 810, Largo Città di Ippocrate, Salerno 84131, Italy; Department of Medicine and Surgery, Schola Medica Salernitana, University of Salerno, Via Salvador Allende, 84081 Baronissi (Salerno), Italy
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7
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Christensen TE, Ahtarovski KA, Bang LE, Holmvang L, Søholm H, Ghotbi AA, Andersson H, Vejlstrup N, Ihlemann N, Engstrøm T, Kjær A, Hasbak P. Basal hyperaemia is the primary abnormality of perfusion in Takotsubo cardiomyopathy: a quantitative cardiac perfusion positron emission tomography study. Eur Heart J Cardiovasc Imaging 2015; 16:1162-9. [PMID: 25851324 DOI: 10.1093/ehjci/jev065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/04/2015] [Indexed: 01/18/2023] Open
Abstract
AIMS Takotsubo cardiomyopathy (TTC) is characterized by acute completely reversible regional left ventricle (LV) akinesia and decreased tracer uptake in the akinetic region on semi-quantitative perfusion imaging. The latter may be due to normoperfusion of the akinetic mid/apical area and basal hyperperfusion. Our aim was to examine abnormalities of perfusion in TTC, and we hypothesized that basal hyperperfusion is the primary perfusion abnormality in the acute state. METHOD AND RESULTS Twenty-five patients were diagnosed with TTC due to (i) acute onset of symptoms, (ii) typical apical ballooning, (iii) absence of significant coronary disease, and (iv) complete remission on 4-month follow-up. The patients underwent coronary angiography (CAG), echocardiography, cardiac magnetic resonance imaging (CMR), and (13)NH3/(82)Rb positron emission tomography (PET) in the acute state and-except CAG-on follow-up. Patients initially had severe heart failure, mid/apical oedema but no infarction, and a rise in cardiac biomarkers. On initial perfusion PET imaging, eight patients appeared to have normal, whereas 17 patients had impaired LV perfusion. In the latter, flow in the basal region was increased in the acute state (1.5 ± 0.1 vs. 1.2 ± 0.1 mL/g/minRPP-corrected, P < 0.01), whereas midventricular (1.7 ± 0.1 vs. 1.6 ± 0.1 mL/g/minRPP-corrected, P = 0.21) and apical (1.4 ± 0.1 vs. 1.5 ± 0.1 mL/g/minRPP-corrected, P = 0.36) flow was unchanged between acute and follow-up, and within normal range. CONCLUSION Our results suggest an abnormal LV perfusion distribution in the acute state of TTC with basal hyperperfusion and a normoperfused akinetic region. The proportion of patients without visualized perfusion abnormalities in the acute state may represent a subgroup with fast remission.
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Affiliation(s)
- Thomas Emil Christensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigation, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lia Evi Bang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Søholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigation, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hedvig Andersson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Kjær
- Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine and PET, Centre of Diagnostic Investigation, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
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8
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Testa M, Feola M. Usefulness of myocardial positron emission tomography/nuclear imaging in Takotsubo cardiomyopathy. World J Radiol 2014; 6:502-506. [PMID: 25071891 PMCID: PMC4109102 DOI: 10.4329/wjr.v6.i7.502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/26/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyse and summarize all the articles related to positron emission tomography and Takotsubo cardiomyopathy (TTC).
METHODS: We performed a systematic review of the existing literature on positron emission tomography/nuclear imaging and Takotsubo cardiomyopathy using PUBMED database. We combined search terms such as “takotsubo”, “takotsubo syndrome”, “myocardial positron emission tomography”, “positron emission tomography”. All case reports were excluded. The list included only four articles which were reviewed by two independent investigators. It was not possible to undertake a formal meta-analysis because of the heterogeneity of the studies; therefore, we made a narrative synthesis of the collected data.
RESULTS: Nuclear medicine techniques can be useful employed in the differential diagnosis of TTC from an acute coronary syndrome (ACS). In fact, transient left ventricular (LV) apical ballooning is a syndrome frequently misdiagnosed as an ACS and can mimic symptoms of myocardial infarction with ST-T segments changes on electrocardiography (ECG), a limited release of myocardial enzyme, mainly reported after sudden emotional or physical stress, and an akinesis or dyskinesis of the left ventricle apex which are completely reversible in a few weeks. In the studies included in this review, nuclear medicine techniques have demonstrated a discrepancy between normal perfusion and a reduced glucose utilization in TTC, commonly known as “inverse flow metabolism mismatch”. This suggests that apical ballooning represents a transient metabolic disorder on the cellular level, rather than a structural contractile disease of the myocardium, due to a transient decrease of glucose metabolism that might be related to a coronary microcirculation impairment followed by prolonged myocardial stunning.
CONCLUSION: Nuclear medicine techniques can be usefully used for the diagnosis of TTC and can increase our knowledge of the pathophysiological mechanisms of TTC.
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9
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Cardiac ⁹⁹mTc sestamibi SPECT and ¹⁸F FDG PET as viability markers in Takotsubo cardiomyopathy. Int J Cardiovasc Imaging 2014; 30:1407-16. [PMID: 24852336 DOI: 10.1007/s10554-014-0453-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/15/2014] [Indexed: 01/19/2023]
Abstract
In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.
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The human female heart incorporates glucose more efficiently than the male heart. Int J Cardiol 2013; 168:2518-21. [PMID: 23545149 DOI: 10.1016/j.ijcard.2013.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/17/2013] [Accepted: 03/13/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Oestrogen is known to play a cardioprotective role in cardiovascular diseases, as demonstrated in a number of animal studies. However, few human studies have investigated sex-based differences with regard to cardiac glucose uptake using (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). METHODS Therefore, we evaluated healthy male and female subjects who underwent FDG-PET/CT examination to determine whether there was a sex-related difference in cardiac glucose uptake with age. RESULTS In females, the prevalence of maximal FDG uptake (PET score 2) demonstrated a convex pattern with ageing, and it peaked at age 51-60 years in the females, gradually decreasing to a minimum at age >70 years. In contrast, the prevalence of maximal FDG uptake by age in males was a mirror image of that in females, i.e. it formed a concave pattern with a nadir at 61-70 years, followed by an increase in the prevalence. These findings suggest that female hearts depend more on glucose as an energy substrate as they age, however, efficient glucose uptake is attenuated with increasing age. In contrast, the male heart sustains its glucose uptake capacity at age >70 years. CONCLUSION This characteristic sex-based difference in cardiac glucose uptake might be related to the female predominance of Takotsubo cardiomyopathy.
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Hantson P, Beauloye C. Myocardial metabolism in toxin-induced heart failure and therapeutic implications. Clin Toxicol (Phila) 2012; 50:166-71. [DOI: 10.3109/15563650.2012.658472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Systemic inflammation impairs cardiac glucose uptake. Int J Cardiol 2012; 154:203-4. [DOI: 10.1016/j.ijcard.2011.10.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 10/18/2011] [Indexed: 11/21/2022]
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Gaddam S, Nimmagadda KC, Nagrani T, Naqi M, Wetz RV, Weiserbs KF, McCord D, Ghavami F, Gala B, Lafferty JC. Serum lipoprotein levels in takotsubo cardiomyopathy vs. myocardial infarction. Int Arch Med 2011; 4:14. [PMID: 21527016 PMCID: PMC3094218 DOI: 10.1186/1755-7682-4-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/28/2011] [Indexed: 01/06/2023] Open
Abstract
Background In the setting of myocardial infarction (MI) or acute coronary syndrome (ACS), current guidelines recommend early and aggressive lipid lowering therapy with statins, irrespective of the baseline lipoprotein levels. Takotsubo cardiomyopathy (TCM) patients have a clinical presentation similar to myocardial infarction and thus receive early and aggressive statin therapy during their initial hospitalization. However, the pathology of TCM is not atherosclerotic coronary artery disease and hence we assumed the lipid profiles in TCM would be healthier than coronary artery disease patients. Methods In this retrospective study, we assessed fasting serum lipoprotein levels of ten TCM patients and compared them with forty, age and sex-matched myocardial infarction (MI) patients. Results Comparing serum lipoprotein levels of TCM with MI group, there was no significant difference in mean total cholesterol between the two groups (174.5 mg/dL vs. 197.6 mg/dL, p = 0.12). However, in the TCM group, mean HDL-C was significantly higher (66.87 mg/dL vs. 36.5 mg/dL, p = 0.008), the mean LDL-C was significantly lower (89.7 mg/dL vs. 128.9 mg/dL, p = 0.0002), and mean triglycerides was also significantly lower (65.2 mg/dL vs. 166.8 mg/dL, p < 0.0001). Conclusions In this study, TCM patients in comparison to MI patients had significantly higher levels of HDL-C, lower levels of LDL-C levels and triglycerides. The lipid profiles in TCM were consistent with the underlying pathology of non-atherosclerotic, non-obstructive coronary artery disease. As lipoproteins in most TCM patients were within the optimal range, we recommend an individual assessment of lipid profiles along with their coronary heart disease risk factors for considering long term lipid-lowering therapy. A finding of hyperalphalipoproteinemia or hypotriglyceridemia in 40% of TCM patients is novel but this association needs to be confirmed in future studies with larger sample sizes. These findings may provide clues in understanding the pathogenesis of takotsubo cardiomyopathy.
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Affiliation(s)
- Sainath Gaddam
- Department of Internal Medicine, Staten Island University Hospital, New York, USA.
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