1
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Popa OA, Amzulescu M, Bugeac C, Tomescu L, Slavu IM, Gheorghita V, Andrei R, Tulin A. Cardiovascular Magnetic Resonance Imaging in Myocardial Disease. Cureus 2024; 16:e58688. [PMID: 38774162 PMCID: PMC11107957 DOI: 10.7759/cureus.58688] [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] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is the central non-invasive imaging investigation for the evaluation of myocardial disease. It is the well-established gold standard for measuring cardiac chamber volumes, systolic function, and left ventricular mass, and it brings unique information for therapeutic decisions. In addition, its tissue characterization capability, through T1, T2, and T2* mapping, as well as early and late gadolinium enhancement (LGE) sequences, allows to differentiate in many cases among ischemic, inflammatory, and infiltrative heart disease and permits the quantification of myocardial fibrosis, providing valuable diagnostic and prognostic information. This review aims to highlight the main CMR features of different cardiomyopathies.
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Affiliation(s)
- Oana-Andreea Popa
- Cardiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Mihaela Amzulescu
- Cardiology, Centre Hospitalier Universitaire (CHU) Saint Pierre, Bruxelles, BEL
| | - Claudia Bugeac
- Radiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Luminita Tomescu
- Radiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Iulian M Slavu
- Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Valeriu Gheorghita
- Infectious Disease, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Rosu Andrei
- Cardiology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
| | - Adrian Tulin
- Clinic of General Surgery, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, ROU
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2
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Mishra T, Saha R, Paramasivam G. Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction. Egypt Heart J 2024; 76:26. [PMID: 38381355 PMCID: PMC10881923 DOI: 10.1186/s43044-024-00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Owing to the limited research on Takotsubo Cardiomyopathy (TCM) in Asia, we aim to evaluate in detail the clinical profiles, lab parameters, investigations, and major adverse cardiovascular events (MACE) seen in patients with TCM in the Indian subcontinent. Additionally, we have compared the electrocardiographic findings of patients with TCM to those of patients with myocardial infarction (MI). RESULTS The average age of the patients affected was found to be 60 ± 11 years. Women (87.5%) and patients with hypertension (40%) were found to be at an increased risk of developing the syndrome. The most common presenting symptom was dyspnea (48%) following a trigger most commonly emotional (45%). ST elevation and significant T wave inversions were observed in 40% of patients with TCM. Echocardiography revealed a low left ventricular ejection fraction of 43 ± 9%. Coronary angiography was normal in 60%, the rest had mild/subcritical stenoses. The 6-month MACE was 20% and the mortality rate was 7.5%. Follow-up echocardiography of patients with TCM showed improvement in EF in 75% patients. CONCLUSIONS TCM was majorly seen in postmenopausal women following an emotional trigger, but a variety of other triggers were noted. T-wave inversions in TCM follow a diffuse pattern in contrast to specific leads seen in MI. Normal or subcritical stenosis in coronaries at presentation, along with a low EF which improves on follow up provide greater evidence for the diagnosis of TCM.
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Affiliation(s)
- Tanisha Mishra
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Rijushree Saha
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Ganesh Paramasivam
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India.
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3
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Padilla-Lopez M, Duran-Cambra A, Belmar-Cliville D, Soriano-Amores M, Arakama-Goikoetxea S, Vila-Perales M, Bragagnini W, Rodríguez-Sotelo L, Peña-Ortega P, Sánchez-Vega J, Carreras-Mora J, Sionis A. Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome. Front Cardiovasc Med 2023; 10:1286975. [PMID: 38111891 PMCID: PMC10725917 DOI: 10.3389/fcvm.2023.1286975] [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: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Takotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS. Methods A retrospective case-control study was conducted where ECGs were reviewed at three time points from symptom onset (within the first 12 h, at 48 h, and at 5-7 days) and compared between patients with typical TTS (n = 33) and those with MV-TTS (n = 27), as classified by ventriculography. Results 12-h ECG findings revealed that typical TTS featured ST-segment elevation through anterior leads V3-V6, with maximal deviation in V3 (0.98 ± 0.99 mm) and V4 (0.91 ± 0.91 mm), whereas MV-TTS featured ST-segment depression in inferior leads (-0.24 ± 0.57 mm in II, -0.30 ± 0.52 mm in III, and -0.32 ± 0.47 mm in aVF) and in precordial leads V4-V6. In 48-h ECG findings, the most significant change was T wave inversion, which was more widespread and deeper in typical TTS, with the most pronounced negative T wave depths, exceeding 3 mm, observed in leads V3-V5; in contrast, in MV-TTS, T wave inversion was evident in fewer leads and showed less depth, with the most pronounced negative T waves reaching 1 mm at most in leads I, aVL, and V2. While the QTc interval was prolonged in both groups at 48 h, this prolongation was more pronounced in typical TTS than in MV-TTS (523 ± 52 ms vs. 487 ± 66 ms; p = 0.029). In ECGs at 5-7 days, results essentially returned to baseline. Conclusion Patients with MV-TTS exhibited a distinctive pattern of ECG abnormalities, marked by ST-segment depression in inferolateral leads, less profound and less extensive T wave inversion that mostly affected leads I, aVL and V2, and attenuated QT interval prolongation compared to typical TTS.
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Affiliation(s)
- Mireia Padilla-Lopez
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Albert Duran-Cambra
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - David Belmar-Cliville
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Marc Soriano-Amores
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sabiñe Arakama-Goikoetxea
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Montserrat Vila-Perales
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Walter Bragagnini
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Laura Rodríguez-Sotelo
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Peña-Ortega
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jesús Sánchez-Vega
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Carreras-Mora
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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4
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Sinigiani G, De Michieli L, De Conti G, Ricci F, De Lazzari M, Migliore F, Perazzolo Marra M, Zorzi A, Corrado D, Cipriani A. Cardiac Magnetic Resonance-Detected Acute Myocardial Edema as Predictor of Favourable Prognosis: A Comprehensive Review. J Cardiovasc Dev Dis 2023; 10:319. [PMID: 37623332 PMCID: PMC10455433 DOI: 10.3390/jcdd10080319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Acute myocardial edema (AME) is increased water content in the myocardium and represents the first and transient pathophysiological response to an acute myocardial injury. In-vivo and non-invasive evaluation is feasible with cardiac magnetic resonance (CMR), which is a powerful imaging technique capable of tissue characterization. In the clinical setting, early demonstration of AME has a recognized diagnostic value for acute coronary syndromes and acute myocarditis, although its prognostic value is not well established. This article provides a comprehensive narrative review on the clinical meaning of AME in heart diseases. In particular, the available evidence of a possible favourable prognostic value in several clinical scenarios is addressed.
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Affiliation(s)
- Giulio Sinigiani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Laura De Michieli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua, 35128 Padua, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
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5
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Ramos GE, Caglevic C, Bulnes JF, Panay SE, Zapata MI, Daniele AJ, Rodríguez ME. Takotsubo cardiomyopathy Afatinib-related in a non-small cell lung cancer patient: Case report. Front Cardiovasc Med 2022; 9:1060813. [PMID: 36483627 PMCID: PMC9724619 DOI: 10.3389/fcvm.2022.1060813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/03/2022] [Indexed: 01/24/2024] Open
Abstract
Endothelial Growth Factor Receptor (EGFR) mutations are frequently found among NSCLC patients. Second-generation Tyrosine Kinase Inhibitor (TKI) Afatinib is frequently used in this population of patients achieving better results than cytotoxic chemotherapy in terms of survival and progression. Afatinib-related cardiotoxicity has been rarely reported. Here we comment on a clinical case of a Takotsubo Cardiomyopathy Afatinib-induced in an NSCLC patient.
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Affiliation(s)
- German E. Ramos
- Department of Cardiology, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Ehocardiography Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Christian Caglevic
- Department of Cancer Research, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Clinical Trials Unit, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Juan F. Bulnes
- Department of Cardiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio E. Panay
- Clinical Trials Unit, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Department of Oncology, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Mario I. Zapata
- Department of Cardiology, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Ehocardiography Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Andrés J. Daniele
- Department of Cardio-Oncology, Institute of Oncology “Angel H. Roffo”, Buenos Aires, Argentina
| | - Manuel E. Rodríguez
- Department of Cardiology, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Ehocardiography Laboratory, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
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6
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Brida MSD, Guimaraes RB, Rothlisberger L, Patricio M. Takotsubo Cardiomyopathy and Myocardial Perfusion Image: Unusual Binomial in the Investigation of Acute Coronary Syndrome without Obstructive Lesions. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210015] [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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7
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Abstract
PURPOSE OF REVIEW Takotsubo syndrome (TTS) is a transient but severe myocardial dysfunction that has been known for decades and is still to be fully understood regarding its clinical presentations and pathophysiological mechanisms. Cardiac magnetic resonance (CMR) imaging plays a key role in the comprehensive analysis of patients with TTS in acute and follow-up examinations. In this review, we focus on the major advantages and latest evolutions of CMR in diagnosis and prognostication of TTS and discuss future perspectives and needs in the field of research and cardiovascular imaging in TTS. RECENT FINDINGS Specific CMR criteria for TTS diagnosis at the time of acute presentation are established. In addition to identifying the typical regional wall motion abnormalities, CMR allows for precise quantification of right ventricular and left ventricular (LV) function, the assessment of additional abnormalities/complications (e.g. pericardial and/or pleural effusion, LV thrombi), and most importantly myocardial tissue characterization (myocardial oedema, inflammation, necrosis/fibrosis). CMR enables a comprehensive assessment of the entire spectrum of functional and structural changes that occur in patients with TTS and may have also a prognostic impact. CMR can distinguish between TTS and other important differential diagnoses (myocarditis, myocardial infarction) with direct consequences on medical therapy.
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Affiliation(s)
- Philipp-Johannes Jensch
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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8
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Prokudina ES, Kurbatov BK, Maslov LN. [Clinical Manifestation of Stressful Cardiomyopathy (Takotsubo Syndrome) and the Problem of Differential Diagnosis with Acute Myocardial Infarction]. ACTA ACUST UNITED AC 2020; 60:777. [PMID: 33487160 DOI: 10.18087/cardio.2020.11.n777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
The presented data show that tacotsubo syndrome (TS) is characterized by the absence of coronary artery obstruction, cardiac contractile dysfunction, apical ballooning, and heart failure, and in some patients, ST-segment elevation and prolongation of the QTc interval. Every tenth patient with TS develops ventricular arrhythmias. Most of TS patients have elevated markers of necrosis (troponin I, troponin Т, and creatine kinase МВ (CK-МВ), which are considerably lower than in patients with acute myocardial infarction (AMI) with ST-segment elevation. The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), in contrast, is considerably higher in patients with TS than with AMI. Differential diagnosis of TS and AMI should be based on a multifaceted approach using coronary angiography, echocardiography, analysis of ECG, magnetic resonance imaging, single-photon emission computed tomography, and measurement of troponins, CK-MB, and NT-proBNP.
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Affiliation(s)
- E S Prokudina
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - B K Kurbatov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - L N Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
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9
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Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). J Echocardiogr 2020; 18:199-224. [PMID: 32886290 PMCID: PMC7471594 DOI: 10.1007/s12574-020-00480-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022]
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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10
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Abstract
Cardiac magnetic resonance (CMR) imaging is a unique imaging modality, which provides accurate noninvasive tissue characterization. Various CMR sequences can be utilized to identify and quantify patterns of myocardial edema, fibrosis, and infiltrates, which are important determinants for diagnosis and prognostication of heart failure. This article describes available methods of tissue characterization imaging applied in CMR. The presence and patterns of abnormal tissue characterization are related to common etiologies of heart failure and the techniques employed to demonstrate this. CMR provides the opportunity to identify the etiology of heart failure based on the recognition of different patterns of myocardial abnormalities.
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11
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Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA, Bertrand P, Donal E, Dweck M, Galderisi M, Haugaa KH, Sade LE, Stankovic I, Cosyns B, Edvardsen T. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). Eur Heart J Cardiovasc Imaging 2020; 21:1184-1207. [DOI: 10.1093/ehjci/jeaa149] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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Affiliation(s)
- Rodolfo Citro
- Cardiothoracic Vascular Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Patrick Meimoun
- Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dana Dawson
- Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ingo Eitel
- Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
- Department of Cardiology, German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan
| | - Yukari Kobayashi
- Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila,” Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Bucharest, Romania
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12
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An Update on Cardiac Magnetic Resonance Imaging in Takotsubo Cardiomyopathy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09536-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Purpose of Review
To provide an update on the use of cardiac magnetic resonance imaging in the diagnosis of Takotsubo cardiomyopathy.
Recent Findings
Long-term prognosis of Takotsubo cardiomyopathy may not be as clear-cut as previously thought. Cardiac magnetic resonance imaging not only allows differentiation between reversible and nonreversible changes but has an emerging role in identifying cellular level changes associated with prognostic indicators such as myocardial energetics using 31P-CMR spectroscopy and detection of myocardial inflammation overlying myocardial oedema, using ultrasmall paramagnetic iron oxide particle uptake in macrophages.
Summary
Takotsubo cardiomyopathy is a non-ischemic acute heart failure syndrome. It is commonly triggered by emotional or physical stress and is possibly the strongest psychosomatic interaction seen in medicine. While clinically its presentation mimics a myocardial infarction, the acute imaging characteristics are critical in correctly identifying the disease entity.
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Haran C, McBean R, Incani A, Tollenaere R, Newbigin K. Mid-Cavity Variant Takotsubo Cardiomyopathy—Magnetic Resonance Imaging Findings. Curr Probl Diagn Radiol 2020; 49:140-142. [DOI: 10.1067/j.cpradiol.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022]
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Câmara N, Sierra E, Fernández A, Arbelo M, Andrada M, Monteros AEDL, Herráez P. Increased Plasma Cardiac Troponin I in Live-Stranded Cetaceans: Correlation with Pathological Findings of Acute Cardiac Injury. Sci Rep 2020; 10:1555. [PMID: 32005888 PMCID: PMC6994679 DOI: 10.1038/s41598-020-58497-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 11/08/2022] Open
Abstract
Capture myopathy (CM), is a syndrome that occurs as the result of the stress during and after capture, handling, restraint, and transport of wild animals. Although CM has been described for many species of cetaceans, characterization of the acute cardiac injury - an important component of this syndrome - are still scarce. In this study, we firstly estimated a normal range for cardiac troponin I (cTnI) on cetaceans. Here, through biochemical analysis (especially of cTnI) and histopathological, histochemical, and immunohistochemical correlations with decreased troponin immunolabelling, we studied the cardiac injury in live-stranded cetaceans. Nine cetaceans which stranded alive on the Canary Islands (January 2016 - June 2019) were included in this study. Sampled individuals presented elevated values of plasma cTnI, which were correlated to histopathological lesions comprised of vascular changes and acute degenerative lesions. Immunohistochemically, injured cardiomyocytes showed a decreased intrafibrillar troponin immunoreaction. This is the first attempt to establish a normal baseline range for cTnI in cetaceans, and the first study comparing plasma biomarkers values with histopathological and immunohistochemical findings. This approach allowed us to demonstrate the degree of cardiac damage as a result of injury, consistent with ischemia-reperfusion lesions. The knowledge gained here could improve decision-making procedures during stressful situations, mainly in live-strandings, handling, and rehabilitation, thereby reducing the mortality of cetaceans.
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Affiliation(s)
- Nakita Câmara
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Sierra
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Antonio Fernández
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Manuel Arbelo
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marisa Andrada
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio Espinosa de Los Monteros
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Herráez
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Câmara N, Sierra E, Fernández-Maldonado C, Espinosa de Los Monteros A, Arbelo M, Fernández A, Herráez P. Stress cardiomyopathy in stranded cetaceans: a histological, histochemical and immunohistochemical study. Vet Rec 2019; 185:694. [PMID: 31554713 DOI: 10.1136/vr.105562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/07/2019] [Accepted: 08/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Free-living cetaceans are exposed to a wide variety of stressful situations, including live stranding and interaction with human beings (capture myopathy), vessel strikes, and fishing activities (bycatch), which affect their wellbeing and potentially lead to stress cardiomyopathy (SCMP). METHODS Here, the authors aimed to characterise SCMP of stranded cetaceans as an injury resulting from extreme stress responses, based on pathological analyses (histological, histochemical and immunohistochemical). Specifically, the authors examined heart samples from 67 cetaceans found ashore (48 live strandings, seven dead from ship collision and 12 dead from bycatch) on the coast of Spain, more specifically in the Canary Islands from 2000 to 2016 and Andalusia from 2011 to 2014. RESULTS The microscopic findings were characterised by vascular changes, acute or subacute cardiac degenerative necrotic lesions, interstitial myoglobin globules, and infiltration of inflammatory cells. Immunohistochemically, cardiac troponin I, cardiac troponin C and myoglobin were depleted, along with fibrinogen being expressed in the degenerated/necrotic cardiomyocytes. A perivascular pattern was also identified and described in the damaged cardiomyocytes. CONCLUSIONS This study advances current knowledge about the pathologies of cetaceans and their implications on conserving this group of animals by reducing mortality and enhancing their treatment and subsequent rehabilitation to the marine environment.
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Affiliation(s)
- Nakita Câmara
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Eva Sierra
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | | | - Antonio Espinosa de Los Monteros
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Manuel Arbelo
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Antonio Fernández
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Pedro Herráez
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
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Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, Moeller FG, Berrocal D, Abbate A. Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:1955-1971. [PMID: 30309474 PMCID: PMC7058348 DOI: 10.1016/j.jacc.2018.07.072] [Citation(s) in RCA: 314] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
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Affiliation(s)
- Horacio Medina de Chazal
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lori Keyser-Marcus
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Liangsuo Ma
- Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - F Gerard Moeller
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia; Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Berrocal
- Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.
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Abstract
Takotsubo syndrome is an acute, profound but reversible heart failure syndrome of unknown aetiology, usually but not always triggered by physical or emotional stress. Cardiac magnetic resonance has become an important tool for the non-invasive assessment of the syndrome, allowing for a comprehensive, safe and reproducible assessment of functional and anatomical myocardial properties, including perfusion, oedema and necrosis. This review focuses on the emerging role of cardiac magnetic resonance for the characterisation, differential diagnosis as well as risk stratification of patients with Takotsubo syndrome.
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Affiliation(s)
- Konstantinos Bratis
- Cardiology Clinical Academic Group, St George's University Hospitals NHS Foundation Trust, London, UK
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Peterzan MA, Rider OJ, Anderson LJ. The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure. Card Fail Rev 2016; 2:115-122. [PMID: 28785465 PMCID: PMC5490982 DOI: 10.15420/cfr.2016.2.2.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/24/2016] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular imaging is key for the assessment of patients with heart failure. Today, cardiovascular magnetic resonance imaging plays an established role in the assessment of patients with suspected and confirmed heart failure syndromes, in particular identifying aetiology. Its role in informing prognosis and guiding decisions around therapy are evolving. Key strengths include its accuracy; reproducibility; unrestricted field of view; lack of radiation; multiple abilities to characterise myocardial tissue, thrombus and scar; as well as unparalleled assessment of left and right ventricular volumes. T2* has an established role in the assessment and follow-up of iron overload cardiomyopathy and a role for T1 in specific therapies for cardiac amyloid and Anderson-Fabry disease is emerging.
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Affiliation(s)
- Mark A Peterzan
- Cardiology Clinical Academic GroupSt George’s Hospital, London, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Lisa J Anderson
- Cardiology Clinical Academic GroupSt George’s Hospital, London, UK
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Salmoirago-Blotcher E, Rosman L, Wittstein IS, Dunsiger S, Swales HH, Aurigemma GP, Ockene IS. Psychiatric history, post-discharge distress, and personality characteristics among incident female cases of takotsubo cardiomyopathy: A case-control study. Heart Lung 2016; 45:503-509. [PMID: 27553636 DOI: 10.1016/j.hrtlng.2016.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/20/2016] [Accepted: 07/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The role of psychological factors in the onset of takotsubo cardiomyopathy (TC) is still controversial. Associations with previous psychiatric conditions are registry-based; associations with personality characteristics and psychological sequelae of TC have been largely unexplored. This case-control study sought to study pre-admission psychiatric morbidity, personality traits, and post-discharge distress in incident cases of TC. METHODS TC cases (Mayo clinic criteria) and acute myocardial infarction (MI) controls were recruited among women admitted to two Emergency Departments in New England. Healthy controls (HC) were recruited from a volunteers' registry. Preadmission psychiatric history (DSM-IV-TR) was abstracted from the medical record. PTSD symptoms (Impact of Events Scale); distress (Hospital Anxiety and Depression Scale); perceived stress (PS scale) and personality traits (optimism; hostility, type D personality) were collected via phone interview one month after discharge. RESULTS From March 2013 through October 2015, 107 participants (45 TC, 32 MI and 30 HC) were enrolled. The prevalence of preadmission anxiety disorders was 24.4% in TC, 9.4% in MI, and 0 in HC (p = 0.007) while that of mood disorders was similar across groups. TC had higher psychological distress, perceived stress, and PTSD symptoms post-discharge vs. MI and HC. In adjusted models, PTSD symptoms remained higher in TC vs. MI (b = 0.55, p < 0.05) and vs. HC (b = 0.92, p < 0.01). Optimism and hostility scores were similar across groups, while type D (social inhibition) scores were higher in TC and MI vs. HC. CONCLUSIONS Preadmission anxiety, but not depression, was associated with the occurrence of TC. High distress and PTSD symptoms post-discharge indicate that TC women may be at risk for poor psychological adjustment.
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Affiliation(s)
- Elena Salmoirago-Blotcher
- Department of Medicine, Brown University Medical School, United States; The Miriam Hospital, United States.
| | - Lindsey Rosman
- Department of Psychology, East Carolina University, United States
| | - Ilan S Wittstein
- Department of Medicine, Johns Hopkins University School of Medicine, United States
| | - Shira Dunsiger
- The Miriam Hospital, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, United States
| | | | - Gerard P Aurigemma
- Department of Medicine, University of Massachusetts Medical School, United States
| | - Ira S Ockene
- Department of Medicine, University of Massachusetts Medical School, United States
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21
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Dastidar AG, Frontera A, Palazzuoli A, Bucciarelli-Ducci C. TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance. Heart Fail Rev 2016; 20:415-21. [PMID: 25896529 PMCID: PMC4464602 DOI: 10.1007/s10741-015-9489-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
TakoTsubo cardiomyopathy (TCM) is a unique type of reversible cardiomyopathy that is precipitated by a stressful emotional or physical event. The increasing incidence is due to the greater use of emergency coronary angiography, newer cardiac biomarkers together with more sensitive cardiac imaging techniques. Few case reports have documented how TCM can present with malignant arrhythmias such as torsades de pointes caused by the repolarisation abnormalities or QTc prolongation. Although TCM is usually considered a benign reversible condition, its associated arrhythmic risk is increasingly recognised. TCM often presents as an acute coronary syndrome with unobstructed coronary arteries at angiography. In this patient population, cardiac magnetic resonance (CMR) is a useful tool to establish a differential diagnosis, discriminating TCM from acute myocarditis and myocardial infarction with spontaneous recanalisation. CMR is becoming a promising new diagnostic modality in risk stratifying patients with potential higher arrhythmic risk.
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Affiliation(s)
- Amardeep Ghosh Dastidar
- NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, BS2 8HW, UK,
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22
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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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23
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Melay M, Oloude E, Hounkpatin B, Ferrier N, Long JL, Croisille P, Marcaggi X. [Atypical MRI image of Tako-Tsubo syndrome: a case report]. Ann Cardiol Angeiol (Paris) 2015; 64:54-58. [PMID: 25281218 DOI: 10.1016/j.ancard.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 08/24/2014] [Indexed: 06/03/2023]
Abstract
Since the 1990s, a new entity cardiomyopathy is described: the Tako-Tsubo syndrome. The Mayo Clinics' criteria have been defined by to help diagnose: LV dysfunction, electrical modifications, and complete recovery. It is a Caucasian woman aged 66 hospitalized for chest pain syndrome occurred during the funeral. In support, we note the presence of STEMI. The patient received the conventional treatment of acute coronary syndrome. Cardiac ultrasound, angiography is in favor of Tako-Tsubo syndrome. MRI shows an unusual location: a delayed enhancement in epicardial associated pericardial effusion mimicking myopericarditis.
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Affiliation(s)
- M Melay
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France.
| | - E Oloude
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - B Hounkpatin
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - N Ferrier
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - J-L Long
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - P Croisille
- Hôpital Nord, service de radiologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - X Marcaggi
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
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Yoon YE, Hong YJ, Kim HK, Kim JA, Na JO, Yang DH, Kim YJ, Choi EY. 2014 korean guidelines for appropriate utilization of cardiovascular magnetic resonance imaging: a joint report of the korean society of cardiology and the korean society of radiology. Korean Circ J 2014; 44:359-85. [PMID: 25469139 PMCID: PMC4248609 DOI: 10.4070/kcj.2014.44.6.359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/17/2014] [Accepted: 10/19/2014] [Indexed: 12/19/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Yoon YE, Hong YJ, Kim HK, Kim JA, Na JO, Yang DH, Kim YJ, Choi EY, The Korean Society of Cardiology and the Korean Society of Radiology. 2014 Korean guidelines for appropriate utilization of cardiovascular magnetic resonance imaging: a joint report of the Korean Society of Cardiology and the Korean Society of Radiology. Korean J Radiol 2014; 15:659-88. [PMID: 25469078 PMCID: PMC4248622 DOI: 10.3348/kjr.2014.15.6.659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 12/18/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 110-744, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
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Heggemann F, Hamm K, Brade J, Streitner F, Doesch C, Papavassiliu T, Borggrefe M, Haghi D. Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography. PLoS One 2014; 9:e103717. [PMID: 25089702 PMCID: PMC4121208 DOI: 10.1371/journal.pone.0103717] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/03/2014] [Indexed: 11/17/2022] Open
Abstract
Aims This study sought to characterize global and regional right ventricular (RV) myocardial function in patients with Takotsubo cardiomyopathy (TC) using 2D strain imaging. Methods We compared various parameters of RV and left ventricular (LV) systolic function between 2 groups of consecutive patients with TC at initial presentation and upon follow-up. Group 1 had RV involvement and group 2 did not have RV involvement. Results At initial presentation, RV peak systolic longitudinal strain (RVPSS) and RV fractional area change (RVFAC) were significantly lower in group 1 (−13.2±8.6% vs. −21.8±5.4%, p = 0.001; 30.7±9.3% vs. 43.5±6.3%, p = 0.001) and improved significantly upon follow-up. Tricuspid annular plane systolic excursion (TAPSE) did not differ significantly at initial presentation between both groups (14.8±4.1 mm vs. 17.9±3.5 mm, p = 0.050). Differences in regional systolic RV strain were only observed in the mid and apical segments. LV ejection fraction (LVEF) and LV global strain were significantly lower in group 1 (36±8% vs. 46±10%, p = 0.006 and −5.5±4.8% vs. −10.2±6.2%, p = 0.040) at initial presentation. None of the parameters were significantly different between the 2 groups upon follow-up. A RVPSS cut-off value of >−19.1% had a sensitivity of 85% and a specificity of 71% to discriminate between the 2 groups. Conclusion In TC, RVFAC, RVPSS, LVEF and LV global strain differed significantly between patients with and without RV dysfunction, whereas TAPSE did not. 2 D strain imaging was feasible for the assessment of RV dysfunction in TC and could discriminate between patients with and without RV involvement in a clinically meaningful way.
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Affiliation(s)
- Felix Heggemann
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karsten Hamm
- Department of Cardiology, Center of Cardiovascular Medicine, Bad Neustadt, Germany
| | - Joachim Brade
- Department of Biometrics and Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florian Streitner
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christina Doesch
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theano Papavassiliu
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dariusch Haghi
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Verschure DO, Somsen GA, van Eck-Smit BLF, Knol RJJ, Booij J, Verberne HJ. Tako-tsubo cardiomyopathy: how to understand possible pathophysiological mechanism and the role of (123)I-MIBG imaging. J Nucl Cardiol 2014; 21:730-8. [PMID: 24464623 DOI: 10.1007/s12350-014-9855-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 12/23/2013] [Indexed: 01/29/2023]
Abstract
Tako-tsubo cardiomyopathy (TCM) is an increasingly recognized clinical syndrome characterized by acute reversible apical ventricular dysfunction, commonly preceded by exposure to severe physical or emotional stress. In this review, we give a short overview on clinical presentation and treatment of TCM and discuss the possible pathophysiological mechanisms of TCM and the role of various non-invasive imaging modalities in TCM with a focus on the potential role of (123)I-meta-iodobenzylguanidine (MIBG) scintigraphy. Currently, the dominating hypothesis on the pathophysiology of TCM postulates that high levels of the neurotransmitter epinephrine may trigger a change in intracellular signaling in ventricular myocytes. More specific, epinephrine stimulates G-protein coupled β2 adenoreceptors (β2AR) which are located on ventricular myocytes. Normal levels of this neurotransmitter predominantly stimulate the intracellular G-protein, and induce a positive inotropic effect. However, with significant increasing levels of epinephrine, the predominance of stimulation is shifted from G-stimulating to the G-inhibitor protein coupling, which leads to a negative inotropic effect. Interestingly, this negative inotropic effect is the largest in the apical myocardium where the β2AR:β1AR ratio is the highest within the heart. Echocardiography and ventriculography are essential to diagnose TCM, but new imaging tools are promising to diagnose TCM and to evaluate therapeutic efficacy. Cardiovascular magnetic resonance can be used to differentiate TCM from other myocardial diseases, such as myocarditis. (123)I-meta-iodobenzylguanidine ((123)I-MIBG) scintigraphy can be used to assess ventricular adrenergic activity and may guide optimization of individual (pharmacological) therapy. These new insights into the possible pathophysiological mechanisms and novel diagnostic imaging modalities can be used as starting point for the development of international guidelines of TCM which may increase the awareness, and optimize the treatment of TCM.
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Affiliation(s)
- Derk O Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, F2-Noord, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome. World J Cardiol 2014; 6:405-414. [PMID: 24976912 PMCID: PMC4072830 DOI: 10.4330/wjc.v6.i6.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/10/2014] [Accepted: 04/19/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
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Kohan AA, Levy Yeyati E, De Stefano L, Dragonetti L, Pietrani M, Perez de Arenaza D, Belziti C, García-Mónaco RD. Usefulness of MRI in takotsubo cardiomyopathy: a review of the literature. Cardiovasc Diagn Ther 2014; 4:138-46. [PMID: 24834411 DOI: 10.3978/j.issn.2223-3652.2013.10.03] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/06/2013] [Indexed: 01/06/2023]
Abstract
Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are critical in the diagnosis and characterization of this pathology. In this review, CMRs role in TC will be evaluated in light of the current available evidence in medical literature, while also revising the clinical and physiopathologic characteristics of TC.
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Affiliation(s)
- Andres Alejandro Kohan
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Ezequiel Levy Yeyati
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Luciano De Stefano
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Laura Dragonetti
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Marcelo Pietrani
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Diego Perez de Arenaza
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Cesar Belziti
- 1 Radiology Department, 2 Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
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Marabotti C, Venturini E, Marabotti A, Pingitore A. Delayed multifocal recurrent stress-induced cardiomyopathy after antidepressants withdrawal. Heart Lung 2014; 43:225-30. [PMID: 24794783 DOI: 10.1016/j.hrtlng.2014.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Abstract
Stress-induced cardiomyopathy is an acute disease characterized by a large left ventricular apical dyskinesia ("apical ballooning"), triggered by intense emotional or physical stress, acute illnesses or, rarely, by alcohol or opiates withdrawal. Connection to stress and apical asynergy suggest a catecholamine-mediated pathogenesis. We recently observed a typical apical stress-induced cardiomyopathy, arising two weeks after a long-lasting antidepressant treatment withdrawal and recurring, a week later, with evidence of inferior wall akinesia. The reported case has several unusual features: 1) both episodes were not preceded by relevant triggering event (except antidepressant discontinuation); 2) early heterozonal relapse was observed; 3) the latency between antidepressant discontinuation and stress-induced cardiomyopathy onset is unusually long. The lack of relevant triggering stress and the evidence of multifocal asynergies could support the hypothesis of a non-catecholaminergic pathogenesis. Moreover, the long latency after antidepressant withdrawal may suggest that prolonged antidepressant treatments may have delayed pathological consequences, possibly related to their known neuroplastic effects.
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Affiliation(s)
- Claudio Marabotti
- CNR Institute of Clinical Physiology, Pisa, Italy; EXTREME CENTRE, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Elio Venturini
- UO Cardiovascolare - UTIC, Ospedale della Bassa val di Cecina, Cecina, Italy
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Yalcinkaya E, Celik M, Yuksel U, Yildirim E, Bugan B. Response to Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension. Clin Cardiol 2013; 36:E32. [DOI: 10.1002/clc.22188] [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: 06/05/2013] [Revised: 06/19/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Emre Yalcinkaya
- Department of Cardiology; Gulhane Military Medical Faculty; Ankara; Turkey
| | - Murat Celik
- Department of Cardiology; Gulhane Military Medical Faculty; Ankara; Turkey
| | - Uygar Yuksel
- Department of Cardiology; Gulhane Military Medical Faculty; Ankara; Turkey
| | - Erkan Yildirim
- Department of Cardiology; Gulhane Military Medical Faculty; Ankara; Turkey
| | - Baris Bugan
- Department of Cardiology; Malatya Army Hospital; Malatya; Turkey
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Sharma A, Chatterjee S, Thakar S, Lichstein E. Apical ballooning in patients with coronary artery disease versus takotsubo cardiomyopathy—A case control study. Int J Cardiol 2013; 166:738-9. [DOI: 10.1016/j.ijcard.2012.09.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022]
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Park JH, Kwon DH, Starling RC, Marwick TH. Role of imaging in the detection of reversible cardiomyopathy. J Cardiovasc Ultrasound 2013; 21:45-55. [PMID: 23837113 PMCID: PMC3701778 DOI: 10.4250/jcu.2013.21.2.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/14/2013] [Accepted: 05/22/2013] [Indexed: 12/19/2022] Open
Abstract
Heart failure is a major clinical problem in developed countries with about half of heart failure patients exhibiting decreased left ventricular systolic function. The correct identification and prompt treatment of some specific etiologies can reverse heart failure, and recognition of myocardial recovery may avoid long-term therapy. However, the echocardiographic patterns of patients with a variety of etiologies of heart failure are similar, so the selective use of other imaging techniques is necessary for identification of specific etiologies. The role of repeat imaging in monitoring the therapeutic response is controversial, as is the cessation of medical therapy in patients demonstrating recovery.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Oh, USA. ; Cardiology Division of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
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Athanasiadis A, Schneider B, Sechtem U. Role of Cardiovascular Magnetic Resonance in Takotsubo Cardiomyopathy. Heart Fail Clin 2013; 9:167-76, viii. [DOI: 10.1016/j.hfc.2012.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Jouhra F, Dworakowski R, MacCarthy P. Atypical form of Takotsubo cardiomyopathy. BMJ Case Rep 2013; 2013:bcr-2012-008376. [PMID: 23420733 DOI: 10.1136/bcr-2012-008376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Fadi Jouhra
- Department of Cardiology, King's College Hospital, London, UK.
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Abstract
Takotsubo cardiomyopathy (TTC) is an increasingly recognized, reversible cardiomyopathy with a clinical presentation that mimics an acute coronary syndrome but without evidence of obstructive coronary lesions. Typical presentation involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram, and a modest increase in cardiac troponin. Cardiac imaging demonstrates wall-motion abnormalities that extend beyond the territory of a single epicardial coronary artery, and the absence of obstructive coronary lesions. Supportive treatment leads to spontaneous, rapid recovery of ventricular function, but about 10% of patients have recurrent events. This article reviews the defining features and clinical profile of TTC.
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Perazzolo Marra M, Zorzi A, Corbetti F, De Lazzari M, Migliore F, Tona F, Tarantini G, Iliceto S, Corrado D. Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Tako-Tsubo cardiomyopathy. Heart Rhythm 2012; 10:70-7. [PMID: 22975421 DOI: 10.1016/j.hrthm.2012.09.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tako-Tsubo cardiomyopathy (TTC) presents with chest pain, ST-segment elevation followed by T-wave inversion and QT interval prolongation (Wellens' electrocardiographic [ECG] pattern), and left ventricular dysfunction, which may mimic an acute coronary syndrome. OBJECTIVE To assess the pathophysiologic basis of the Wellens' ECG pattern in TTC by characterization of underlying myocardial changes by using cardiac magnetic resonance (CMR). METHODS The study population included 20 consecutive patients with TTC (95% women; mean age 65.3 ± 10.4 years) who underwent CMR studies both in the initial phase and after 3-month follow-up by using a protocol that included cine images, T2-weighted sequences for myocardial edema, and post-contrast sequences for late gadolinium enhancement. Quantitative ECG indices of repolarization, such as maximal amplitude of negative T waves, sum of the amplitudes of negative T waves, and maximum corrected QT interval (QTc max), were correlated to CMR findings. RESULTS At the time of initial CMR study, there was a significant linear correlation between the apicobasal ratio of T2-weighted signal intensity for myocardial edema and the maximal amplitude of negative T waves (ρ = 0.498; P = .02), sum of the amplitudes of negative T waves (ρ = 0.483; P = .03), and maximum corrected QT interval (ρ = 0.520; P = .02). Repolarization indices were unrelated to either late gadolinium enhancement or quantitative cine parameters. Wellens' ECG abnormalities and myocardial edema showed a parallel time course of development and resolution on initial and follow-up CMR studies. CONCLUSIONS Our study results show that the ischemic-like Wellens' ECG pattern in TTC coincides and quantitatively correlates with the apicobasal gradient of myocardial edema as evidenced by using CMR. Dynamic negative T waves and QTc prolongation are likely to reflect the edema-induced transient inhomogeneity and dispersion of repolarization between apical and basal left ventricular regions.
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Friedrich MG, Cocker MS. Stress-induced cardiomyopathy: a syndrome of the susceptible patient? Expert Rev Cardiovasc Ther 2012; 10:271-3. [PMID: 22390796 DOI: 10.1586/erc.12.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aborted Myocardial Infarction: Evaluation of Changes in Area at Risk, Late Gadolinium Enhancement, and Perfusion Over Time and Comparison With Overt Myocardial Infarction. AJR Am J Roentgenol 2012; 199:328-35. [DOI: 10.2214/ajr.11.6765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ilhan E, Gurkan U, Yilmaz HY, Guvenc TS, Canga Y, Bolca O. Takotsubo cardiomyopathy resembling acute high lateral myocardial infarction. Ann Saudi Med 2012; 32:424-6. [PMID: 22705617 PMCID: PMC6081026 DOI: 10.5144/0256-4947.2012.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 65-year-old female patient admitted to the emergency department was diagnosed with acute high lateral myocardial infarction, but later Takotsubo cardiomyopathy (TC) was discovered. She had squeezing chest pain that started shortly after an emotional stress. The electrocardiogram revealed a loss of R wave voltage in leads V1 to V4 and an ST-segment elevation in I and aVL. After an urgent coronary angiography and ventriculography, TC was considered, and supportive anti-ischemic treatment was started. The severe left ventricular systolic dysfunction improved and normalized during the follow-up. She was discharged without any complications. TC is a new entity of acute cardiac events, and patients usually recover completely without sequelae with proper diagnosis and management. An exact diagnosis may also prevent an inappropriate application in the setting of recurrences.
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Affiliation(s)
- Erkan Ilhan
- Department of Cardiology, Cardiovascular and Thoracic Surgery Training and Research Hospital, Tibbiye Caddesi, Haydarpasa, Istanbul, Turkey.
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Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz 2012; 35:240-3. [PMID: 20582391 DOI: 10.1007/s00059-010-3339-x] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Tako-Tsubo cardiomyopathy (TTC) is a reversible cardiomyopathy with a clinical presentation indistinguishable from myocardial infarction. TTC is estimated to represent 1%-2% of patients presenting with acute myocardial infarction. It most commonly occurs in postmenopausal women and is frequently precipitated by a stressful event. Chest pain and dyspnea are the typical presenting symptoms. Transient ST-segment elevation on ECG and a small rise in cardiac biomarkers are common. Characteristic wall motion abnormalities extend beyond the territory of a single epicardial coronary artery in the absence of obstructive coronary lesions. Supportive treatment leads to spontaneous rapid recovery in nearly all patients. The prognosis is excellent, and recurrence occurs in < 10% of patients. In this article, we review the clinical features of TTC that form the basis of the Mayo Clinic diagnostic criteria, as well as the long-term prognosis for this type of cardiomyopathy.
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Affiliation(s)
- M Madhavan
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, 55905, Rochester, Minnesota, USA
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Saller A, De Stefano F, Allemand E, Bigolin P, Realdi G, Fabris F. Broken heart in elderly patients: two clinical observations. Aging Clin Exp Res 2012; 24:97-103. [PMID: 22643308 DOI: 10.1007/bf03325357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tako-tsubo cardiomyopathy (idiopathic or transient left ventricular apical ballooning syndrome [ABS]) is a reversible condition frequently precipitated by a stressful trigger that clinically mimics an acute ST-elevation myocardial infarction. Characteristically, hypokinesis or akinesis occurs in the mid- and apical segments of the left ventricle in the absence of epicardial coronary lesions. Preserved or hyperdynamic function of the basal myocardial segments results in apical ballooning, assuming the shape of a Japanese pot used to catch octopus (a takotsubo). We report on 2 well over 70 years old women (78 and 82 years) admitted to the emergency room with chest pain. Clinical signs, ECG alterations and high troponin I in both patients imposed urgent diagnostic testing and management. The electrocardiographic findings were consistent with acute myocardial infarction and transthoracic echocardiography showed in both simultaneous apical akinesia and a hyperkinetic basal area with a moderately reduced left ventricular ejection fraction. Coronary angiography, performed on an emergency basis, in both cases revealed minimal luminal irregularities, with no evidence of plaque rupture or thrombus. The wall motion abnormality extended beyond the distribution of any single coronary artery, making it less likely that an occlusive thrombus had spontaneously dissolved or that intermittent vasospasm had occurred. Taken together, these findings were consistent with ABS, and critical observations on coronary angiography indicated the diagnosis by exclusion. The patients were seen in the clinic 4 weeks after discharge. They had had no recurrent chest pain, and had returned to the normal life they had had before the cardiovascular event. A repeat echocardiography showed a normalized estimated ejection fraction in both patients. ABS is a diagnosis of exclusion and its incidence is probably underestimated in elderly patients in whom coronary angiography is not common.
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Haghi D, Hamm K, Heggemann F, Walter T, Suselbeck T, Papavassiliu T, Borggrefe M. Coincidence of coronary artery disease and Tako-Tsubo cardiomyopathy. Herz 2011; 35:252-6. [DOI: 10.1007/s00059-011-3447-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Naruse Y, Sato A, Kasahara K, Makino K, Sano M, Takeuchi Y, Nagasaka S, Wakabayashi Y, Katoh H, Satoh H, Hayashi H, Aonuma K. The clinical impact of late gadolinium enhancement in Takotsubo cardiomyopathy: serial analysis of cardiovascular magnetic resonance images. J Cardiovasc Magn Reson 2011; 13:67. [PMID: 22035445 PMCID: PMC3215669 DOI: 10.1186/1532-429x-13-67] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 10/29/2011] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Our study aimed to investigate both the clinical implications of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) and the relation of LGE to clinical findings in patients with Takotsubo cardiomyopathy (TTC). METHODS We evaluated 20 consecutive patients (2 men, 18 women; median age, 77 years; interquartile range [IQR] 67-82 years) who were admitted to our hospital with the diagnosis of TTC. CMR was performed within 1 week after admission, and follow-up studies were conducted 1.5 and 6 months later. RESULTS In 8 patients, CMR imaging during the sub-acute phase revealed LGE in the area matched with wall motion impairment. Cardiogenic shock was more frequently observed in patients with LGE than in those without LGE (38% vs 0%, p = 0.049). The patients with LGE needed a longer duration for ECG normalization and recovery of wall motion than did those without LGE (median 205 days, IQR [152-363] vs 68 days, [43-145], p = 0.005; 15 days, [10-185] vs 7 days, [4-13], p = 0.030, respectively). In 5 of these 8 patients, LGE disappeared within 45-180 days (170, IQR [56-180]) of onset. The patients with LGE remaining in the chronic phase had higher peak creatine kinase levels than did those without LGE (median 307 IU/L, IQR [264-460] vs 202 IU/L, [120-218], p = 0.017). CONCLUSION LGE by CMR in the sub-acute phase may be associated with the severity and prolonged recovery to normal of clinical findings in TTC.
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Affiliation(s)
- Yoshihisa Naruse
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Akira Sato
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazuyuki Kasahara
- Department of Cardiology, Seirei Mikatahara Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka 433-8575, Japan
| | - Kiwa Makino
- Department of Cardiology, Seirei Mikatahara Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka 433-8575, Japan
| | - Makoto Sano
- Department of Cardiology, Seirei Mikatahara Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka 433-8575, Japan
| | - Yasuyo Takeuchi
- Department of Cardiology, Seirei Mikatahara Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka 433-8575, Japan
| | - Shiro Nagasaka
- Department of Cardiology, Seirei Mikatahara Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka 433-8575, Japan
| | - Yasushi Wakabayashi
- Department of Cardiology, Seirei Mikatahara Hospital, 3453 Mikatahara, Hamamatsu, Shizuoka 433-8575, Japan
| | - Hideki Katoh
- Internal Medicine III, Hamamatsu University School of Medicine: 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan
| | - Hiroshi Satoh
- Internal Medicine III, Hamamatsu University School of Medicine: 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan
| | - Hideharu Hayashi
- Internal Medicine III, Hamamatsu University School of Medicine: 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Castillo Rivera AM, Ruiz-Bailén M, Rucabado Aguilar L. Takotsubo cardiomyopathy--a clinical review. Med Sci Monit 2011; 17:RA135-47. [PMID: 21629203 PMCID: PMC3539553 DOI: 10.12659/msm.881800] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.
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Affiliation(s)
- Ana María Castillo Rivera
- Department of Critical Care and Emergency, Intensive Medicine Unit, Jaén Hospital Complex, Jaén, Spain.
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Avegliano G, Huguet M, Costabel JP, Ronderos R, Bijnens B, Kuschnir P, Thierer J, Tobón-Gomez C, Martinez GO, Frangi A. Morphologic pattern of late gadolinium enhancement in Takotsubo cardiomyopathy detected by early cardiovascular magnetic resonance. Clin Cardiol 2011; 34:178-82. [PMID: 21400545 DOI: 10.1002/clc.20877] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) presents clinically as an acute coronary syndrome. It is characterized by transient left ventricular wall dyskinesis-akinesis, without significant epicardial coronary lesions. Late gadolinium enhancement (LGE) sequences on cardiac magnetic resonance (CMR) allow to clarify the pathophysiology in patients with chest pain, elevated troponin, and normal epicardial coronary arteries; in patients with TTC, previous studies have shown absence of LGE. HYPOTHESIS Early CMR in Takotsubo patients could show a morphological pattern of LGE improving clinical diagnosis. METHODS Between January 2005 and January 2007, 8 consecutive patients with TTC criteria underwent CMR within the first 3 days of admission. Cine, T2-weighted, and LGE images were acquired. Patient follow-up included clinical exam and imaging techniques: echocardiogram on days 3, 7, 30, and 60, and CMR at 3 months. RESULTS Six patients had experienced a previous stressful situation. No significant lesions were found on coronary angiography, and wall motion improvement was noted at 15 (7-30) days. Median EFs at admission and recovery were 46.5% and 65%, respectively. Dyskinesis was midapical in 6 cases, apical in 1 case, and mid-ventricular in 1 case. Late gadolinium enhancement showed mild hyperenhancement in areas of abnormal wall motion, whereas normal segments had no contrast enhancement. On follow-up CMR, wall motion was normal without late enhancement. CONCLUSIONS Early CMR in TTC demonstrates a special morphological pattern of late gadolinium uptake that might correspond to localized inflammation and edema in the affected area, suggesting diffuse microcirculation damage rather than epicardial vessel involvement.
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Regional wall motion abnormality in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): importance of biplane left ventriculography for differentiating from spontaneously aborted anterior myocardial infarction. Int J Cardiovasc Imaging 2011; 28:687-94. [PMID: 21688133 DOI: 10.1007/s10554-011-9911-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 06/11/2011] [Indexed: 01/29/2023]
Abstract
Understanding the precise distribution of the regional wall motion abnormality (RWMA) in apical ballooning syndrome (ABS) is important because the cardiomyopathy can mimic an acute anterior ST-elevation myocardial infarction (STEMI). The aim of the study was to quantify the severity and distribution of RWMA in ABS, compare it to anterior STEMI, and correlate with clinical features. RWMA (normal = 1, hypokinetic = 2, akinetic = 3) was quantified from the biplane left ventriculogram using a nine-segment model in 95 ABS and 17 anterior STEMI patients at the time of their presentation. Regional wall motion score index (RWMSI) was higher in ABS [2.1 (1.9, 2.1)] compared to anterior STEMI [2.0 (1.8, 2.0)], P = 0.024]. The region that most clearly differentiated ABS from anterior STEMI was the posterolateral segment (sensitivity 81% and specificity 100%) which was hypocontractile in 81% of ABS, but none of the STEMI patients (P < 0.001). RWMSI in ABS had a modest positive correlation with the troponin T levels (r = 0.23, P = 0.029). Patients with ABS with ST-segment elevation had the highest RWMSI [2.1(2.0, 2.2)], while those with non specific changes had the lowest [1.9 (1.8, 2.1)] (P = 0.007). In conclusion, patients with ABS have greater and more diffuse RWMA compared to anterior STEMI. The presence of systolic dysfunction in the posterolateral segment in the left anterior oblique projection of the left ventriculogram most accurately distinguishes ABS from an anterior STEMI highlighting the utility of biplane angiography for this purpose. The severity of RWMA correlates with the extent of troponin release and ECG abnormality.
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