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Ghasemi H, Kazemian S, Nejadghaderi SA, Shafie M. Takotsubo syndrome and COVID‐19: A systematic review. Health Sci Rep 2023; 6:e972. [PMID: 36479387 PMCID: PMC9718950 DOI: 10.1002/hsr2.972] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is characterized by acute and transient left ventricular dysfunction and has increased during the COVID-19 pandemic. Herein, we aim to review studies on TTS that were associated with COVID-19 infection, vaccine, and other COVID-19-related etiologies including psychosocial stressors. Methods We systematically searched PubMed, EMBASE, and Scopus up to May 12, 2022. We included case reports, case series, and original articles that reported at least one TTS case associated with COVID-19, or TTS cases after receiving COVID-19 vaccines, or TTS cases secondary to psychological stress due to the COVID-19 pandemic. The quality assessment was conducted using the Joanna Briggs Institute checklist. Results Sixty-seven articles including 102 cases were included. Hypertension was the most frequently accompanying comorbidity (N = 67 [65.6%]) and the mean left ventricular ejection fraction was 36.5%. Among COVID-19 patients, the in-hospital mortality rate was 33.3%. On the other hand, only one COVID-19-negative individual expired (2.3%). The most common presenting clinical symptom was dyspnea in 42 (73.6%) patients. the mean time interval from the first symptom to admission was 7.2 days. The most common chest imaging finding was ground-glass opacity which was reported in 14 (31.1%) participants. The most common abnormalities were T-wave inversion in 35 (43.2%) and ST-segment elevation in 30 (37%). Brain natriuretic peptide and troponin were elevated in 94.7% and 95.9% of participants, respectively. Conclusion The TTS in patients with COVID-19 is almost rare, whereas it could lead to a great mortality and morbidity. An individual with COVID-19, especially an elderly woman, presented with dyspnea in addition to a rise in brain natriuretic peptide and troponin should be evaluated for TTS.
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Affiliation(s)
- Hoomaan Ghasemi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
| | - Sina Kazemian
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Seyed Aria Nejadghaderi
- Research Center for Integrative Medicine in Aging, Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Systematic Review and Meta‐Analysis Expert Group (SRMEG) Universal Scientific Education and Research Network (USERN) Tehran Iran
| | - Mahan Shafie
- School of Medicine Tehran University of Medical Sciences Tehran Iran
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Moady G, Atar S. Stress-Induced Cardiomyopathy—Considerations for Diagnosis and Management during the COVID-19 Pandemic. Medicina (B Aires) 2022; 58:medicina58020192. [PMID: 35208516 PMCID: PMC8875249 DOI: 10.3390/medicina58020192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is associated with several cardiovascular manifestations including myocardial injury, myocarditis, arrhythmia, and pulmonary embolism. Rare cases of stress-induced cardiomyopathy, or takotsubo syndrome have also been reported during the acute infection, and secondary to stress following lockdown and self-isolation. Diagnosis in the setting of the acute infection is challenging since conventional imaging modalities such as transthoracic echocardiography and coronary angiography should be restricted to minimize physician-patient contact until the patients is tested negative for COVID-19. The use of point of care hand-held ultrasound is appropriate for this purpose. The overall course of the disease seems to be similar to takotsubo in the general population. Physicians should be familiar with the clinical presentation, possible complications, and management of takotsubo during COVID-19 outbreak. Here, we review the special considerations in the diagnosis and management of takotsubo syndrome during the current pandemic.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya 2221006, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
- Correspondence: ; Tel.: +972-4-9107273
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya 2221006, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
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Techasatian W, Nishimura Y, Nagamine T, Ha G, Huang R, Shah P, Yeo J, Kanitsoraphan C. Characteristics of Takotsubo cardiomyopathy in patients with COVID-19: Systematic scoping review. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100092. [PMID: 35128499 PMCID: PMC8802667 DOI: 10.1016/j.ahjo.2022.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 12/01/2022]
Abstract
Background COVID-19 has recently been associated with the development of Takotsubo cardiomyopathy (TCM). This scoping review aims to summarize the existing evidence regarding TCM in COVID-19 and offer future direction for study. Methods Following the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including “Takotsubo”, “Stress-induced cardiomyopathy” and “COVID-19” from their inception to September 25, 2021. Results A total of 40 articles with 52 cases were included. Patients with TCM and COVID-19 showed only slight female predominance (59.6%), median age of 68.5 years, and were mostly of the apical subtype (88.6%). All-cause mortality was 36.5%. The median LVEF was 30%. Compared to those without TCM, those with TCM in COVID-19 had more critical illness, higher mortality, lower LVEF, and higher cardiac and inflammatory biomarkers. Notably, the diagnostic criteria of TCM were considerably different between case reports and observational studies. Conclusion This scoping review identifies that TCM in COVID-19 may have distinct features that distinguish this condition from TCM without COVID-19. Future studies are warranted to help describe risk factors, determine the utility of inflammatory biomarkers and serum catecholamine levels, and establish disease-specific diagnostic criteria.
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Moady G, Atar S. Takotsubo syndrome during the COVID-19 pandemic, state-of -the- art review. CJC Open 2021; 3:1249-1256. [PMID: 34056570 PMCID: PMC8149464 DOI: 10.1016/j.cjco.2021.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
The current coronavirus disease 2019 (COVID-19) presents an ongoing medical challenge, as it involves multiple organs, including the cardiovascular system. Takotsubo syndrome (TTS) has been described in the context of COVID-19 in 2 different scenarios: as a direct complication of the infection, and as an indirect outcome secondary to the psychological burden of quarantine and social isolation (ie, stress-induced cardiomyopathy). Confirming the diagnosis of TTS in COVID-19 may be challenging due to the limited use of coronary angiography consistent with the recommended guidelines aimed at minimizing contact with infected individuals. The use of natriuretic peptide as a diagnostic and prognostic marker in this context may not be reliable as this peptide is already elevated in severe cases of COVID-19 regardless of TTS diagnosis. A relatively high incidence of complications has been reported in these cases, probably related to the severity of the underlying infectious disease. Although quarantine-induced stress cardiomyopathy is an unsurprising outcome of the powerful stress resulting from the current pandemic, conflicting results have been reported, and further studies are encouraged to determine the true incidence.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Almas T, Khedro T, Haadi A, Ahmed R, Alshaikh L, Al-Awaid AH, Panhwar MS, Hassan Virk HU. COVID-19-induced takotsubo cardiomyopathy: Venturing beyond the obvious. Ann Med Surg (Lond) 2021; 65:102291. [PMID: 33981423 PMCID: PMC8082200 DOI: 10.1016/j.amsu.2021.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Abdul Haadi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Reema Ahmed
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lamees Alshaikh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Muhammad Siyab Panhwar
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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6
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John K, Lal A, Mishra A. A review of the presentation and outcome of takotsubo cardiomyopathy in COVID-19. Monaldi Arch Chest Dis 2021; 91. [PMID: 33759445 DOI: 10.4081/monaldi.2021.1710] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/23/2021] [Indexed: 12/26/2022] Open
Abstract
Although the most frequent presentation of the novel Coronavirus disease-2019 (COVID-19) is a respiratory syndrome, cardiac involvement is being increasingly recognized. One such entity is takotsubo cardiomyopathy. We sought to review the various cases of takotsubo cardiomyopathy reported during the COVID-19 pandemic and consolidate the information available on its clinical features, evaluation and treatment. We performed a PubMed search using the MeSH terms "Takotsubo Cardiomyopathy" or "Stress Cardiomyopathy" and "COVID-19", and identified 16 case reports, two case series, and one retrospective cohort study. There was a total of 24 reported patients with COVID-19 infection, who developed takotsubo cardiomyopathy, and two patients without COVID-19 who developed takotsubo cardiomyopathy due to the emotional stress associated with the global pandemic. The mean age of the patients was 67.19 years (SD 15.83) and 16(59.3%) were women. Chest pain was reported in only ten patients (38.46 %) and ST-elevation was seen in 11 patients (42.3%). While most patients had typical takotsubo cardiomyopathy, four patients had inverted(reverse) takotsubo cardiomyopathy, two had bi-ventricular involvement, one had median takotsubo and another had global takotsubo with apical sparing variant. Most patients had a positive outcome with complete or near-complete reversal of cardiac dysfunction at the time of discharge. Five deaths (19.23%) were reported. Takotsubo cardiomyopathy is a rare, but increasingly reported reversible cardiomyopathy that can be seen in patients with COVID-19 infection and the diagnosis must be actively sought for in these patients.
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Affiliation(s)
- Kevin John
- Department of Critical Care, Bangalore Baptist Hospital, Bellary Road, Hebbal, Bengaluru, Karnataka.
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN.
| | - Ajay Mishra
- Department of Medicine, Saint Vincent Hospital, Worcester, MA.
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Catapano F, Marchitelli L, Cundari G, Cilia F, Mancuso G, Pambianchi G, Galea N, Ricci P, Catalano C, Francone M. Role of advanced imaging in COVID-19 cardiovascular complications. Insights Imaging 2021; 12:28. [PMID: 33625637 PMCID: PMC7903405 DOI: 10.1186/s13244-021-00973-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/28/2021] [Indexed: 01/08/2023] Open
Abstract
Clinical manifestations of COVID-19 patients are dominated by respiratory symptoms, but cardiac complications are commonly observed and associated with increased morbidity and mortality. Underlying pathological mechanisms of cardiac injury are still not entirely elucidated, likely depending on a combination of direct viral damage with an uncontrolled immune activation. Cardiac involvement in these patients ranges from a subtle myocardial injury to cardiogenic shock. Advanced cardiac imaging plays a key role in discriminating the broad spectrum of differential diagnoses. Present article aims to review the value of advanced multimodality imaging in patients with suspected SARS-CoV-2-related cardiovascular involvement and its essential role in risk stratification and tailored treatment strategies. Based on our experience, we also sought to suggest possible diagnostic algorithms for the rationale utilization of advanced imaging tools, such as cardiac CT and CMR, avoiding unnecessary examinations and diagnostic delays.
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Affiliation(s)
- Federica Catapano
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giuseppe Mancuso
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
- Unit of Emergency Radiology, Policlinico Umberto I, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Kow CS, Hasan SS. Neurohormonal treatment in tako-tsubo cardiomyopathy precipitated by COVID-19. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2021; 74:200-201. [PMID: 32962968 PMCID: PMC7502002 DOI: 10.1016/j.rec.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
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9
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Kow CS, Hasan SS. [Neurohormonal treatment in tako-tsubo cardiomyopathy precipitated by COVID-19]. Rev Esp Cardiol 2020; 74:200-201. [PMID: 33012950 PMCID: PMC7524657 DOI: 10.1016/j.recesp.2020.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malasia
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, Reino Unido.,School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia
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