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Laghlam D, Touboul O, Herry M, Estagnasié P, Dib JC, Baccouche M, Brusset A, Nguyen LS, Squara P. Takotsubo cardiomyopathy after cardiac surgery: A case-series and systematic review of literature. Front Cardiovasc Med 2023; 9:1067444. [PMID: 36704455 PMCID: PMC9871635 DOI: 10.3389/fcvm.2022.1067444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Background Takotsubo cardiomyopathy (TTC) is a rare entity after cardiac surgery. Aims To describe patients' profile who developed postoperative TTC after cardiac surgery, management, and outcomes. Methods We performed a systematic literature search to extract cases of TTC after adult cardiac surgery (from 1990 to 2021). Additionally, we extracted all cases of TTC in a prospective single-center cohort database of 10,000+ patients (from 2007 to 2019). We then combined all cases in a single cohort to describe its clinical features. Results From 694 screened articles, we retained 71 individual cases published in 20 distinct articles (19 cases reports and 1 case-series). We combined these to 10 cases extracted from our cohort [among 10,682 patients (0.09%)]. Overall, we included 81 cases. Patients were aged 68 ± 10 years-old and 64/81 (79%) were women. Surgery procedures included mitral valve and/or tricuspid valve surgery in 70/81, 86%. TTC was diagnosed in the first days after surgery [median 4 (1-4) days]. Incidence of cardiogenic shock, defined as requirement of vasopressor and/or inotropic support was 24/29, 83% (data available on 29/81 patients). Refractory cardiogenic appeared in 5/81, 6% who required implantation of arterio-venous extra-corporeal membrane oxygenation, and 6/81, 7%, intra-aortic balloon pump. In-hospital mortality was 5/81, 6%. Conclusion This systematic review, based on case reports and case series, showed that postoperative TTC appears as a rare complication after cardiac surgery and mainly occurred after mitral and/or tricuspid valve repair procedures. In this population, TTC is associated with high rate of cardiogenic shock.
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Safdar A, Ahmed T, Liu VY, Addoumieh A, Agha AM, Giza DE, Balanescu DV, Donisan T, Dayah T, Lopez-Mattei JC, Kim PY, Hassan S, Karimzad K, Palaskas N, Tsai JY, Iliescu GD, Yang EH, Herrmann J, Marmagkiolis K, Angelini P, Iliescu CA. Trigger related outcomes of takotsubo syndrome in a cancer population. Front Cardiovasc Med 2022; 9:1019284. [PMID: 36386379 PMCID: PMC9651211 DOI: 10.3389/fcvm.2022.1019284] [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: 08/14/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023] Open
Abstract
Background Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied. Objectives The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS. Methods All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to the TTS trigger. The groups were compared with regards to major adverse cardiac events, overall survival and recovery of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after TTS presentation. Results Eighty one of the 373 cancer patients who presented with ACS met the Mayo criteria for TTS. The triggering event was determined to be "cancer specific triggers" (use of chemotherapy in 23, immunomodulators use in 7, and radiation in 4), and "traditional triggers" (medical triggers 22, and procedural 18 and emotional stress in 7). Of the 81 patients, 47 died, all from cancer-related causes (no cardiovascular mortality). Median survival was 11.9 months. Immunomodulator (IM) related TTS and radiation related TTS were associated with higher mortality during the follow-up. Patients with medical triggers showed the least recovery in LVEF and GLS while patients with emotional and chemotherapy triggers, showed the most improvement in LVEF and GLS, respectively. Conclusion Cancer patients presenting with ACS picture have a high prevalence of TTS due to presence of traditional and cancer specific triggers. Survival and improvement in left ventricular systolic function seem to be related to the initial trigger for TTS.
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Affiliation(s)
- Ayesha Safdar
- Department of Medicine, Army Medical College, Rawalpindi, Pakistan
| | - Talha Ahmed
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Victor Y. Liu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Antoine Addoumieh
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ali M. Agha
- Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dana E. Giza
- Department of Family and Community Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Dinu V. Balanescu
- Department of Family and Community Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tariq Dayah
- Department of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Juan C. Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Y. Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - January Y. Tsai
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gloria D. Iliescu
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Eric H. Yang
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Joerg Herrmann
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiovascular Medicine, Florida Hospital Pepin Heart Institute, Tampa, FL, United States
| | - Paolo Angelini
- Department of Cardiology, Texas Heart Institute, Houston, TX, United States
| | - Cezar A. Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Cezar A. Iliescu,
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Kim YS, Lim JY. Risk factors for Takotsubo syndrome following cardiac surgery: A case-control study. J Card Surg 2021; 36:2767-2773. [PMID: 33993525 DOI: 10.1111/jocs.15626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/13/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Takotsubo syndrome following cardiac surgery is a rare occurrence. However, early diagnosis is essential to prevent treatment which could increase the left ventricular outflow tract pressure gradient in patients with Takotsubo syndrome, and lead to cardiogenic shock. Therefore, our study aimed to identify the incidence of Takotsubo syndrome after cardiopulmonary bypass and the associated risk factors and prognosis. METHODS We retrospectively studied 5773 patients who underwent cardiopulmonary bypass between February 2007 and July 2017. Among these, Takotsubo syndrome was diagnosed in 52 (0.9%). To evaluate the risk factors for Takotsubo syndrome, 104 of the remaining 5721 patient were randomly selected as the control group (1:2 ratio). Univariate and multivariate logistic regression analyses were used for risk factor analysis. RESULTS Majority of patients (69.2%) in the Takotsubo syndrome group underwent mitral valve surgery, compared with 32.7% in the control group. The following risk factors of Takotsubo syndrome were identified: atrio-ventricular valve surgery (odds ratio (OR) 10.5; 95% confidence interval (CI), 2.6-42.5; p = 0.001); and the immediate postoperative use of epinephrine (OR, 3.3; 95% CI, 1.0-10.7; p = 0.05) and dobutamine (OR, 4.8; 95% CI, 1.72-13.3; p = 0.003). Hypertension was a significant protective factor against Takotsubo syndrome following cardiac surgery (OR, 0.22; 95% CI, 0.06-0.73; p = 0.01). CONCLUSION Takotsubo syndrome following cardiac surgery is rare. Immediate postoperative use of epinephrine and doputamine, as well as atrio-ventricular valve surgery were factors associated with the development of Takotsubo syndrome.
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Affiliation(s)
- Yun Seok Kim
- Departments of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Ju Yong Lim
- Departments of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
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Devesa A, Hernández-Estefanía R, Tuñón J, Aceña Á. Takotsubo syndrome after mitral valve surgery: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33442643 PMCID: PMC7793183 DOI: 10.1093/ehjcr/ytaa327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery. CASE SUMMARY We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery. DISCUSSION Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.
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Affiliation(s)
- Ana Devesa
- Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Católicos 2, 28040 Madrid, Spain
| | - Rafael Hernández-Estefanía
- Department of Cardiac Surgery, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Católicos 2, 28040 Madrid, Spain
| | - José Tuñón
- Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Católicos 2, 28040 Madrid, Spain
- Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Católicos 2, 28040 Madrid, Spain
- Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
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Choi JH, Oh ID, Shin E, Lee S, Jeon JM, Kim HT, Youn HC. Extracorporeal membrane oxygenation for takotsubo cardiomyopathy that developed after mitral valve replacement. Acute Crit Care 2019; 35:51-55. [PMID: 31743637 PMCID: PMC7056952 DOI: 10.4266/acc.2018.00304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022] Open
Abstract
Takotsubo cardiomyopathy is a transient systolic and diastolic left ventricular dysfunction that presents several wall-motion abnormalities, while the coronary artery shows normal findings. Because patients with Takotsubo cardiomyopathy present with symptoms similar to acute coronary syndrome, the initial diagnosis and treatment are often difficult. The condition is often precipitated by acute emotional or physical stress and frequently occurs in postmenopausal women. Takotsubo cardiomyopathy may also occur in the perioperative period after cardiac and noncardiac surgery; surgery-associated Takotsubo cardiomyopathy reportedly accounts for 3%–23% of all cases. Of these perioperative cases, cardiothoracic surgery accounted for 16%. However, few cases have been reported in patients undergoing cardiac surgery and managed with extracorporeal membrane oxygenation (ECMO). We report a case of Takotsubo cardiomyopathy managed with ECMO in a patient in the intensive care unit after mitral valve replacement.
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Affiliation(s)
- Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - In Duk Oh
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eunsil Shin
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jong-Mi Jeon
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyung-Tak Kim
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
| | - Hyo-Chul Youn
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Koehne J, Dix S, Walther T, Holubec T. Emergency off-pump CABG in a patient with Takotsubo cardiomyopathy and coronary artery disease. J Card Surg 2017; 32:702-703. [PMID: 29169201 DOI: 10.1111/jocs.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Josepha Koehne
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Stephan Dix
- Department of Anesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Tomas Holubec
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
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