Assessment with intracoronary pressure and flow guidewire, at baseline and after intracoronary adenosine infusion, in a patient with Takotsubo syndrome

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

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Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm10153235 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3235

Author(s):

Davide Di Vece ◽

Angelo Silverio ◽

Michele Bellino ◽

Gennaro Galasso ◽

Carmine Vecchione ◽

...

Keyword(s):

Cardiogenic Shock ◽

Systolic Function ◽

Hemodynamic Instability ◽

Left Ventricular ◽

Takotsubo Syndrome ◽

Benign Condition ◽

Coronary Syndrome ◽

Lv Dysfunction ◽

Appropriate Therapy ◽

Selection Of

Takotsubo syndrome (TTS) is characterized by acute, generally transient left ventricular (LV) dysfunction. Although TTS has been long regarded as a benign condition, recent evidence showed that rate of acute complications and in-hospital mortality is comparable to that of patients with acute coronary syndrome. In particular, the prevalence of cardiogenic shock ranges between 6% and 20%. In this setting, detection of mechanisms leading to cardiogenic shock can be challenging. Besides a severely impaired systolic function, onset of LV outflow tract obstruction (LVOTO) together with mitral regurgitation related to systolic anterior motion of mitral valve leaflets can lead to hemodynamic instability. Early identification of LVOTO with echocardiography is crucial and has important implications on selection of the appropriate therapy. Application of short-acting b1-selective betablockers and prudent administration of fluids might help to resolve LVOTO. Conversely, inotrope agents may increase basal hypercontractility and worsen the intraventricular pressure gradient. To date, outcomes and management of patients with TTS complicated by LVOTO as yet has not been comprehensively investigated.

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Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

Clinical Research in Cardiology ◽

10.1007/s00392-021-01857-4 ◽

2021 ◽

Author(s):

Yoichi Imori ◽

Ken Kato ◽

Victoria L. Cammann ◽

Konrad A. Szawan ◽

Manfred Wischnewsky ◽

...

Keyword(s):

Hospital Mortality ◽

Clinical Characteristics ◽

Ethnic Disparities ◽

Japanese Patients ◽

Learning Approach ◽

Takotsubo Syndrome ◽

Unique Identifier ◽

Hospital Outcomes ◽

Machine Learning Approach ◽

The Impact

Abstract Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers. Trial Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01947621.

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Takotsubo syndrome after mitral valve surgery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa327 ◽

2020 ◽

Author(s):

Ana Devesa ◽

Rafael Hernández-Estefanía ◽

José Tuñón ◽

Álvaro Aceña

Keyword(s):

Mitral Valve ◽

Fatal Outcome ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Lv Function ◽

Partial Recovery ◽

Takotsubo Syndrome ◽

Left Circumflex Artery ◽

Coronary Syndrome

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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Ventilatory effects of hypoxia and adenosine infusion in patients after bilateral carotid endarterectomy

Clinical Science ◽

10.1042/cs0780025 ◽

1990 ◽

Vol 78 (1) ◽

pp. 25-31 ◽

Cited By ~ 13

Author(s):

T. L. Griffiths ◽

S. J. Warren ◽

A. D. B. Chant ◽

S. T. Holgate

Keyword(s):

Carotid Endarterectomy ◽

Ventilatory Response ◽

Adenosine Infusion ◽

Respiratory Drive ◽

Stimulant Effect ◽

Carotid Bodies ◽

Ventilatory Drive ◽

Bilateral Carotid ◽

Respiratory Stimulant ◽

Ventilatory Effects

1. We have studied the carotid body contribution to hypoxic respiratory drive, using a hypoxic/hyperoxic switching technique, and the ventilatory response to intravenous infusion of adenosine, a recently described respiratory stimulant, in five patients with bilateral carotid endarterectomy. 2. The contribution made by the carotid bodies to total ventilatory drive during hypoxia varied from 2.5% to 45.9%. 3. The ventilatory response to adenosine infusion varied from a 7% decrease to a 25% increase in ventilation. 4. Those patients with intact hypoxic ventilatory drive showed respiratory stimulation, whereas of the two patients with attenuated chemoreflexes, one showed no stimulation and the other depression of ventilation in response to adenosine infusion. 5. We conclude that adenosine exerts its respiratory stimulant effect via an action on the peripheral chemoreceptors. This may coexist with a centrally mediated respiratory depression that is masked when the carotid bodies are intact.

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