scholarly journals P1354 Prognostic value of the left ventricular longitudinal and circumferential function in patients with takotsubo syndrome during the acute phase

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Koshino ◽  
N Yamaguchi ◽  
T Oshima ◽  
K Hiroe ◽  
Y Ohta ◽  
...  
Keyword(s):  
Acute Phase ◽  
Prognostic Value ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Hospital Death ◽  
Takotsubo Syndrome ◽  
Hemodynamic Assessment ◽  
Echocardiographic Examination ◽  
Severe Group ◽  
Fractional Shortening

Abstract Background Takotsubo syndrome is generally considered a benign disease with a reversible condition; however, hemodynamic and electrical instability during the acute phase exposes patients to the risk of serious adverse in-hospital events. The purpose of this study was to investigate the prognostic value of the left ventricular longitudinal and circumferential function in patients with TTS during the acute phase. Methods We divided the 27 patients with TTS (77.4 ± 10.2 years old, 21 females) into two groups; the severe group (SG) of 9 patients (in-hospital death, mechanical assist devices such as IABP or ECMO, oozing rupture) and non-severe group (NSG) of 18 patients. The echocardiographic examination on admission, catheter hemodynamic assessment, and laboratory data, and ST-T change in electrocardiogram were compared between two groups. Results There were no differences in age, laboratory data, electrocardiogram findings between the two groups. The LVEF was lower in SG (35.3 ± 6.1% vs. 45.9 ± 13.5%, p = 0.03). The index of Ballooning, the ratio of the systolic left ventricular diameter of ballooning segments to that of basal segments, was higher in SG (2.07 ± 0.61% vs.1.60 ± 0.32%, p = 0.016). The circumferential fractional shortening (CFS) of ballooning segments was lower in SG (4.6 ± 3.2% vs. 18.2 ± 8.2%, p = 0.00007), CFS of basal segments was not different between the two groups, and the ratio of CFS of ballooning segments to CFS of basal segments (CFS imbalance index) was lower in SG (5.60 ± 3.84 vs. 10.83 ± 3.92, p = 0.00003). The left ventricular longitudinal fractional shortening was lower in SG (0.12 ± 0.09 vs. 0.46 ± 0.19, p = 0.00003). The absolute value of GLS was lower in SG (7.6 ± 4.3% vs. 13.0 ± 3.6%, p = 0.002). In all three cases of in-hospital death, the CFS imbalance index was lower than 0.14. Conclusion In patients with TTS, left ventricular longitudinal and circumferential function could be related to serious adverse in-hospital events.

Prognostic value of acute mitral insufficiency among patients admitted with Takotsubo syndrome. Preliminary data from a prospective multicenter registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Mallardi ◽  
F Santoro ◽  
A Leopizzi ◽  
E Vitale ◽  
T Zimotti ◽  
...  
Keyword(s):  
Adverse Events ◽  
Prognostic Value ◽  
Laboratory Data ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Control Group ◽  
Mitral Insufficiency ◽  
Takotsubo Syndrome ◽  
Increased Risk ◽  
And Gender

Abstract Background Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction, whose pathophysiological mechanisms are not completely known. Aim of the study is to evaluate the incidence and prognostic value of acute mitral insufficiency among TTS patients. Methods Three hundred sixteen consecutive patients admitted for TTS were enrolled from July 2007 to December 2019 in a prospective registry among four hospitals. Clinical features, laboratory data, ECG and echocardiographic parameters and in-hospital complications were recorded. Results Eighty-five (27%) patients, mean age 76±8 years, presented with moderate/severe mitral insufficiency (msMI). Compared to the control group, patients that presented with msMI were older (76±8 vs 71±12 years, p<0.01), had lower LVEF (34±7% vs 37±9% p=0.02) and experienced higher rate of in-hospital complications (42 vs 32% p=0.04). The incidence of in-hospital adverse events was higher in case of both msMI and LVEF <35% than in one of the two previous conditions or neither (69%, 42%, 23% respectively, p<0.05). Differences remained statistically significant even after correction for age and gender in the multivariate analysis. There was a reduction of mitral insufficiency from moderate/severe into mild in 30 out of 87 (34%) pts after 48h from admission and in 52 out of 87 pts at discharge (60%). Left ventricular outflow tract obstruction (LVOTO) was found in 13 out of 87 (15%) pts with msMI at admission and was transient in 11 out of 13 pts (84%). At long term follow up (650 days) patients with msIM when compared to those without, experienced higher rate of mayor cardiovascular events (31.7% vs 20% p=0.03). Conclusions Patients with TTS and moderate/severe mitral insufficiency at admission have an increased risk of in and out-of hospital mayor cardiac adverse events. Funding Acknowledgement Type of funding source: None

scholarly journals Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome

2020 ◽  
Vol 9 (12) ◽  
pp. 3882
Author(s):  
Thomas Stiermaier ◽  
Kira Busch ◽  
Torben Lange ◽  
Toni Pätz ◽  
Moritz Meusel ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Prognostic Information ◽  
Long Term Mortality

Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS −11.28%, TT-GLS −11.45%, and fast manual LAS −10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > −11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > −11.45% (20.0% versus 5.4%; p = 0.016), and LAS > −10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.

scholarly journals Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE)

2020 ◽  
Vol 21 (11) ◽  
pp. 1184-1207 ◽  
Author(s):  
Rodolfo Citro ◽  
Hiroyuki Okura ◽  
Jelena R Ghadri ◽  
Chisato Izumi ◽  
Patrick Meimoun ◽  
...  
Keyword(s):  
Acute Phase ◽  
Wall Motion ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Metabolic Imaging ◽  
Lv Function ◽  
Complication Rates ◽  
Takotsubo Syndrome ◽  
Clinical Scenarios ◽  
Wall Motion Abnormalities

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.

Left Ventricular Thrombi and Embolic Events in Takotsubo Syndrome despite Therapeutic Anticoagulation

Cardiology ◽  
2020 ◽  
Vol 145 (8) ◽  
pp. 504-510
Author(s):  
Claudia Stöllberger ◽  
Josef Finsterer ◽  
Birke Schneider
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Heart Team ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Therapeutic Anticoagulation ◽  
Echocardiographic Examination

Introduction: Takotsubo syndrome (TTS) may be complicated by left-ventricular (LV) thrombus formation in 1.3–5.3% of patients. Risk factors for thrombi comprise apical TTS, elevated levels of C-reactive protein and troponine, thrombocytosis, persisting ST segment elevation and right-ventricular involvement. Embolic risk appears high, and anticoagulation is recommended. Case Presentation: We present 3 females, aged 60–82 years, with TTS-associated LV thrombi and cerebral embolism despite therapeutic anticoagulation. Two patients showed apical and 1 patient midventricular ballooning. In 2 patients LV thrombi had not been present at the first echocardiographic examination. LV thrombi were multiple and highly mobile in 2 patients; 1 patient had a single immobile thrombus associated with spontaneous echocardiographic contrast (SEC). In each case, 3 of the described risk factors for LV thrombus formation were identified. The embolic stroke occurred 41–120 h after TTS symptom onset and 21–93 h after the initiation of therapeutic anticoagulation. Two patients were discharged with a neurological deficit, and 1 of them eventually died as a consequence of the stroke. LV thrombectomy to prevent embolism, which has been reported in a small number of cases, had not been considered in our patients. Conclusion: At present, the management of patients with TTS-related thrombi is still unclear, and further studies are urgently needed to assess the best methods for imaging and anticoagulation and to determine the role of thrombolysis and cardiac surgery. Until these studies are available, we suggest the following approach: patients with a TTS-related thrombus should be monitored by echocardiography while receiving anticoagulation. In case of highly mobile LV thrombi, the heart team may consider cardiac surgery to prevent systemic embolism. The role of SEC in TTS remains to be determined.

Ventricular fractional shortening in 108 dogs with malignant lymphoma undergoing chemotherapy with a cyclic combination protocol including doxorubicin

2012 ◽  
Vol 40 (04) ◽  
pp. 261-266 ◽  
Author(s):  
N. Eberle ◽  
S. Hungerbuehler ◽  
A. Joetzke ◽  
I. Nolte ◽  
G. Wess ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Combination Chemotherapy ◽  
Systolic Dysfunction ◽  
Reference Value ◽  
Left Ventricular ◽  
Echocardiographic Examination ◽  
Chemotherapy Protocol ◽  
Significant Change ◽  
Doxorubicin Administration ◽  
Fractional Shortening

Summary Objective: The aim of this study was to evaluate whether changes in the left ventricular fractional shortening (LVFS) can be detected in dogs with malignant lymphoma undergoing a cyclic combination chemotherapy protocol including doxorubicin. Hypothesis: Left ventricular fractional shortening as a stand-alone measurement will not show a significant change during the cyclic combination protocol. Material and methods: In this retrospective study, the records of dogs with malignant lymphoma treated between April 2001 and October 2010 were reviewed. Inclusion criteria comprised: a diagnosis of malignant lymphoma, a cyclic combination chemotherapy (including L-asparaginase, vincristine, cyclophosphamide, doxorubicin and prednisolone), and an echocardiographic examination by an experienced examiner before treatment and after each doxorubicin administration. Results: One hundred and eight dogs were included and a total of 446 LVFS measurements had been performed. Patients were divided into four groups according to the number of doxorubicin administrations. Median LVFS did not change significantly during the cyclic combination protocol in all groups. All median LVFS values remained above the lower reference value of 25%. Conclusion and clinical relevance: The measurement of LVFS did not show a significant change during the cyclic combination protocol treatment including doxorubicin in this population of dogs. Therefore either this cyclic combination protocol does not cause a systolic dysfunction or LVFS is not sensitive enough to detect early changes. Newer methods that are more sensitive then LVFS might be necessary to detect such changes.

scholarly journals Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 2—Treatment and Prognosis

2021 ◽  
Vol 10 (3) ◽  
pp. 468
Author(s):  
Francesco Santoro ◽  
Adriana Mallardi ◽  
Alessandra Leopizzi ◽  
Enrica Vitale ◽  
Elias Rawish ◽  
...  
Keyword(s):  
Acute Phase ◽  
Ace Inhibitors ◽  
Current Knowledge ◽  
Left Ventricular Systolic Dysfunction ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Long Term Outcome

Takotsubo syndrome (TTS) represents a form of acute heart failure featured by reversible left ventricular systolic dysfunction. The management during the acute phase is mainly performed with supportive pharmacological (diuretics, ACE-inhibitors/angiotensin-receptor blockers (ARBs), anticoagulants, antiarrhythmics, non-catecholamine inotropics (levosimendan), and non-pharmacological (mechanical circulatory and respiratory support) therapy, due to the wide clinical presentation and course of the disease. However, there is a gap in evidence and there are no randomized and adequately powered studies on clinical effectiveness of therapeutic approaches. Some evidence supports the use ACE-inhibitors/ARBs at long-term. A tailored approach based on cardiovascular and non-cardiovascular risk factors is strongly suggested for long-term management. The urgent need for evidence-based treatment approaches is also reflected by the prognosis following TTS. The acute phase of the disease can be accompanied by various cardiovascular complications. In addition, long term outcome of TTS patients is also related to non-cardiovascular comorbidities. Physical triggers such as hypoxia and acute neurological disorders in TTS are associated with a poor outcome.

scholarly journals 274 Cerebrovascular events in takotsubo syndrome: short- and long-term outcome. Results from a multicentre-prospective registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandra Leopizzi ◽  
Francesco Santoro ◽  
Adriana Mallardi ◽  
Enrica Vitale ◽  
Natale Daniele Brunetti
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hospital Death ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
Cerebrovascular Events ◽  
Long Term Follow Up

Abstract Aims Several studies have shown that Takotsubo syndrome (TTS) secondary to neurological disorders is associated with higher rate of in-hospital complications. Imaging brain studies found that atrophy or damage of some regions and their altered connectivity with other brain regions are typical features of TTS patients. The aim of the study is to evaluate rates of in hospital and long-term Follow-up events in TTS patients with history or acute cerebrovascular events (CVE). Methods and results 395 consecutive patients were enrolled in a multicentre prospective registry. History, clinical data, echocardiographic parameters and in-hospital and long-term follow-up events of all patients were evaluated. Prevalence of cerebrovascular events among TTS patients was 9.4% (num = 37). Compared to the control group, these patients were older (80 ± 7 vs. 71 ± 12, P = 0.01) and predominantly men (24% vs. 9%, P = 0.01). No differences in term of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found among the two groups. The prevalence of physical stressor was higher in the CVE group (67% vs. 44% P = 0.01). The incidence of in-hospital adverse events was higher in the CVE than in the control one (70% vs. 29%), mainly driven by higher rate of Cardiogenic shock (19 vs. 8% P = 0.01) and in-hospital death (19 vs. 4%, P = 0.01). At long-term follow-up, patients in CVE group hat higher mortality rate (38% vs. 20% P = 0.01)). Patients presenting with acute CVE, 10 out of 37 patients (27%) when compared with chronic CVE had higher in-hospital mortality (40% vs. 11% P = 0.01). Conclusions TTS patients with history or acute cerebrovascular events had higher rate of in-hospital events and death at long-term follow-up. Acute cerebrovascular events in the setting of TTS are featured with worst prognosis.

scholarly journals Novel Aspects of Classification, Prognosis and Therapy in Takotsubo Syndrome

2019 ◽  
Vol 14 (3) ◽  
pp. 191-196
Author(s):  
Chiara Di Filippo ◽  
Beatrice Bacchi ◽  
Carlo Di Mario
Keyword(s):  
Acute Phase ◽  
Current Knowledge ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
Cardiac Symptoms ◽  
Left Ventricular Outflow ◽  
Life Threatening ◽  
Physiological Abnormalities

Takotsubo syndrome (TTS) can be considered a transient form of acute heart failure that mimics an acute coronary syndrome. Although many hypotheses have been formulated, the precise physiopathology of TTS remains unknown. TTS is associated with a heterogeneous clinical course, which ranges from benign to poor outcome, comprising life-threatening phenotypes. In the acute phase, TTS patients may experience complications including left ventricular outflow tract obstruction, cardiogenic shock, arrhythmias and thromboembolic events. Furthermore, after the acute episode, physiological abnormalities can persist and some patients continue to suffer cardiac symptoms. To recognise patients at higher risk earlier, many variables have been proposed and risk stratifications suggested. There is no solid evidence regarding specific therapy and the proper management of TTS patients, either in the acute phase or long term. This review describes the current knowledge regarding diagnostic criteria, prognosis and therapy in TTS.

scholarly journals Prognostic value of admission high-sensitivity troponin in patients with ST-elevation myocardial infarction

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319225
Author(s):  
Jose Coelho-Lima ◽  
Georgios Georgiopoulos ◽  
Javed Ahmed ◽  
Syeda E R Adil ◽  
David Gaskin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
Prognostic Value ◽  
Troponin T ◽  
Laboratory Data ◽  
High Sensitivity ◽  
University Hospital ◽  
Hospital Death ◽  
Mortality Data ◽  
Overall Mortality

Background and aimAlthough the diagnostic usefulness of high-sensitivity cardiac troponin T (hs-cTnT) is well established in ST-segment elevation myocardial infarction (STEMI), its prognostic relevance in risk stratification of patients with STEMI remains obscure. This study sought to determine the prognostic value of pre-reperfusion (admission) and post-reperfusion (12-hour) hs-cTnT in patients with STEMI treated with primary percutaneous coronary intervention (PPCI).MethodsRetrospective observational longitudinal study including consecutive patients with STEMI treated with PPCI at a university hospital in the northeast of England. hs-cTnT was measured at admission to the catheterisation laboratory and 12 hours after PPCI. Clinical, procedural and laboratory data were prospectively collected during patient hospitalisation (June 2010–December 2014). Mortality data were obtained from the UK Office of National Statistics. The study endpoints were in-hospital and overall mortality.ResultsA total of 3113 patients were included. Median follow-up was 53 months. Admission hs-cTnT >515 ng/L (fourth quartile) was independently associated with in-hospital mortality (HR=2.53 per highest to lower quartiles; 95% CI: 1.32 to 4.85; p=0.005) after multivariable adjustment for a clinical model of mortality prediction. Likewise, admission hs-cTnT >515 ng/L independently predicted overall mortality (HR=1.27 per highest to lower quartiles; 95% CI: 1.02 to 1.59; p=0.029). Admission hs-cTnT correctly reclassified risk for in-hospital death (net reclassification index (NRI)=0.588, p<0.001) and overall mortality (NRI=0.178, p=0.001). Conversely, 12-hour hs-cTnT was not independently associated with mortality.ConclusionAdmission, but not 12-hour post-reperfusion, hs-cTnT predicts mortality and improves risk stratification in the PPCI era. These results support a prognostic role for admission hs-cTnT while challenge the cost-effectiveness of routine 12-hour hs-cTnT measurements in patients with STEMI.

scholarly journals Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE)

2020 ◽  
Vol 18 (4) ◽  
pp. 199-224
Author(s):  
Rodolfo Citro ◽  
Hiroyuki Okura ◽  
Jelena R Ghadri ◽  
Chisato Izumi ◽  
Patrick Meimoun ◽  
...  
Keyword(s):  
Acute Phase ◽  
Wall Motion ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Metabolic Imaging ◽  
Lv Function ◽  
Complication Rates ◽  
Takotsubo Syndrome ◽  
Clinical Scenarios ◽  
Wall Motion Abnormalities

AbstractTakotsubo 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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