Mechanisms of takotsubo syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 1280-1283
Author(s):  
Leonarda Galiuto ◽  
Filippo Crea
Keyword(s):  
Cell Survival ◽  
Left Ventricular Dysfunction ◽  
Functional Recovery ◽  
Ventricular Dysfunction ◽  
Myocardial Dysfunction ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Microvascular Spasm

The pathogenesis of takotsubo syndrome can be considered the result of a catecholamine surge that, in predisposed and susceptible individuals, produces microvascular spasm responsible for myocardial dysfunction. The reversibility of microvascular dysfunction along with the activation of the cell survival cascade guarantees prompt and complete functional recovery in the majority of patients. Yet, about 20% of patients have serious in-hospital complications probably related to the severity of left ventricular dysfunction and/or lack of resolution. The reasons for these different outcomes are still unknown.

Abstract 2294: The Use of Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michael Becker ◽  
Mithra Lenzen ◽  
Katharina Stempel ◽  
Andreas Franke ◽  
Malte Kelm ◽  
...  
Keyword(s):  
Left Ventricular Dysfunction ◽  
Myocardial Viability ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Myocardial Dysfunction ◽  
Radial Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Deformation Imaging ◽  
Myocardial Deformation Imaging

Objective. Myocardial deformation imaging allows analysis of myocardial Objective. Myocardial deformation imaging allows analysis of myocardial viability in ischemic left ventricular dysfunction. This study evaluated the predictive value of myocardial deformation imaging for improvement in cardiac function after revascularization therapy in comparison to contrast-enhanced cardiac magnetic resonance imaging (ceMRI). Methods and Results. In 53 patients with ischemic left ventricular dysfunction, myocardial viability was assessed using pixel-tracking-derived myocardial deformation imaging and ceMRI to predict recovery of function at 9±2 months follow-up. For each left ventricular segment in a 16-segment model peak systolic radial strain was determined from parasternal 2D echocardiographic views using an automatic frame-by-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound), and maximal thickness of myocardial tissue without late enhancement (LE) using ceMRI. Of 463 segments with abnormal baseline function, 227 showed regional recovery. Compared with segments showing functional improvement, those that failed to recover had lower radial strain (15.2±7.5 vs 22.6±6.3 %; p<0.001) and lower thickness without LE (5.2±2.9 vs 8.7±2.2 mm; p<0.001). Using a cut-off of 17.2 % for peak systolic radial strain, functional recovery could be predicted with high accuracy (specificity 85%, sensitivity 70%, area under the curve (AUC) 0.859, 95% CI: 0.825– 0.893). The predictive value of thickness without LE by ceMRI was similar at a cut-off of 8.2 mm (specificity 84%, sensitivity 70%, AUC 0.831, 95% CI: 0.793– 0.870). Conclusion. Myocardial deformation imaging based on frame-to-frame tracking of acoustic markers in 2D echocardiographic images is a powerful novel modality to identify reversible myocardial dysfunction.

Evaluation of myocardial function using the Tei index in patients with Kawasaki disease

2009 ◽  
Vol 20 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Gholamhossein Ajami ◽  
Mohammad Borzouee ◽  
Hamid Amoozgar ◽  
Feridoon Ashnaee ◽  
Sara Kashef ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Acute Phase ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Myocardial Function ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Healthy Children ◽  
Tei Index ◽  
Systolic And Diastolic Function

AbstractMyocarditis is a well-recognized component of Kawasaki disease, with left ventricular dysfunction occurring in more than half of the patients during the acute phase of the disease. The purpose of our study was to evaluate myocardial function in these patients using the myocardial performance index, also known as the Tei index. In a prospective study, 14 patients underwent echocardiographic evaluation, first at the time of diagnosis of the disease, in its acute phase before treatment with intravenous immunoglobulin and then 2 weeks later after treatment with immunoglobulin. We assessed the Tei-index, the ejection fraction, shortening fraction, and the presence of valvar regurgitation, pericardial effusion, or coronary arterial involvement. As a control, we also assessed 22 healthy children, matched for age and sex with the study population. Of the patients, half had an increased left ventricular Tei-index in the acute phase, as compared with the data obtained after treatment, the index changing from 0.43 ± 0.08 to 0.35 ± 0.06 (p equal to 0.003). An increased index for the right ventricle was found in 5 patients (36%), values being 0.30 ± 0.05 as opposed to 0.26 ± 0.04 (p equal to 0.009). Of the patients, 5 (35.7%) also had decreased ejection fractions and proportional shortening fractions during the acute phase, confirming left ventricular dysfunction. We concluded that the Tei-index, which measures combined systolic and diastolic function, is a simple, sensitive, and accurate tool for estimating global myocardial dysfunction in patients with Kawasaki disease.

Prediction of functional recovery after revascularization in patients with coronary artery disease and left ventricular dysfunction by gated FDG-PET

2006 ◽  
Vol 13 (2) ◽  
pp. 210-219 ◽  
Author(s):  
Riemer H. J. A. Slart ◽  
Jeroen J. Bax ◽  
Dirk J. van Veldhuisen ◽  
Ernst E. van der Wall ◽  
Rudi A. Dierckx ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular Dysfunction ◽  
Functional Recovery ◽  
Fdg Pet ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Artery Disease

scholarly journals Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1—Pathophysiology and Diagnosis

2021 ◽  
Vol 10 (3) ◽  
pp. 479
Author(s):  
Elias Rawish ◽  
Thomas Stiermaier ◽  
Francesco Santoro ◽  
Natale Brunetti ◽  
Ingo Eitel
Keyword(s):  
Clinical Presentation ◽  
Current Knowledge ◽  
Myocardial Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Adrenergic Stimulation ◽  
Pathophysiological Mechanisms ◽  
Cardiac Condition

First recognized in 1990, takotsubo syndrome (TTS) constitutes an acute cardiac condition that mimics acute myocardial infarction commonly in the absence of obstructive coronary artery disease; it is characterized by temporary left ventricular dysfunction, regularly in a circumferential apical, midventricular, or basal distribution. Considering its acute clinical presentation, coronary angiography with left ventriculography constitutes the gold standard diagnostic tool to exclude or confirm TTS. Frequently, TTS is related to severe emotional or physical stress and a subsequent increased adrenergic stimulation affecting cardiac function. Beyond clinical presentation, epidemiology, and novel diagnostic biomarkers, this review draws attention to potential pathophysiological mechanisms for the observed reversible myocardial dysfunction such as sympathetic overdrive-mediated multi-vessel epicardial spasms, microvascular dysfunction, the direct toxicity of catecholamines, lipotoxicity, and inflammation. Considering the long-term prognosis, further experimental and clinical research is indispensable to elucidate further pathophysiological mechanisms underlying TTS before randomized control trials with evidence-based therapeutic management can be performed.

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