Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis

Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.

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ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽

10.1093/med/9780198784906.003.0320 ◽

2018 ◽

pp. 1298-1301

Author(s):

Federico Migliore ◽

Sebastiano Gili ◽

Domenico Corrado

Keyword(s):

Left Ventricular ◽

Stunned Myocardium ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

T Wave ◽

Wave Inversion ◽

Qt Interval Prolongation ◽

St Segment ◽

Reversible Left Ventricular Dysfunction ◽

Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

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EFFECT OF PREHOSPITAL SYSTEMIC THROMBOLYSIS ON LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION

10.54185/tbem/vol14_iss3/a4 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

A Alavi ◽

S Kenzhaev ◽

I Kakharov

Keyword(s):

Standard Therapy ◽

Left Ventricular Systolic Dysfunction ◽

Myocardial Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Control Group ◽

Ventricular Systolic Dysfunction ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Objective: to study the effect of prehospital thrombolysis on left ventricular systolic dysfunction in patients with acute ST-segment elevation coronary syndrome.Material and methods: The study included 70 patients with acute coronary syndrome with ST-segment elevation. Patients were randomized into two groups: control (group A) - 35 patients receiving standard therapy, and hospital TLT. Group B included 35 patients who underwent standard therapy and prehospital TLT. All 70 patients underwent echocardiography 1 day after myocardial revascularization and 3 months later.Results: the use of early myocardial reperfusion in patients with STEMI had a positive effect on central hemodynamics, reduced the development of LV volume overload, as a result of which end-diastolic and systolic volumes did not change during 3 months of follow-up. LVEF grew in both groups, and its growth was more pronounced in group B.Conclusion: timely prehospital reperfusion reduces the severity of myocardial damage and thus prevents the development of severe systolic myocardial dysfunction LV.

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Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10051066 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1066

Author(s):

Małgorzata Zalewska-Adamiec ◽

Hanna Bachórzewska-Gajewska ◽

Sławomir Dobrzycki

Keyword(s):

Female Gender ◽

Left Ventricular ◽

Cardiac Rupture ◽

Control Group ◽

Mechanical Complication ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

Glucose Levels ◽

Risk Of Death ◽

St Segment

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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Analysis of risk factors for different subtypes of acute coronary syndrome

Journal of International Medical Research ◽

10.1177/03000605211008326 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110083

Author(s):

Lei Zhang ◽

Juledezi Hailati ◽

Xiaoyun Ma ◽

Jiangping Liu ◽

Zhiqiang Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Brain Natriuretic Peptide ◽

Left Ventricular ◽

St Segment Elevation ◽

Amino Terminal ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

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Takotsubo Cardiomyopathy and Non-ST-Segment Elevation Myocardial Infarction: Predictors of Left Ventricular Dysfunction

Clinical Medicine Insights Cardiology ◽

10.1177/1179546817716103 ◽

2017 ◽

Vol 11 ◽

pp. 117954681771610

Author(s):

Andrew Hinojos ◽

Thomas E Vanhecke ◽

Susan Enright ◽

Nathan Elg ◽

Kristina Gifft ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Retrospective Case ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

Lv Dysfunction ◽

St Segment ◽

Artery Disease ◽

Control Study

Background: Acute coronary syndrome (ACS) from non-ST-segment elevation myocardial infarction (NSTEMI) and Takotsubo (TK) cardiomyopathy present with similar initial clinical features and can result in left ventricular (LV) dysfunction and acute heart failure. Methods: This study was a retrospective case-control study that identified patients aged 18 years and older who presented with ACS and underwent cardiac catheterization. Results: There were a total of 321 patients in the TK group and 1031 patients in the NSTEMI group. There was significantly worse LV dysfunction in the TK group with average ejection fraction (EF) of 44.35% (±15.11%) versus NSTEMI with an average EF of 47.36% (±13.5%) ( P < .001). The presence of TK yielded of an odds ratio (OR) of 2.373 (95% confidence interval [CI]: 1.165-3.618) and presence of peripheral artery disease (PAD) yielded an OR of 2.053 (95% CI: 1.165-3.618). Conclusions: The presence of TK cardiomyopathy and PAD were independent predictors of patients who had LVEF of <35% and elevated B-type natriuretic peptide levels.

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Analysis of ticagrelor’s cardio-protective effects on patients with ST-segment elevation acute coronary syndrome accompanied with diabetes

Open Medicine ◽

10.1515/med-2019-0017 ◽

2019 ◽

Vol 14 (1) ◽

pp. 234-240 ◽

Cited By ~ 1

Author(s):

Dong-Tao Li ◽

Shun-Bao Li ◽

Jian-Yong Zheng ◽

Hai-hong Tang ◽

Yi-Gang Qiu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Adverse Reactions ◽

Left Ventricular ◽

Control Group ◽

Observation Group ◽

Protective Effects ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Elevation Acute Coronary Syndrome

AbstractBackgroundTo analyze the cardio-protective effects of ticagrelor in patients with acute coronary syndrome with S-T segment elevation.MethodsThe sample was 200 patients who had been diagnosed with acute coronary syndrome accompanied by diabetes Mellitus type II. Only patients having ST segment elevation before the treatment were included. Then, the subjects were further randomly divided into an observation group and a control group. The control group of 100 patients received clopidogrel; the observation group of 100 patients of ticagrelor. The serous creatine kinase CK-MB, functional cardiac indexes of left ventricular end diastolic diameter (LVDD), cardiac troponin I, ventricular ejection fraction, and relevant major adverse cardiovascular events (MACE) were compared between the two groups.ResultsOne month after a percutaneous coronary intervention (PCI) the observation group showed better results against angina, stent thrombosis, and all-cause mortality compared with those of the control subjects. Six months after treatment, both groups suffered adverse reactions. The number of patients who suffered adverse reactions in respiratory tract in the observation group was higher than in the control group. The inhibition of platelet aggregation IPA of ticagrelor was found to be significantly higher than clopidogrel, having a significant p value.ConclusionTicagrelor can effectively protect myocardial function for patients with ST-segment elevation acute coronary syndrome accompanied by diabetes and can reduce the incidence of adverse reactions..

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