Clinical Characteristics and Outcome of Apical Ballooning Syndrome in Auckland, New Zealand

Looi, Jen-Li; Wong, Chi-Wing; Khan, Ali; Webster, Mark; Kerr, Andrew

doi:10.1016/j.hlc.2011.11.010

Cited by 39 publications

(52 citation statements)

References 23 publications

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“…Life threatening arrhythmia like VT, VF and sudden cardiac arrest were also observed, but at a low frequency and the exact pathophysiology for occurrence of these arrhythmias is unknown. In our cohort of 100 patients, 17 7 patients presented with new atrial arrhythmias. Five patients presented with ventricular arrhythmias: 3 patients presented with ventricular fibrillation arrest and two patients had ventricular tachycardia.…”

Section: In-hospital Complicationsmentioning

confidence: 81%

“…9,60 Nearly one fifth of the patients in our cohort had pulmonary oedema at admission and there was a subset of patients who were critically ill at presentation. 17 Apart from one patient who died of cardiogenic shock, all patients with pulmonary oedema, including those requiring intubation and/or intra-aortic balloon pump, fully recovered, and at late follow-up had normalisation of LV function. Age, gender, presence of a stressor, ST-segment elevation on ECG, troponin level, and moderate-severe MR during the acute phase did not identify a subgroup of patients at greater risk of complicated in-hospital course.…”

Section: In-hospital Complicationsmentioning

confidence: 88%

“…In particular, the ECG and severity of LV dysfunction at presentation and the extent of myocardial necrosis measured by troponin level were similar. 17 Thus the presence of an emotional or physical trigger did not identify a subgroup of patients at greater risk of acute complications and long-term recurrence. This finding is consistent with a prior European report 10 and suggests that there is a common underlying pathophysiology, regardless of the precipitating cause.…”

Section: Clinical Presentationmentioning

confidence: 91%

“…This is supported by the fact that the observed myocardial necrosis in TC is modest and in the range typically seen in non ST-segment elevation myocardial infarction (NSTEMI). 17 Plasma cardiac brain natriuretic peptide (BNP) levels are also elevated in TC patients compared to patients with myocardial infarction. 28 A recent study demonstrated up to a threefold increase in patients with TC compared to STEMI patients.…”

Section: Diagnostic Methods and Imaging Techniques Cardiac Biomarkersmentioning

confidence: 99%

“…Our study showed similar findings with a good long-term prognosis with a low mortality rate and low rate of recurrence during a follow-up of six years. 17 On the other hand, Sharkey et al 9 have demonstrated that the risk for all-cause mortality was greater among TC patients compared to an age-and gender-matched population. The risk of death was greatest in the year following the diagnosis of TC and then decreased considerably in the ensuing years.…”

Section: Prognosismentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

Looi¹,

Kerr²

2016

ICFJ

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Takotsubo cardiomyopathy (TC) is a transient, reversible form of cardiomyopathy which predominantly affects post-menopausal women and is an important differential diagnosis of acute coronary syndrome. It is characterised by normal (or near-normal) coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often proceeded by a stressful event. The pathophysiologic mechanism is complex and remains to be elucidated. There is increasing awareness among physicians about TC and hence, more cases are being reported. The diagnosis of TC has important clinical implications in the management at presentation and afterward. In this review, we discuss the demographics, clinical features, prognosis and management of this cardiomyopathy.

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Section: In-hospital Complicationsmentioning

confidence: 81%

Section: In-hospital Complicationsmentioning

confidence: 88%

Section: Clinical Presentationmentioning

confidence: 91%

Section: Diagnostic Methods and Imaging Techniques Cardiac Biomarkersmentioning

confidence: 99%

Section: Prognosismentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

Looi¹,

Kerr²

2016

ICFJ

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Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Santoro

Ieva

Musaico

et al. 2014

Clinical Cardiology

127

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Background: Efficacy of chronic drug therapy in prevention of stress-induced cardiomyopathy recurrences is not well established. We therefore aimed to evaluate in this meta-analysis whether pharmacological treatment can effectively prevent takotsubo cardiomyopathy (TTC) recurrences, according to available studies. Hypothesis: There is no evidence for preventing TTC recurrence by drug therapy. Methods: After a PubMed search, we conducted a meta-analysis of available studies (clinical nonrandomized registries) on efficacy of drug therapy in preventing recurrence of TTC. Results: A total of 23 (4.5%) TTC recurrences occurred in the 511 patients included in the analysis. Seven studies on the effects of β-blockers on prevention of TTC recurrence were evaluated; the odds ratio (OR) was 0.44 and the 95% confidence interval (CI) was 0.15-1.31. In 5 studies on the effects of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the OR was 0.42 and the 95% CI was 0.08-2.36; in 3 studies on statins, the OR was 0.74 and the 95% CI was 0.07-7.3; and in 4 studies on aspirin, the OR was 0.33 with a 95% CI of 0.05-2.17 (P value not significant in all cases). Conclusions: A meta-analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β-Blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue. IntroductionTakotsubo cardiomyopathy (TTC) is a rapidly reversible form of acute heart failure occurring mainly in postmenopausal women after an episode of physical or emotional stress 1 and is associated with a typical left ventricular (LV) contraction pattern. 2 Increased catecholamine levels were thought to be the primary precipitator of the condition, 3 but the exact mechanism is still not well elucidated. 4,5 The initial treatment for TTC is usually the same as adopted for acute heart failure, except for contraindication to β-adrenergic inotropes 6 ; data on the efficacy of chronic pharmacological therapy, however, are scanty. Despite its relatively good long-term prognosis, 7 recurrences of TTC are not infrequent, with a rate ranging from 5% to 11.4% within the first 4 years and an incidence per year of 2.4%. 8,9 β-Blockers are commonly used chronically to prevent TTC recurrence, but, given the rarity of TTC, there are no randomized studies supporting this approach.We therefore conducted a meta-analysis of currently available studies to evaluate whether drug therapy can effectively prevent TTC recurrences.

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Long‐term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences

Stiermaier

Moeller

Oehler

et al. 2016

European J of Heart Fail

215

142

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Aims Despite increasing research efforts, the prognostic consequences of takotsubo cardiomyopathy (TTC) remain largely unknown. The aim of this study was therefore to compare the long‐term mortality rate of TTC patients with high‐risk patients presenting with ST‐segment elevation myocardial infarction (STEMI). Methods and results A total of 286 patients with TTC were matched for age and gender with 286 STEMI patients. Outcome was obtained with a standardized telephone follow‐up. The primary analysis determined long‐term mortality. A secondary analysis was performed evaluating 28‐day and 1‐year mortality. Follow‐up was available for 96% of patients after a mean of 3.8 ± 2.5 years. In TTC patients, long‐term mortality was significantly higher compared with the matched STEMI cohort [24.7% vs. 15.1%, hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.07–2.33; P = 0.02]. There was no significant difference in the rates of 28‐day (5.5% vs. 5.7%, HR 0.96, 95% CI 0.47–1.94; P = 0.91) and 1‐year mortality (12.5% vs. 9%, HR 1.42, 95% CI 0.85–2.38; P = 0.18). In multivariable regression analysis, male sex, a high Killip class on admission, and diabetes mellitus were identified as independent predictors of mortality in TTC patients. A risk score consisting of these factors showed a higher mortality with an increasing number of risk factors. Conclusion Mortality rates in TTC patients are higher than previously expected and long‐term mortality exceeded that of patients with STEMI. A simple risk score may provide an approach to identify high‐risk patients and predict clinical prognosis.

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Clinical Characteristics and Outcome of Apical Ballooning Syndrome in Auckland, New Zealand

Cited by 39 publications

References 23 publications

Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Long‐term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences

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