Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy

Kawaji, Tetsuma; Shiomi, Hiroki; Morimoto, Takeshi; Tazaki, Junichi; Imai, Michitaka; Saito, Naritatsu; Makiyama, Takeru; Shizuta, Satoshi; Ono, Koh; Kimura, Takeshi

doi:10.1253/circj.cj-14-1148

Cited by 48 publications

(38 citation statements)

References 35 publications

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“…Left ventricular tract obstruction(LVOTO) results from basal LV wall hyperkinesis and systolic anterior motion of the mitral leaflet(25) and the incidence is estimated between 20 to 50% of TCM patients (5,26,27). In the present study, LVOTO was significantly more common in the cardiogenic shock group and this is in agreement with previous reports (5).…”

Section: Discussionsupporting

confidence: 92%

“…Prevalence of complications including cardiogenic shock is reported to be as high as 20% patients (1)(2)(3)(4) though the pathogenesis remains elusive and under-estimation can be disastrous. Pre-existent literature has attempted to identify various risk factors that may pre-dispose to cardiogenic shock in such patients, including the role of gender, age, BMI, coronary disease risk factors (diabetes, hypertension or smoking), electrolyte imbalance, extent of ischemic damage and pathological changes in myocardium identified on echocardiography (5)(6)(7)(8). An understanding of the risk factors inherent to the patient as well as the disease related manifestations linked to presentation with shock can help early risk-stratification, assessment of severity, anticipation of the future course and guide appropriate therapy.…”

Section: Background/objectivesmentioning

confidence: 99%

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Estimation of Risk Factors for Cardiogenic Shock in Takotsubo Cardiomyopathy: A Retrospective Study

Vaidya

Madhira

2017

ICFJ

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Introduction: Presentation of Takotsubo cardiomyopathy(TCM) widely varies amongst the patients, ranging from asymptomatic patients to cardiogenic shock or even cardiac arrest. The underlying risk factors inherent to the patient that predispose to a catastrophic presentation have not been delineated well in the past.Objective: To distinguish risk factors and presenting characteristics of patients diagnosed with cardiogenic shock from TCM.Methods: Total 51 angiography-confirmed TCM patients admitted in Upstate Hospital from 2010 – 2014 were compared retrospectively, 13 presenting with cardiogenic shock.Results: While TCM was predominantly common in elderly females, four of the total six male TCM patients presented with shock (Odds ratio= 8.0, p=0.027). TSH was higher in cardiogenic shock group. Patients with shock had significantly higher incidence of ST elevations on EKG and higher peak troponins. Moreover, ST elevations were predominantly in the inferior, anteroseptal and lateral leads in the shock group as compared to only the septal leads in the control group. Echocardiography revealed lower LV ejection fraction, LV outflow tract obstruction and concomitant significant mitral regurgitation in shock patients. No correlation was found with age, BMI, coronary disease risk factors (diabetes, hypertension, smoking), coincident infection, electrolyte imbalance, QTc interval length.Conclusion: Risk factors and pathophysiology for cardiogenic shock in TCM were identified. TCM in males is rare, but male gender is a risk factor for shock.

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Section: Discussionsupporting

confidence: 92%

Section: Background/objectivesmentioning

confidence: 99%

Estimation of Risk Factors for Cardiogenic Shock in Takotsubo Cardiomyopathy: A Retrospective Study

Vaidya

Madhira

2017

ICFJ

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“…In F1 generation mice exposed to caffeine from E6.5–9.5, we observed an increase in Myh7 expression 18 . The increase in Myh7 expression is indicative of the phenotype induced by caffeine as increased Myh7 expression is associated with cardiomyopathy and heart failure 101, 102 .…”

Section: Long-term Effects Of In Utero Caffeine Exposurementioning

confidence: 99%

Long-term consequences of disrupting adenosine signaling during embryonic development

Rivkees

Wendler

2017

Molecular Aspects of Medicine

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There is growing evidence that disruption in the prenatal environment can have long-lasting effects on an individual’s health in adulthood. Research on the fetal programming of adult diseases, including cardiovascular disease, focuses on epi-mutations, which alter the normal pattern of epigenetic factors such as DNA methylation, miRNA expression, or chromatin modification, rather than traditional genetic alteration. Thus, understanding how in utero chemical exposures alter epigenetics and lead to adult disease is of considerable public health concern. Few signaling molecules have the potential to influence the developing mammal as the nucleoside adenosine. Adenosine levels increase rapidly with tissue hypoxia and inflammation. Adenosine antagonists including the methlyxanthines caffeine and theophylline are widely consumed during pregnancy. The receptors that transduce adenosine action are the A1, A2a, A2b, and A3 adenosine receptors (ARs). We examined the long-term effects of in utero disruption of adenosine signaling on cardiac gene expression, morphology, and function in adult offspring. One substance that fetuses are frequently exposed to is caffeine, which is a non-selective adenosine receptor antagonist. Over the past several years, we examined the role of adenosine signaling during embryogenesis and cardiac development. We discovered that in utero alteration in adenosine action leads to adverse effects on embryonic and adult murine hearts. We find that cardiac A1ARs protect the embryo from in utero hypoxic stress, a condition that causes an increase in adenosine levels. After birth in mice, we observed that in utero caffeine exposure leads to abnormal cardiac function and morphology in adults, including an impaired response to β-adrenergic stimulation. Recently, we observed that in utero caffeine exposure induces transgenerational effects on cardiac morphology, function, and gene expression. Our findings indicate that the effects of altered adenosine signaling are dependent on signaling through the A1ARs and timing of disruption. In addition, the long-term effects of altered adenosine signaling appear to be mediated by alterations in DNA methylation, an epigenetic process critical for normal development.

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“…TTS patients with cardiogenic shock due to left ventricular dysfunction, arrhythmia, or left ventricular outflow tract (LVOT) obstruction, and death caused by hemodynamic failure have been reported. 4,5 For patients with TTS accompanied with LVOT obstruction, betablockers are reported to be effective. 6,7 However, there is no report about using ultrashort-acting beta-blockers, such as landiolol hydrochloride, for treating TTS.…”

Section: Backg Rou N Dmentioning

confidence: 99%

A case of ultrashort‐acting beta‐blocker landiolol hydrochloride for takotsubo syndrome with left ventricular outflow tract obstruction

Takama¹,

Fukue²,

Sato

et al. 2018

J of Gen and Family Med

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Takotsubo syndrome ( TTS ) has been known to have a favorable prognosis. Beta‐blockers are reported to be effective for TTS patients with cardiogenic heart failure due to left ventricular outflow tract ( LVOT ) obstruction. However, there is no report on ultrashort‐acting beta‐blockers being used for treating TTS , and there are no clear guidelines for their dosages or applications. Herein, we describe a 72‐year‐old woman in whom landiolol hydrochloride was used in the acute phase of TTS with LVOT obstruction. In this case, the dose of landiolol hydrochloride was increased to 10 μg/kg/min, resulting in improvement of LVOT obstruction, which led to hemodynamic stabilization.

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Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy

Cited by 48 publications

References 35 publications

Estimation of Risk Factors for Cardiogenic Shock in Takotsubo Cardiomyopathy: A Retrospective Study

Estimation of Risk Factors for Cardiogenic Shock in Takotsubo Cardiomyopathy: A Retrospective Study

Long-term consequences of disrupting adenosine signaling during embryonic development

A case of ultrashort‐acting beta‐blocker landiolol hydrochloride for takotsubo syndrome with left ventricular outflow tract obstruction

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