Concomitant acute myocardial infarction and stress cardiomyopathy

Jiménez-Méndez, César; Cecconi, Alberto; Vera, Alberto; Olivera, María José; Jiménez-Borreguero, Luis Jesús; Alfonso, Fernándo

doi:10.1097/mca.0000000000000910

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Most recently, Radfar et al [7] used F-FDG-PET/computed tomography imaging to show an association between amygdala activity, the timing of TTS onset, and leucopoietic activity. This finding, in conjunction with other reports that have linked increased leucopoietic activity with atherosclerosis and coronary vessel disease [8][9][10], highlights the possible significance of CAD in the onset and severity of TTS and necessitates further research into its exact role, which our study will aim to do.…”

Section: Introductionsupporting

confidence: 68%

Physiologic and compositional coronary artery disease extension in patients with takotsubo syndrome assessed using artificial intelligence: an optical coherence tomography study

Kumar

Chu

Kuku

et al. 2022

Coronary Artery Disease

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Background Takotsubo syndrome (TTS) is an acute and reversible ventricular motion abnormality without epicardial coronary obstruction. Optical flow ratio (OFR) is an approach to evaluate the coronary stenosis significance based on three-dimensional optical coherence tomography (3D-OCT). The aim of this study is to utilize OCT and an artificial intelligence plaque characterization model to show the prevalence and composition of atherosclerotic disease in coronary vessels of patients with TTS. Methods This is a retrospective and observational study which enrolled patients with TTS who underwent coronary angiography and OCT examination. OCT images were analyzed for tissue characterization and OFR computation using a novel artificial intelligence algorithm. Results A total of 37 patients and 49 vessels were studied. All patients were imaged in the left anterior descending coronary artery (LAD) and about two-thirds were also imaged in the left circumflex coronary artery (LCX). Most patients were women (n = 35), and apical was the most common takotsubo type. Tissue composition analysis yielded the following overall plaque types: fibrous (67.1%), lipid (15.5%), and calcium (3.77%). The mean OFR for LAD and LCX was 0.97 ± 0.04 and 0.98 ± 0.02, respectively. Conclusion Utilizing automatic plaque characterization on OCT images by artificial intelligence, we found that TTS patients have coronary artery disease (i.e. presence of lipid, calcified, or fibrous tissue). The advent of artificial intelligence methods may allow for large-scale studies of patients with TTS.

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Section: Introductionsupporting

confidence: 68%

Physiologic and compositional coronary artery disease extension in patients with takotsubo syndrome assessed using artificial intelligence: an optical coherence tomography study

Kumar

Chu

Kuku

et al. 2022

Coronary Artery Disease

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“…The initial diagnosis of TTS often involves coronary angiography and left ventriculography, which reveals, in typical cases, akinesis in the mid and apical segments of the LV and the characteristic hyperdynamic basal segments ( 2 , 127 ). Patients may exhibit either normal coronary arteries on angiography or a degree of atherosclerosis that does not match the extent of left ventricular dysfunction or RWMA ( 128 , 129 ). Interestingly, TTS patients who exhibit coronary slow flow at presentation experience a more severe clinical manifestation, with an elevated incidence of intrahospital complications and an unfavorable long-term clinical prognosis ( 130 ).…”

Section: Discussionmentioning

confidence: 99%

Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?—a narrative review

Salamanca,

Alfonso

2023

Cardiovasc Diagn Ther

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Background and Objective Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Methods Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. Key Content and Findings TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Conclusions Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.

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“…Due to the inherent characteristics of magnetic resonance imaging (MRI), it has been the only non-invasive method that can be used for three-dimensional (3D) evaluation of myocardial activity with various parameters in recent years (1). Delayed-enhancement MRI (DE-MRI) is rapidly emerging as an outstanding and effective means of assessing cardiac activity, where patients can be examined at rest without being exposed to radiation (2). The delayed enhancement mechanism of DE-MRI in acute myocardial infarction (AMI) is different from that in old myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of myocardial stress detection based on feature tracking MRI in patients with acute myocardial infarction

Li¹,

Zhao²,

Chen³

et al. 2022

J Thorac Dis

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Background: Evaluate the predictive value of myocardial stress measured by magnetic resonance imaging (MRI) on the severity of coronary artery stenosis and acute myocardial infarction (AMI). In the early stage of acute myocardial infarction, many imaging findings are negative, and MRI myocardial stress detection is controversial in the diagnosis of this aspect. Therefore, it is necessary to determine whether MRI myocardial stress can diagnose acute myocardial infarction.Methods: A total of 120 patients were divided into an AMI group and non-AMI group. The AMI group was further divided into a mild group, moderate group, and severe group. The myocardial stress was measured by MRI, compared in each group, the correlation between myocardial stress and coronary artery stenosis rate was analyzed, and coronary artery disease (CAD) compared between patients with AMI, and the relationship between myocardial stress and AMI was observed.Results: Among the 120 patients, there were 77 cases in the AMI group, including 21 cases in the mild group, 40 cases in the moderate group, and 16 cases in the severe group. There were a total of 43 cases in the non-AMI group. Myocardial stress in the AMI group was significantly higher than that in the non-AMI group (P<0.05). The myocardial stress increased gradually in the mild, moderate, and severe AMI groups (P<0.001). Myocardial stress was positively correlated with coronary artery stenosis rate (P<0.001) and CAD (P<0.05). Logistic regression analysis showed that myocardial stress was an independent risk factor for AMI (P<0.05). The sensitivity and specificity of myocardial stress >5.15 mm in the diagnosis of AMI were 83.5%, 68.6% (AUC =0.834), respectively. Acute myocardial infarction is often caused by risk factors such as hyperlipidemia, hypertension and hyperglycemia, as well as vascular stenosis caused by arterial wall malformation, vascular wall inflammation or vasospasm. Conclusions:The MRI measurement of myocardial stress is simple, reliable, and practical to evaluate the degree of coronary artery lesions. Myocardial stress is closely related to AMI and can assist in the diagnosis of AMI.

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Concomitant acute myocardial infarction and stress cardiomyopathy

Cited by 3 publications

References 3 publications

Physiologic and compositional coronary artery disease extension in patients with takotsubo syndrome assessed using artificial intelligence: an optical coherence tomography study

Physiologic and compositional coronary artery disease extension in patients with takotsubo syndrome assessed using artificial intelligence: an optical coherence tomography study

Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?—a narrative review

Diagnostic value of myocardial stress detection based on feature tracking MRI in patients with acute myocardial infarction

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