Effect of Intravenous Propranolol on Left Ventricular Apical Ballooning Without Coronary Artery Stenosis (Ampulla Cardiomyopathy). Three Cases.

Kyuma, Michifumi; Tsuchihashi, Kazufumi; Shinshi, Yasuyuki; Hase, Mamoru; Nakata, Tomoaki; Ooiwa, Hitoshi; Abiru, Masayoshi; Hikita, Nobuichi; Adachi, Takeo; Shoji, Tetsuro; Fujise, Yukiyasu; Shimamoto, Kazuaki

doi:10.1253/circj.66.1181

Cited by 125 publications

(102 citation statements)

References 20 publications

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“…Several investigators 35,36 reported that propranolol, a b-blocker, may be very effective in patients who showed a significant intraventricular pressure gradient because of the activation of the sympathetic nerve. The efficacy of b-blockers may be attributed to the improvement of b-adrenergic signaling and to protection from catecholamine myocyte toxicity in the heart because of a severe increase in plasma catecholamine and the activation of the sympathetic nerve.…”

Section: Discussionmentioning

confidence: 99%

Effects of metoprolol on epinephrine-induced takotsubo-like left ventricular dysfunction in non-human primates

et al. 2009

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Takotsubo cardiomyopathy, alternatively known as stress cardiomyopathy, is an increasingly recognized clinical syndrome characterized by acute reversible apical ventricular dysfunction. To elucidate the mechanism, we tried to make a new model of takotsubo-like cardiomyopathy in non-human primates. Echocardiography revealed that repeated intravenous infusion of epinephrine overdose in cynomolgus monkeys induced takotsubo-like cardiomyopathy, which is characterized by progressive left ventricle and depressed systolic function with severe hypokinesis in apical regions and hyperkinesis in the basal region. Although this cardiac dysfunction almost normalized after a month even without any treatment, metoprolol, a b-blocker, improved the decreased ejection fraction earlier than in the control. Luxol fast blue staining, which is useful for estimating myocytolysis, showed that increased myocytolysis was observed in the apical ventricle of the epinephrine-infused heart. Metoprolol diminished epinephrine-induced cardiomyocytolysis. To explain the mechanism of takotsubo myopathy and the effect of metoprolol, gene expressions in apical or basal ventricle were compared. Heart failure-related genes, such as brain natriuretic peptide, connective tissue growth factor and osteopontin; calcium signaling-related genes, such as ryanodine receptor 2, sarcoendoplasmic reticulum Ca 2+ -ATPase 2A2 and adenylate cyclase 7; renin-angiotensin system-related genes, such as angiotensinogen, angiotensin II receptor, type 1 and type 2; and mitochondria-related genes, such as peroxisome proliferatoractivated receptor-c co-activator-1a, cytochrome c and transcription factor A mitochondrial, were significantly changed at the apical ventricle rather than at the basal ventricle. The changes of some genes improved with metoprolol treatment. These results indicate that this model is valuable in understanding the pathogenesis of takotsubo cardiomyopathy and the effectivity of b-blockers.

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Section: Discussionmentioning

confidence: 99%

Effects of metoprolol on epinephrine-induced takotsubo-like left ventricular dysfunction in non-human primates

et al. 2009

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“…[7][8][9][10] The potential role of catecholamine excess in the pathogenesis of takotsubo cardiomyopathy has been long debated, 11 and as such beta-blockers have been proposed as a therapeutic strategy. 12 Nevertheless, to our knowledge, no prospective trials evaluating the therapeutic management have been reported to date. The aim of this study was to investigate the clinical features, define prognostic predictors, and assess the clinical course and outcome of takotsubo cardiomyopathy.…”

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confidence: 99%

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Templin¹,

et al. 2015

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BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age-and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

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“…Concerning bêta-blockers, there is no direct evidence for a protective effect. They could be indicated when basal hypercontractility is associated with the echocardiographic evidence of an intraventricular pressure gradient [23]. The decision to perform conorary angiography should be guided by the interpretation of patient's complaints, cardiac markers, ECG, and echocardiographic findings.…”

Section: Discussionmentioning

confidence: 99%

Tako-tsubo syndrome following nortriptyline overdose

Roock

Beauloye

Bauwer

et al. 2008

Clinical Toxicology

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Background. Tako-tsubo syndrome (TTS) refers to the apical ballooning of the left ventricle observed when angiographic ventriculography is performed in patients presenting with electrocardiographic changes suggestive of acute coronary syndrome (new transient ST-segment deviation (>0.05 mV) or T-wave inversion (>0.2 mV)), mild elevation of cardiac markers, but normal coronary arteries at the angiogram. Case report. A 54-year-old woman developed the characteristic features of TTS 44 hours following nortriptyline overdose. The admission ECG showed increased QRS duration rapidly reversible after sodium bicarbonate infusion. There was a minimal increase in troponin I level. The ECG performed at the time of chest pain revealed deeply negative T waves in leads I, II, III, aVF, V1 to V6 and remained abnormal at 5 weeks follow-up. In contrast, a complete recovery of left ventricular function was observed within one week. Discussion. The pathophysiology of TTS, a variant of myocardial stunning, is still incompletely understood but could be related to sympathetic overstimulation. The possibility of TTS following toxic exposure is discussed.

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Effect of Intravenous Propranolol on Left Ventricular Apical Ballooning Without Coronary Artery Stenosis (Ampulla Cardiomyopathy). Three Cases.

Cited by 125 publications

References 20 publications

Effects of metoprolol on epinephrine-induced takotsubo-like left ventricular dysfunction in non-human primates

Effects of metoprolol on epinephrine-induced takotsubo-like left ventricular dysfunction in non-human primates

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Tako-tsubo syndrome following nortriptyline overdose

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