Incidence and Clinical Impact of Right Ventricular Involvement (Biventricular Ballooning) in Takotsubo Syndrome

El‐Battrawy, Ibrahim; Santoro, Francesco; Stiermaier, Thomas; Möller, Christian; Guastafierro, Francesca; Novo, Giuseppina; Novo, Salvatore; Mariano, Enrica; Romeo, Francesco; Romeo, Fabiana; Thiele, Holger; Guerra, Federico; Capucci, Alessandro; Giannini, Irene; Brunetti, Natale Daniele; Eitel, Ingo; Akın, İbrahim

doi:10.1016/j.chest.2021.04.072

Cited by 24 publications

(10 citation statements)

References 32 publications

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“…In the work of Vieillard-Baron et al [ 20 ] right ventricular failure was reported to be frequently presented in 120 (42%) of 282 septic shock patients. Interestingly, in a large recent registry of TTS patients (n = 839), El-Battrawy et al [ 21 ] identified an incidence of RV involvement of 11%. It seems that there are some common characteristics shared between sepsis-induced myocardial dysfunction and TTS.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of patients with septic shock-triggered Takotsubo syndrome: a single-center 7 case series

Jing

Wang

Kang

et al. 2022

BMC Cardiovasc Disord

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Background Myocardial dysfunction is common in septic shock and has long been recognized. Takotsubo syndrome is an acute and usually reversible myocardial injury without evidence of an obstructive coronary artery disease, yet little is known about this syndrome in septic shock patients. Case presentation Among 84 septic shock patients admitted to the ICU over a period of 8 months, 7 patients (8.3%) were diagnosed with Takotsubo syndrome. The percentage of men was 71%, and the mean age was 58 (19–87) years. Sudden hemodynamic deterioration and/or dyspnea were the presenting symptoms in 6 patients. T-wave inversion was the major ECG anomaly in 5 patients. The mean left ventricular ejection fraction was 31.8% (20.0–53.0). Mild elevation of cardiac troponin disproportionate to the extent of regional wall motion abnormalities was present in all patients. Cardiac complications occurred in 6 patients. The mean time to recover the cardiac function was 6.5 (3–11) days. In-hospital death was observed in 2 patients. Conclusions Takotsubo syndrome is not uncommon in septic shock patients and may be the cause of some patients with sepsis-induced myocardial dysfunction. New-onset hemodynamic and respiratory worsening could arouse the suspicion of Takotsubo syndrome and prompt the screening for this syndrome using echocardiography in this clinical context.

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Section: Discussionmentioning

confidence: 99%

Clinical features of patients with septic shock-triggered Takotsubo syndrome: a single-center 7 case series

Jing

Wang

Kang

et al. 2022

BMC Cardiovasc Disord

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“…Of published case reports, only three cases presented with cardiogenic shock, with a larger number (34.6%; 27/78) complicated by subsequent cardiogenic shock [ 7 ]. The GEIST registry found right ventricular involvement (as seen in our patient) in TS to be rare (~11%), and significantly associated with cardiogenic shock and all-cause mortality [ 16 ]. Symptom severity and greater complication rates may be attributable to the episodic and extreme nature of catecholamine surges in pheochromocytoma, which would impair coronary vasomotor function [ 17 ], and over a prolonged period, may influence density of myocardial B1–B2-adrenoreceptors, 1 2 leading to further dysfunction.…”

Section: Discussionmentioning

confidence: 99%

The heart of the matter: secretory pheochromocytoma presenting as recurrent biventricular heart failure (Takotsubo cardiomyopathy)

Turner

Serraro-Brown

McLaren

et al. 2022

Oxford Medical Case Reports

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Takotsubo’s syndrome (TS) is an acute, transient cardiomyopathy occurring secondary to physical or emotional stressors through catecholamine excess. Secretory pheochromocytomas have been previously implicated in cases of TS (PTS), however, often present atypically, are associated with reoccurrence, and have higher rates of complications. We describe the case of a 70-year-old female who presented central chest pain, hypotension and electrocardiogram changes on a background of a 6-month prior episode of resolved Takotsubo’s with unknown cause. After progressing to cardiogenic shock with biventricular failure, computerized tomography coronary aortogram revealed an incidental adrenal mass, later proven to be a secretory pheochromocytoma on biochemistry and subsequent histology. PTS has been associated with recurrence and rarely presents as cardiogenic shock. This case highlights the complexity of TS presentations and complications and the diagnostic delays that may occur in PTS.

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“…Takotsubo syndrome is a type of acute heart failure that usually involves apical ballooning of the left ventricle but can also involve the right ventricle (1). This syndrome mainly affects post-menopausal women.…”

Section: Introductionmentioning

confidence: 99%

Case report: Changes in the levels of stress hormones during Takotsubo syndrome

Ruiz

Gabarre

Chenevier‐Gobeaux

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTakotsubo syndrome is an acute cardiac condition usually involving abnormal regional left ventricular wall motion and impaired left ventricular contractility. It is due mainly to hyper-stimulation of the sympathetic nerve system, inducing an excess of catecholamines, usually triggered by intense psychological or physiological stress. The relationship between Takotsubo syndrome and the circulating stress hormones cortisol and copeptin (a surrogate marker of arginine vasopressin) has not been well documented.Case summaryHere, we describe the dynamic changes in circulating cortisol and copeptin during an entire episode of Takotsubo syndrome in a post-partum woman after spontaneous vaginal delivery. The patient was diagnosed with inverted Takotsubo syndrome accompanied by HELLP syndrome. We found qualitative and quantitative changes in cortisol: a loss of circadian rhythm and a three-fold elevation in the plasma concentration of the hormone with a peak appearing several hours before circulating cardiac biomarkers began to rise. By contrast, levels of copeptin remained normal during the entire episode.DiscussionOur findings indicate that the levels of cortisol change during Takotsubo syndrome whereas those of copeptin do not. This association between elevated cortisol and Takotsubo syndrome suggests that aberrant levels of this stress hormone may contribute to the observed cardiac pathology. We conclude that biochemical assays of circulating cortisol and cardiac biomarkers may be a useful complement to the diagnosis of Takotsubo syndrome by non-invasive cardiac imaging.

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Incidence and Clinical Impact of Right Ventricular Involvement (Biventricular Ballooning) in Takotsubo Syndrome

Cited by 24 publications

References 32 publications

Clinical features of patients with septic shock-triggered Takotsubo syndrome: a single-center 7 case series

Clinical features of patients with septic shock-triggered Takotsubo syndrome: a single-center 7 case series

The heart of the matter: secretory pheochromocytoma presenting as recurrent biventricular heart failure (Takotsubo cardiomyopathy)

Case report: Changes in the levels of stress hormones during Takotsubo syndrome

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