Novel rat model reveals important roles of β-adrenoreceptors in stress-induced cardiomyopathy

Shao, Yangzhen; Redfors, Björn; Täng, Margareta Scharin; Möllmann, Helge; Troidl, Christian; Szardien, Sebastian; Hamm, Christian W.; Nef, Holger; Borén, Jan; Ömerovic, Elmir

doi:10.1016/j.ijcard.2012.12.092

Cited by 139 publications

(150 citation statements)

References 36 publications

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“…This hypothesis was tested in a rat takotsubo model where high dose epinephrine-induced reversible apical hypokinesia, and this takotsubo model could be prevented by pretreatment with the Gi protein inhibitor pertussis toxin 72 . This observation was replicated in another preclinical model where pertussis toxin prevented acute apical dysfunction induced by high dose isoproterenol injection, albeit with a high mortality in the pertussis toxin treated group 76 . Recently computer modelling studies evaluated the impact of varying βAR gradients across the left ventricle under different haemodynamic situations and could replicate the acute apical dysfunction observed when the βAR density was highest at the apex 77 .…”

Section: Direct Catecholamine-mediated Myocardial Stunningmentioning

confidence: 65%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

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Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, and often in a circumferential apical, mid-ventricular or basal distribution. A number of pathophysiological explanations for this syndrome with its intriguing appearance have been proposed, and there is a growing awareness that these are not mutually exclusive, and that the reversible apical myocardial dysfunction observed could result from more than one pathophysiological phenomenon. The pathophysiology of takotsubo syndrome is complex, with integration of both neuroendocrine physiology involving the cognitive centres of the brain and hypothalamic-pituitary-adrenal axis, and the cardiovascular responses to the sudden sympathetic activation and surge in circulating catecholamines. The latter have been explored in detail, starting with the histological findings at biopsy, with the multiple morphological changes seen in the myocardium matching those seen after established catecholamine cardiotoxic effects. Clinically, both the acute prognosis and recurrence rate are unfortunately worse than previously reported. It is clear that the modern cardiology community has much still to learn regarding the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways. 3 Key points Approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome. There is a predominance in post-menopausal women compared to men or younger women. Both the acute and long-term mortality are higher than previously recognized.The cumulative incidence of recurrence increased from 1.2% at first 6 months to nearly 5% at 6 years, and there is no current evidence to support treatment with any specific to prevent recurrence. Systemic surges in catecholamines may cause vascular effects including acute coronary vasospasm and severe acute hypertension due to acute peripheral vasospasm followed by later peripheral vasodilation and hypotension. In the clinical setting, profound hypotension and cardiogenic shock is a common complication, however, it is not solely related to the extent of impairment of left ventricular (LV) systolic function, and thus probably relates in part to inappropriate peripheral vasodilation. Biopsies during acute takotsubo syndrome are characterized by multiple morphological changes that are similar to those after catecholamine cardiotoxic effects supporting a direct effect in addition to the vascular influences. The apical myocardium of the left ventricle has the highest density of β-adrenergic receptors (βAR), and is therefore most sensitive to circulating catecholamines.

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Section: Direct Catecholamine-mediated Myocardial Stunningmentioning

confidence: 65%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

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“…There have been some reports regarding the effects of inhaled beta2 agonists on cardiovascular function (29) and stress cardiomyopathy precipitated by the intravenous administration of catecholamines and beta-receptor agonists (5). Moreover, Shao et al used a rat model to support the hypothesis of circulating catecholamines as initiators of stress-induced cardiomyopathy and the importance of beta-adrenoreceptors (30).…”

Section: Discussionmentioning

confidence: 99%

Asthmatic Attack Complicated with Takotsubo Cardiomyopathy after Frequent Inhalation of Inhaled Corticosteroids/Long-Acting Beta2-Adrenoceptor Agonists

et al. 2016

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A 63-year-old man was transferred to our hospital because of an exacerbation of asthma. His symptoms deteriorated even after increasing the dose of inhaled corticosteroids/long-acting beta2-adrenoceptor agonists (ICS/LABA). He had no chest pain and an electrocardiogram revealed ST elevation. A coronary angiogram revealed a reduced left ventricular function with an apical ballooning pattern without coronary stenosis. He was diagnosed with Takotsubo cardiomyopathy. Catecholamine elevation due to acute asthma and an overdose of ICS/LABA may be triggers of this disease. We should remember that Takotsubo cardiomyopathy is a complication of asthma and that catecholamine plays an important role in its onset, although it is essential for asthma treatment.

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“…Several factors may synergistically influence TCC; some mechanistic studies have reported the conflicting results. Dobutamine or epinephrine, which has a dominant coronary vasodilatory effect, induces clinical cases (24): likewise, the high dose of β-adrenoceptor agonist isoproterenol induces acute apical dysfunction (25). These findings do not support vasospasm as a primary cause of TTC (5,7).…”

Section: Introductionmentioning

confidence: 99%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

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Novel rat model reveals important roles of β-adrenoreceptors in stress-induced cardiomyopathy

Cited by 139 publications

References 36 publications

Epidemiology and pathophysiology of Takotsubo syndrome

Epidemiology and pathophysiology of Takotsubo syndrome

Asthmatic Attack Complicated with Takotsubo Cardiomyopathy after Frequent Inhalation of Inhaled Corticosteroids/Long-Acting Beta2-Adrenoceptor Agonists

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

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