Observational study on Takotsubo-like cardiomyopathy: clinical features, diagnosis, prognosis and follow-up

Cacciotti, Luca; Passaseo, Ilaria; Marazzi, Giuseppe; Camastra, Giovanni; Campolongo, Giuseppe; Beni, Sergio; Lupparelli, Fabrizio; Ansalone, Gerardo

doi:10.1136/bmjopen-2012-001165

Cited by 50 publications

(42 citation statements)

References 37 publications

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“…Seven studies on the effects of β‐blockers on the prevention of TTC recurrence were evaluated in a pooled analysis . In aggregate, the pooled studies included 471 subjects.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies on the effects of angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on prevention of TTC recurrence were evaluated in a pooled analysis . In aggregate, the pooled studies included 275 subjects.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 165 records were screened, and 140 of them were excluded because the median follow‐up was shorter than 3 months. Twenty‐five full‐text articles were assessed for eligibility, but only 8 studies met all the inclusion criteria (Table ) …”

Section: Methodsmentioning

confidence: 99%

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Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Santoro

Ieva

Musaico

et al. 2014

Clinical Cardiology

127

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Background: Efficacy of chronic drug therapy in prevention of stress-induced cardiomyopathy recurrences is not well established. We therefore aimed to evaluate in this meta-analysis whether pharmacological treatment can effectively prevent takotsubo cardiomyopathy (TTC) recurrences, according to available studies. Hypothesis: There is no evidence for preventing TTC recurrence by drug therapy. Methods: After a PubMed search, we conducted a meta-analysis of available studies (clinical nonrandomized registries) on efficacy of drug therapy in preventing recurrence of TTC. Results: A total of 23 (4.5%) TTC recurrences occurred in the 511 patients included in the analysis. Seven studies on the effects of β-blockers on prevention of TTC recurrence were evaluated; the odds ratio (OR) was 0.44 and the 95% confidence interval (CI) was 0.15-1.31. In 5 studies on the effects of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the OR was 0.42 and the 95% CI was 0.08-2.36; in 3 studies on statins, the OR was 0.74 and the 95% CI was 0.07-7.3; and in 4 studies on aspirin, the OR was 0.33 with a 95% CI of 0.05-2.17 (P value not significant in all cases). Conclusions: A meta-analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β-Blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue. IntroductionTakotsubo cardiomyopathy (TTC) is a rapidly reversible form of acute heart failure occurring mainly in postmenopausal women after an episode of physical or emotional stress 1 and is associated with a typical left ventricular (LV) contraction pattern. 2 Increased catecholamine levels were thought to be the primary precipitator of the condition, 3 but the exact mechanism is still not well elucidated. 4,5 The initial treatment for TTC is usually the same as adopted for acute heart failure, except for contraindication to β-adrenergic inotropes 6 ; data on the efficacy of chronic pharmacological therapy, however, are scanty. Despite its relatively good long-term prognosis, 7 recurrences of TTC are not infrequent, with a rate ranging from 5% to 11.4% within the first 4 years and an incidence per year of 2.4%. 8,9 β-Blockers are commonly used chronically to prevent TTC recurrence, but, given the rarity of TTC, there are no randomized studies supporting this approach.We therefore conducted a meta-analysis of currently available studies to evaluate whether drug therapy can effectively prevent TTC recurrences.

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“…Seven studies on the effects of β‐blockers on the prevention of TTC recurrence were evaluated in a pooled analysis . In aggregate, the pooled studies included 471 subjects.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Santoro

Ieva

Musaico

et al. 2014

Clinical Cardiology

127

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“…Anticoagulant therapy in patients at risk of ventricular mural thrombus should be considered. Of note, anti-arrhythmic drugs play a crucial role in the acute and sub-acute phases of TS, whereas in patients with cardiogenic shock, intravascular treatment with inotropic agents, intra-aortic balloon pumping and utilization of LV-assist devices might be required [109].…”

Section: Coronary Arteriovenous Fistulamentioning

confidence: 99%

A focus on the prognosis and management of ischemic heart disease in patients without evidence of obstructive coronary artery disease

Scalone

Niccoli

2015

Expert Review of Cardiovascular Therapy

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Ischemic heart disease without evidence of obstructive coronary artery disease is a common phenotype comprising different coronary syndromes with either stable or unstable clinical presentation. In this context, the clinical outcome and management appear extremely variable, due to different etiologies. Of note, coronary microvascular dysfunction is the pathogenetic mechanism linking different clinical scenarios in most of the cases. Hence, in this article, we aim to provide a systematic approach of reviewing the prognosis and management of angina or myocardial infarction without evidence of obstructive coronary artery disease. Moreover, we will propose a new scheme of classification by distinguishing between angina with normal coronary artery and myocardial infarction with normal coronary artery in order to facilitate clinicians to perform a proper management workflow.

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“…Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular (LV) (usually apical) dysfunction often triggered by physical or emotional stress, and clinically mimics an acute coronary syndrome (ACS), but is distinguished from ACS by the absence of significant coronary artery disease (CAD) on angiography. 1 Hemodynamically significant mitral regurgitation (MR) can occur in TTC, the mechanism of which must be accurately determined, as dynamic MR caused by systolic anterior motion (SAM) of the mitral valve is generally reversible with medical management, as opposed to significant MR in ACS which may require surgical intervention. We present 2 cases of TTC presenting to our institution with SAM-associated moderate or severe MR, which resolved with resolution of LV dysfunction on follow-up echocardiography.…”

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confidence: 99%

Acute Mitral Regurgitation in Suspected Acute Coronary Syndrome: What Is the Cause?

2013

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Patients presenting with acute chest pain and suspected acute coronary syndrome (ACS) who have nonobstructive coronary disease on angiography, but new regional wall motion abnormalities are often diagnosed with takotsubo cardiomyopathy (TTC). The cause of TTC is often physical or emotional stress, and this clinical syndrome occurs more often in women than men. When hemodynamically significant mitral regurgitation (MR) accompanies TTC, the mechanism must be carefully elucidated, as systolic anterior motion (SAM) of the mitral valve can cause significant MR and left ventricular outflow tract (LVOT) obstruction. These patients can be conservatively managed, with SAM-associated MR and LVOT obstruction resolving with medical therapy as TTC-associated left ventricular (LV) dysfunction resolves, as opposed to true ACS where further intervention for MR is often necessary. This case report describes 2 cases of TTC presenting with severe MR, who were initially thought to have ACS-associated MR caused by ischemia, but on further echocardiographic interrogation were found to have SAM-associated MR which resolved along with resolution of LV wall motion abnormalities on medical therapy by follow-up echocardiography.

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Observational study on Takotsubo-like cardiomyopathy: clinical features, diagnosis, prognosis and follow-up

Cited by 50 publications

References 37 publications

Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

A focus on the prognosis and management of ischemic heart disease in patients without evidence of obstructive coronary artery disease

Acute Mitral Regurgitation in Suspected Acute Coronary Syndrome: What Is the Cause?

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