Relation of Delayed Recovery of Myocardial Function After Takotsubo Cardiomyopathy to Subsequent Quality of Life

Neil, Christopher; Nguyen, Thanh Ha; Singh, Kuljit; Raman, Betty; Stansborough, Jeanette; Dawson, Dana; Frenneaux, Michael; Horowitz, John D.

doi:10.1016/j.amjcard.2015.01.541

Cited by 47 publications

(38 citation statements)

References 19 publications

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“…18 Furthermore, in a recent publication Neil et al demonstrated that despite normalization of the left ventricular (LV) ejection fraction there is ongoing inflammation of the myocardium, which persists, at least, up to 3 months and correlates with impairment of quality of life. 24 These findings are in line with the findings published by Dawson et al who demonstrated that acute episodes of TTS are associated with profound cardiac energetic impairment, which did not resolve completely by 4 months. 25 These findings from various studies argue for the fact that the development of therapeutics should not only be directed at the acute episodes of TTS but also towards the rapid recovery of LV along with a reduction in the rate of recurrence.…”

supporting

confidence: 83%

Takotsubo Syndrome Therapy: Current Status and Future Directions

Singh¹,

Akashi²,

Horowitz³

2016

ICFJ

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<p>Tako-Tsubo Cardiomyopathy (TTC), which is now known as Tako-Tsubo Syndrome (TTS) is a transient left ventricular (LV) systolic dysfunction of uncertain pathogenesis, which occurs predominantly in ageing women. There is considerable uncertainty regarding the management of TTS related acute and chronic issues and most of the evidence regarding therapy comes from retrospective data and case studies. In this review we have tried to concise the available information on the TTS therapeutics to help clinicians make treatment decisions in patients diagnosed with TTS. At the same time we have highlighted some of the uncertainties regarding TTS therapy, in particular the inability of b-blocker therapy to improve survival or prevent recurrence. We have also emphasized the issue of incomplete recovery in some cases of TTS where there is ongoing inflammation and evidence of impaired myocardial energetics despite normalization of LV ejection fraction. Although there is no scientific evidence on how to improve or fasten the recovery of TTS, we believe therapy improving energy efficiency may play some role in future. Lastly, we would like to reiterate that in the absence of randomized studies evaluating medical therapy in TTS, the treatment for this syndrome remains entirely empirical and should be individualized according to the patient characteristics at the time of presentation.</p>

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supporting

confidence: 83%

Takotsubo Syndrome Therapy: Current Status and Future Directions

Singh¹,

Akashi²,

Horowitz³

2016

ICFJ

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“…Both of these case-control studies found an overwhelming improvement in most parameters studied. However, in a separate, earlier cohort of patients, we documented reduced global longitudinal strain 3 months after the acute phase (a finding replicated by others at 21 days follow-up 19 ), associated with incomplete resolution of symptoms in a large proportion of takotsubo patients 20 . In further separate takotsubo cohorts, we previously described additional persistent abnormalities, such as elevated natriuretic peptide concentrations at 3 months, persistent myocardial edema at 3 months 21 and impaired myocardial energetic status (together with persistence of edema) at 4 months of follow-up 7 .…”

Section: Current Results In Context Of Previous Literaturementioning

confidence: 60%

“…Whilst these findings were observed using resting echocardiography, it is not known how these parameters would change with exercise, but it is conceivable that they provide at least a partial explanation for recent reports of fatigue and inability to engage in physical exercise in these patients 20 . The takotsubo patients in this study appear to sustain a relative resting tachycardia compared to controls.…”

Section: Importance and Extent Of Systolic Diastolic And Extracellulmentioning

confidence: 89%

“…additionally we showed a persistently abnormal Global Longitudinal Strain (GLS) at 3 months follow-up of a cohort of 36 tako-tsubo patients comprising all comers (ST-elevation, non-ST elevation, normal ECG and all LV-ballooning subtypes, i.e apical, mid-cavity and basal) 4 .…”

Section: Discussionmentioning

confidence: 99%

“…While this introduces a paradigm shift in the way that takotsubo prognosis was viewed until recently, new important questions arise, with an urgent need to explain why a condition considered until recently as "transient" and "naturally recovering" portends such a poor outlook. It has become increasingly obvious that the relatively rapid recovery of left (± right) ventricular ejection fraction (LV EF) after an acute attack of takotsubo is not paralleled by symptomatic 4 or ECG recovery 5 , for example. We have previously shown that acute takotsubo hearts demonstrate severe global edema associated with profound cardiac energetic impairment with incomplete resolution of both at 4 months 6, 7 ;…”

Section: Discussionmentioning

confidence: 99%

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Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Schwarz

Ahearn

Srinivasan

et al. 2017

Journal of the American Society of Echocardiography

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108

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Background: Takotsubo syndrome is an increasingly recognized cause of chest pain and occasionally of cardiogenic shock. Despite rapid improvement of the Left Ventricular Ejection Fraction (LV EF), recent registry data raises concerns about long term prognosis. We hypothesized that restoration of normal EF after acute tako-tsubo is not equivalent to full functional recovery. Methods: We prospectively recruited 52 takotsubo patients [according to the Mayo criteria plus cardiac magnetic resonance imaging (CMR) to exclude myocardial infarction] and 44 healthy controls of the same age, gender and cardiovascular co-morbidity distribution. We focused the investigation on takotsubo patients presenting with ST-elevation type ECG or malignant arrhythmias and with LV apical ballooning variant and examined a 4 months recovery end-point. Patients underwent Echocardiography assessment of LV myocardial deformation (Global longitudinal, radial and circumferential strain, LV twist, torsion, untwist, time to peak twist and untwist) and assessment of LV myocardial structure by pre and post contrast-enhanced CMR by T1 mapping acutely and at 4 months follow-up. Controls had a single time-point investigation. Data were analyzed using paired or unpaired tests, as appropriate for their distribution and corrected for multiple comparisons. Results: The patients' mean age was 66 years (range 28-87) and 92% were women. All abnormal echocardiographic indices observed acutely in takotsubo patients improved (but not necessarily normalized) at followup. Significant mechano-temporal alterations characterizing both systole (global longitudinal strain, apical circumferential strain, both p<0.01; left ventricular twist, twist rate and torsion, all p<0.0001) and diastole (untwist rate and time to peak untwisting, all p<0.001) persisted at 4 months follow-up when compared with controls, despite normalization of LV ejection fraction and volumes. Whilst native T1 (which demonstrates edema) normalized at 4 months follow-up only in segments contracting normally during the acute phase [T1=1180± 40.6ms (normally contracting, p=0.2 vs control values of 1189±16 ms) and 1208± 60.3 ms (dysfunctional segments, p<0.05 vs control)], the extracellular volume fraction (ECV, which demonstrates diffuse fibrosis) remained significantly abnormal in all LV segments (whether normally contracting, 0.328±0.043, p<0.001 or ballooning during acute presentation, 0.320±0.044, p<0.001, both vs control values of 0.273±0.045). Conclusion: In patients with the most clinically severe spectrum of takotsubo cardiomyopathy, regional LV systolic and diastolic deformation abnormalities persist beyond the acute event, despite normalization of global LV EF and size. In addition, although myocardial edema partly subsides, a process of global microscopic fibrosis develops in its place, detected as early as 4 months.Suggested Reviewers:Opposed Reviewers: 1 24 th March, 2017 Dear Dr Pearlman, Thank you once again for your comments and those of the associate editors. I think it i...

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Takotsubo Syndrome

Kucia¹

2022

Cardiac Care

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Relation of Delayed Recovery of Myocardial Function After Takotsubo Cardiomyopathy to Subsequent Quality of Life

Cited by 47 publications

References 19 publications

Takotsubo Syndrome Therapy: Current Status and Future Directions

Takotsubo Syndrome Therapy: Current Status and Future Directions

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Takotsubo Syndrome

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