Revised clinical diagnostic criteria for Tako-tsubo syndrome: The Tako-tsubo Italian Network proposal

Parodi, Guido; Citro, Rodolfo; Bellandi, Benedetta; Provenza, Gennaro; Marrani, Marco; Bossone, Eduardo

doi:10.1016/j.ijcard.2013.12.239

Cited by 81 publications

(60 citation statements)

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“…Diagnosis: Diagnostic criteria have been previously proposed from a few centres around the world (Table 1), and several diagnostic references have been proposed [5][6][7][8][9] .…”

Section: Epidemiologymentioning

confidence: 99%

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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“…Diagnosis: Diagnostic criteria have been previously proposed from a few centres around the world (Table 1), and several diagnostic references have been proposed [5][6][7][8][9] .…”

Section: Epidemiologymentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

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“…The symptoms of TTC include chest pain or dyspnea but they do not present the same severity as the ACS [17]. Clinical state is associated to electrocardiographic alterations such ST-segment elevation and T-wave inversion respecting the leads of a single coronary territory.…”

Section: Discussionmentioning

confidence: 99%

Stress Related Takotsubo Cardiomyopathy: A Case Report

Cortela¹,

Bernardo²,

Kavanishi³

et al. 2018

JPP

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First described in Hiroshima City Hospital in 1990, Takotsubo Cardiomyopathy emerged as an important differential diagnosis for acute coronary syndrome, since this disease mimics some commemoratives presentations of acute coronary syndrome such as chest symptoms, electrocardiographic changes and cardiac injury biomarker alteration. Also, it's important to emphasize that, although it commonly occurs among woman, TCC can happen in males, as demonstrated in other studies which 10% of the cases occurred in male sex. In this way, this study shows the importance of Takotsubo Cardiomyopathy as a differential diagnosis for acute coronary syndrome.

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“…Patients admitted to 20 centers participating in the Takotsubo Italian Network were included in the Registry according to the Takotsubo Italian Network diagnostic criteria11: (1) Typical transient left ventricular wall motion abnormalities extending beyond a single epicardial vascular distribution with complete functional normalization within 6 weeks; (2) Absence of potentially culprit coronary stenosis, or angiographic evidence of acute plaque rupture, dissection, thrombosis, or spasm; (3) New and dynamic ST‐segment abnormalities or T‐wave inversion or new‐onset transient or permanent left bundle branch block; (4) Mild increase in myocardial injury markers (creatine kinase‐MB value >50 U/L); (5) Clinical and/or instrumental exclusion of myocarditis; (6) Postmenopausal woman (optional); (7) Antecedent stressful event (optional). Antecedent stressful trigger event was defined as an occurrence that produced short‐term physiological change that may lead directly to the onset of acute cardiovascular disease.…”

Section: Methodsmentioning

confidence: 99%

Risk Stratification Using the CHA ₂ DS ₂ ‐VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network

Parodi

Scudiero

Citro

et al. 2017

JAHA

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BackgroundThe CHA2DS2‐VASc score predicts stroke in patients with atrial fibrillation and has been reported to have a prognostic role even in acute coronary syndrome patients. The Takotsubo syndrome is a condition that mimics acute coronary syndrome and may present several complications including stroke. We sought to assess the ability of CHA2DS2‐VASc score to predict adverse events in Takotsubo syndrome patients.Methods and ResultsOverall, 371 Takotsubo syndrome patients were enrolled in a prospective registry. Patients were divided into 3 groups according to the CHA2DS2‐VASc score: Group A (≤1), B (2–3), and C (≥4). The median CHA2DS2‐VASc score was 3 (interquartile range: 2–4). Overall, 9%, 42%, and 49% were included in Group A, B, and C, respectively. Follow‐up length was 26±20 months. The mortality rate was 6%, 7%, and 17% in Group A, B, and C, respectively (P=0.011). The stroke rate was 3% and not different among the 3 groups. Estimated major adverse cardiac and cerebrovascular events (the composite of death, myocardial infarction, and stroke) rates in the 3 groups were 6%, 9%, and 17% in Group A, B, and C, respectively (P=0.033). The CHA2DS2‐VASc score resulted as a predictor of major adverse cardiac and cerebrovascular events (odds ratio 2.1, 95% confidence interval, 1.2–3.6; P=0.01) and all‐cause mortality (odds ratio 1.5, 95% confidence interval, 1.2–1.9; P=0.001).ConclusionsIn Takotsubo syndrome, the CHA2DS2‐VASc score allows prediction of cardiovascular events and mortality at long‐term follow‐up.

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Revised clinical diagnostic criteria for Tako-tsubo syndrome: The Tako-tsubo Italian Network proposal

Cited by 81 publications

References 10 publications

Epidemiology and pathophysiology of Takotsubo syndrome

Epidemiology and pathophysiology of Takotsubo syndrome

Stress Related Takotsubo Cardiomyopathy: A Case Report

Risk Stratification Using the CHA ₂ DS ₂ ‐VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network

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Revised clinical diagnostic criteria for Tako-tsubo syndrome: The Tako-tsubo Italian Network proposal

Cited by 81 publications

References 10 publications

Epidemiology and pathophysiology of Takotsubo syndrome

Epidemiology and pathophysiology of Takotsubo syndrome

Stress Related Takotsubo Cardiomyopathy: A Case Report

Risk Stratification Using the CHA 2 DS 2 ‐VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network

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Risk Stratification Using the CHA ₂ DS ₂ ‐VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network