Systolic and Diastolic Mechanics in Stress Cardiomyopathy

Medeiros, Keith; O'Connor, Mark J.; Baicu, Catalin F.; Fitzgibbons, Timothy P.; Shaw, P.W.; Tighe, Dennis A.; Zile, Michael R.; Aurigemma, Gerard P.

doi:10.1161/circulationaha.113.002781

Cited by 106 publications

(73 citation statements)

References 27 publications

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“…When comparing the acute phase of ST‐elevation myocardial infarction and TTS, similar systolic and diastolic mechanisms have been described 24. Therefore, it is not surprising that similar predictors of thrombus formation have been found in our comprehensive study.…”

Section: Discussionsupporting

confidence: 80%

“…Angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers could have some benefit in term of improved survival at 1 year 3. β‐Blockers showed no effect on survival and recurrence rate,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 whereas calcium antagonists could be used if coronary vasospasm has been proven during coronary angiogram or with acetylcholine test 32…”

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

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BackgroundLeft ventricular (LV) thrombi during Takotsubo syndrome represent a potential complication and can be associated with cerebrovascular embolic events. The aim of this study was to evaluate the exact incidence, predictors, and management strategies of LV thrombi in patients with Takotsubo syndrome.Methods and ResultsWe enrolled 541 consecutive patients in a multicenter international registry. Clinical features and echocardiographic data at admission, during hospitalization, and after 3 months were evaluated. Survival rates for long‐term follow‐up (mean 984±908 days) were recorded. Twelve Takotsubo syndrome patients (2.2%) developed LV thrombi (all female presenting with apical ballooning pattern). All patients with LV thrombi were treated with oral anticoagulation therapy; however, 2 (17%) had a stroke before treatment initiation. These patients were characterized by a higher prevalence of ST‐elevation (56% versus 16%; P<0.001) and higher troponin I levels (10.8±18.3 ng/mL versus 3.5±4.3 ng/mL; P=0.001) as compared with those without LV thrombi. At multivariate analysis including age, sex, LV ejection fraction, ST‐elevation at admission, and apical ballooning pattern, troponin I level >10 ng/mL was the only predictor for LV thrombosis (hazard ratio 6.6, confidence interval, 1.01–40.0; P=0.04). After 3 months all LV thrombi disappeared. Oral anticoagulation therapy was interrupted in all patients except 1. At long‐term follow‐up, the survival rate was not different between patients with and without LV thrombi (84% versus 85%; P=0.99).Conclusions LV thrombi have a relatively low incidence among patients with Takotsubo syndrome and were detected in female patients with apical ballooning pattern and increased troponin levels. Oral anticoagulation therapy for 3 months seems reasonable in these high‐risk patients.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Santoro

Stiermaier

Tarantino

et al. 2017

JAHA

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“…7,63 LV stroke work is 50% of normal, with markedly increased end-systolic volume reflecting major impairment of LV pump function and leading to reduction in stroke volume and cardiac output. 63 Furthermore, LV diastolic function is also acutely disturbed, with an upward shift in the LV diastolic pressurevolume curve, resulting in substantially elevated LV end-diastolic pressure without significant increase in LV end-diastolic volume. 63 Under these circumstances, TTC patients may experience clinically important hemodynamic instability, including profound hypotension (requiring intervention with inotropic drug therapy and/or intra-aortic balloon pump [IABP]), pulmonary edema, and cardiogenic shock.…”

Section: Cardiac Biomarkersmentioning

confidence: 99%

Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy

Sharkey

Maron

2014

Circ J

111

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“…The disease is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wall-motion abnormalities. 2,3 It predominantly affects elderly women and is often preceded by an emotional or physical trigger, 4 but the condition has also been reported with no evident trigger. In the acute phase, the clinical presentation, electrocardiographic findings, and biomarker profiles are often similar to those of an acute coronary syndrome.…”

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confidence: 99%

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Templin¹,

et al. 2015

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BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age-and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

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Systolic and Diastolic Mechanics in Stress Cardiomyopathy

Cited by 106 publications

References 27 publications

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

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