Takotsubo syndrome: a neurocardiac syndrome inside the autonomic nervous system

Marafioti, Vincenzo; Benfari, Giovanni

doi:10.1007/s10741-018-9748-2

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…The authors observed that many of regional wall motion patterns did not follow a coronary artery supply territory but correlated with the distribution of the myocardial sympathetic nerve terminals providing an indirect evidence for a neuro - mediated mechanism of myocardial injury[ 75 ]. This circumferential pattern of LVWMA is congruent with cardiac nerve distribution[ 76 , 77 ]. Details of further evidence for the local cardiac sympathetic nervous system involvement in TS is described elsewhere[ 5 , 6 , 44 , 45 ].…”

Section: Evidences For Hyperactivation Of Autonomic (Sympathetic) Nermentioning

confidence: 79%

Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Y‐Hassan¹

2020

WJC

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Myocardial infarction (MI) is defined as myocardial cell death due to prolonged myocardial ischemia. Clinically, troponin rise and/or fall have become the “defining feature of MI” according to the universal definition of MI (UD-MI). Takotsubo syndrome (TS) and TS-related disease conditions also cause troponin elevation with typical rise and/or fall pattern but through a mechanism other than coronary ischemia. By strict application of the clinical diagnostic criteria for type-1 MI, type-2 MI, type-3 MI, and MI with non-obstructive coronary arteries according to the UD-MI including the fourth one published recently, TS and most of the 26 other causes of troponin elevation mentioned in the fourth UD-MI may erroneously be classified as MI. The existing evidence argues for the case that TS by itself is not a MI. Hyper-activation of the autonomic-sympathetic nervous system including local cardiac sympathetic hyper-activation and disruption with nor-epinephrine churn and spillover is the most probable cause of TS. This autonomic neuro-cardiogenic (ANCA) mechanism results in myocardial “cramp” (stunning), the severity and duration of which depend on the degree of the sympathetic-hyperactivation and nor-epinephrine spillover. The myocardial cramp may squeeze the cytosolic free troponin pools causing mild to moderate troponin elevation in TS and TS-related disease conditions. This ANCA syndrome, which has hitherto been enveloped by the UD-MI over more than one decade, may occur in acute, recurrent, and chronic forms. In this critical review, the controversies of UD-MI, evidence for ANCA syndrome, and a hypothetical mechanism for the troponin elevation in ANCA syndrome are provided.

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Section: Evidences For Hyperactivation Of Autonomic (Sympathetic) Nermentioning

confidence: 79%

Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Y‐Hassan¹

2020

WJC

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“…This impacts on pre-existing microvascular abnormalities, determining unbalance between inappropriate α-mediated vasoconstriction and inadequate β2-mediated vasodilation. External microvascular compression due to myocardial oedema and inflammation-related cell accumulation and to increased intracardiac pressures may also contribute to the microvascular perfusion abnormalities [ 5 , 29 ]. In accordance with the most plausible pathophysiological momentum subtending TTS, a prevalent functional microvascular impairment is expected compared to ST-segment elevation MI where a profound structural microvascular deterioration has been proved also in the acute phases.…”

Section: Discussionmentioning

confidence: 99%

Angiography-derived index of microvascular resistance in takotsubo syndrome

Castaldi

Fezzi

Widmann

et al. 2022

Int J Cardiovasc Imaging

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Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess CMD in patients with TTS through the computation of the angiography-derived index of microcirculatory resistance (IMR) and its correlation with clinical presentation. Coronary angiograms of 41 consecutive TTS patients were retrospectively analyzed to derive angiography-based indices of CMD. Three indices (NH-IMRangio, AngioIMR and A-IMR) were calculated based on quantitative flow ratio. CMD was defined as an IMRangio value ≥ 25 units. The correlation between CMD and clinical presentation was then assessed. Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in left anterior descending artery (LAD) than circumflex and right coronary artery with either NH-IMRangio (53.9 ± 19.8 vs 35.8 ± 15.4 vs 40.8 ± 18.5, p-value < 0.001), AngioIMR (47.2 ± 17.3 vs 31.8 ± 12.2 vs 37.3 ± 13.7, p-value < 0.001) or A-IMR (52.7 ± 19 vs 36.1 ± 14.1 vs 41.8 ± 16.1, p-value < 0.001). All patients presented CMD with angiography-derived IMR ≥ 25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤ 40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 ± 18.1 vs 46.3 ± 16.0 p-value = 0.030; AngioIMR: 52.9 ± 17.8 vs 41.4 ± 14.2, p-value = 0.037; A-IMR: 59.2 ± 18.6 vs 46.3 ± 17.0, p-value = 0.035). CMD assessed with angiography-derived IMR is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.

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“…The authors concluded that the available studies confirm the role of the autonomic nervous system, with a predominant report of activations of the sympathetic nervous system and fewer reports of alterations in the parasympathetic 24 . However, the specific autonomic nervous system alterations explaining changes in the modulation of catecholamine are not clear [25][26][27] .…”

Section: Discussionmentioning

confidence: 99%

Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies

Rojas-Gualdrón¹,

Osorio-Moreno²,

Molina-Escobar³

et al. 2022

RCCAR

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Background: Functional neuroimaging studies may aid to our understanding of the pathophysiology of the takotsubo cardiomyopathy. Objective: The aim of the study was to review the available evidence of brain functional connectivity in takotsubo cardiomyopathy patients. Methods: This was a systematic review. We searched MEDLINE, LILACS, Ovid (Cochrane), Scopus, and Science Direct for studies conducting functional magnetic resonance imaging (fMRI) in takotsubo patients. After reviewing title/abstract and full text, we selected relevant studies, extracted methodological characteristics, and their main findings, and assessed their risk of bias with the Newcastle-Ottawa scale. We present a narrative review. Results: We included five case-control studies from 600 registries. The risk of bias was low; comparability was the main issue. Resting-state fMRI findings suggest significant differences for the hippocampus, the Insula, the amygdala, and the para-hippocampal gyrus. Task fMRI findings suggest significant differences for the Insula, the superior occipital gyrus, and the amygdala. Studies were heterogeneous about the laterality and directionality of these differences. Conclusion: Brain connectivity alterations involving elements relevant for autonomic control like the Insula and the Amygdala provide evidence in favor of the role of functional networks in the neurocardiology of stress-related cardiomyopathies. However, it is not possible to determine if this role is causal or consequential.

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Takotsubo syndrome: a neurocardiac syndrome inside the autonomic nervous system

Cited by 4 publications

References 4 publications

Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction

Angiography-derived index of microvascular resistance in takotsubo syndrome

Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies

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