Takotsubo syndrome and respiratory diseases: a systematic review

Abstract

Aims Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown the association of respiratory diseases with TTS. Here, we comprehensively reviewed the literature and examined the available evidence for this association. Methods and Results After searching PubMed, EMBASE, and Cochrane Library databases, two investigators independently reviewed 3117 studies published through May 2021. Of these studies, 99 met the inclusion criteria (n = 108 patients). In patients with coexisting respiratory disease and TTS, the most common TTS symptom was dyspnea (70.48%), followed by chest pain (24.76%) and syncope (2.86%). The most common type of TTS was apical, accounting for 81.13% of cases, followed by the midventricular (8.49%), basal (8.49%), and biventricular (1.89%) types. Among the TTS cases, 39.82% were associated with obstructive lung disease and 38.89% were associated with pneumonia. Coronavirus disease 2019 (COVID-19), which has been increasingly reported in patients with TTS, was identified in 29 of 42 patients with pneumonia (69.05%). The overall mortality rate for patients admitted for respiratory disease complicated by TTS was 12.50%. Conclusion Obstructive lung disease and pneumonia are the most frequently identified respiratory triggers of TTS. Medications and invasive procedures utilized in managing respiratory diseases may also contribute to the development of TTS. Furthermore, the diagnosis of TTS triggered by these conditions can be challenging due to its atypical presentation. Future prospective studies are needed to establish appropriate guidelines for managing respiratory disease with concurrent TTS.

Takotsubo syndrome and COVID‐19: A systematic review

“…12 In addition, Haussner et al 81 A systematic review on 99 studies, including 108 patients, showed that dyspnea (70.5%), chest pain (24.8%), and syncope (2.9%) had the highest frequency in patients with coexisting respiratory disease and TTS. 82 In patients receiving mRNA COVID-19 vaccines which lead to cardiac consequences, the most common signs/ symptoms were chest pain (96.1%) and fever (38.2%). 83 TTS can also clinically be presented with chest pain and dyspnea.…”

Machine learning‐based prediction of in‐hospital death for patients with takotsubo syndrome: The InterTAK‐ML model

“…As for asthma, a growing body of evidence supports the concept that obstructive lung disease can be intrinsically connected with TTS. 32 Beyond representing potential physical triggers of TTS through acute attacks and exacerbations, we report for the first time that such conditions may also be associated with an adverse short-term prognosis. This finding may be intuitively explained by the synergistic effect of respiratory impairment and acute cardiac stunning.…”

Long-Term Functional Limitations on Cardiopulmonary Exercise Testing in Emotion-Triggered Takotsubo Syndrome

“…The relevance of CPET, where mortality in the long-term is mainly driven by non-cardiovascular events [9], remains to be assessed. Indeed, it was observed that most patients with TTS, after the acute phase of the disease, died for causes linked to comorbidities such as cancer [33] chronic kidney disease [34], diabetes mellitus [35] and respiratory disorders [36] that all together can have a relevant impact on prognosis beyond the TTS episode [9]. Notwithstanding, a recent study highlighted that TTS patients might experience an excess of cardiovascular mortality, and that although lower than that of patients with a previous AMI, it remains higher than matched controls [37].…”