Takotsubo Syndrome: Uncovering Myths and Misconceptions

Cammann, Victoria L.; Würdinger, Michael; Ghadri, Jelena R.; Templin, Christian

doi:10.1007/s11883-021-00946-z

Cited by 16 publications

(22 citation statements)

References 96 publications

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“…Instead the term neurogenic stunned myocardium was frequently found in the literature to describe myocardial dysfunction after acute neurological injury especially after subarachnoid hemorrhage 23 , 24 . Over the last years, the interplay of the brain and heart has gained growing interest in the medical community and TTS is now acknowledged as a cardiac consequence of acute neurological events 2 , 6 , 25 – 27 . While the understanding of the precise pathomechanisms underlying TTS development remain incomplete, there is evidence that autonomic imbalance with excessive catecholamine release and increased cardiomyocyte response to catecholamines infer the pathophysiology 28 – 30 .…”

Section: Discussionmentioning

confidence: 99%

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

Cammann

Scheitz

Rennenberg

et al. 2021

Sci Rep

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Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.

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Section: Discussionmentioning

confidence: 99%

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

Cammann

Scheitz

Rennenberg

et al. 2021

Sci Rep

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“…The train and the internal validation cohorts derived from the International Takotsubo (InterTAK) Registry. The InterTAK Registry is an observational, prospective, and retrospective registry established in 2011 at the University Hospital of Zurich in collaboration with 58 cardiovascular centres across 17 countries 10,11 . Patients were included in the registry between 2011 and 2021 as previously reported.…”

Section: Methodsmentioning

confidence: 99%

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

Filippo

Cammann

Pancotti

et al. 2023

European J of Heart Fail

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AimsTakotsubo syndrome (TTS) is associated with a substantial rate of adverse events. We sought to design a machine‐learning (ML) based model to predict the risk of in‐hospital death and to perform a clustering of TTS patients to identify different risk profiles.Methods and resultsA Ridge Logistic Regression‐based ML model for predicting in‐hospital death was developed on 3482 TTS patients from the International Takotsubo Registry, randomly split in a train and an internal validation cohort (75% and 25% of the sample size, respectively) and evaluated in an external validation cohort (1037 patients). 31 clinically relevant variables were included in the prediction model. Model performance represented the primary endpoint and was assessed according to area under the receiver‐operating characteristic curve (AUC), Sensitivity and Specificity. As secondary endpoint, a K‐Medoids clustering algorithm was designed to stratify patients into phenotypic groups based on the ten most relevant features emerging from the main model. The overall incidence of in‐hospital death was 5.2%. The InterTAK‐ML model showed an AUC of 0.89 (0.85‐0.92), Sensitivity 0.85 (0.78‐0.95) and Specificity 0.76 (0.74‐0.79) in the internal validation cohort and an AUC of 0.82 (0.73‐0.91), a sensitivity of 0.74 (0.61‐0.87) and a specificity of 0.79 (0.77‐0.81) in the external cohort for in‐hospital death prediction. By exploiting the 10 variables showing the highest feature importance, TTS patients were clustered into six groups associated with different risks of in‐hospital death (28.8% vs 15.5% vs 5.4% vs 0.8% vs 0.5%) which were consistent also in the external cohort.ConclusionA ML‐based approach for the identification of TTS patients at risk of adverse short‐term prognosis is feasible and effective. The InterTAK‐ML model showed unprecedented discriminative capability for the prediction of in‐hospital death.This article is protected by copyright. All rights reserved.

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“…O termo takotsubo (tako = polvo, tsubo = pote) foi introduzido por Sato e Dote em 1990 e 1991 para descrever a silhueta do ventrículo esquerdo durante a sístole em cinco pacientes apresentando características clínicas de infarto do miocárdio, mas sem doença arterial coronariana obstrutiva. (1,2,3) Pacientes com síndrome de Takotsubo podem apresentar uma variedade de padrões clínicos diferentes; ela é frequentemente precipitada por estresse emocional significativo ou doença física grave acompanhada de ativação do sistema nervoso simpático. A síndrome tem uma apresentação 3 clínica e eletrocardiográfica semelhante à de uma síndrome coronariana aguda (SCA).…”

Section: Introductionunclassified

“…Todos esses eventos emocionais e físicos agem como gatilhos que agem no coração via cérebro e liberação de catecolaminas induzida por estresse. (3,4) A toxicidade miocárdica por catecolaminas transmitidas pelo sangue tem sido sugerida como um dos mecanismos fisiopatológicos da ST. Isso se baseia na história de estresse emocional anterior ao início da doença em muitos pacientes com ST; há relatos da ocorrência de ST em pacientes com feocromocitoma, a indução de ST pela administração terapêutica e acidental de epinefrina, norepinefrina e outros inotrópicos de catecolaminas. A ST pode ser diagnosticada prontamente com acesso a imagens cardíacas modernas.…”

Section: Introductionunclassified

“…1 Estudante de Medicina na Universidade José do Rosário Vellano -UNIFENAS, atualmente acadêmica do 12º semestre. 2 Universidade José do Rosário Vellano -UNIFENAS 3 Graduando em medicina na Universidade José do Rosário Vellano (UNIFENAS -Alfenas -Minas Gerais)atualmente 8º período. Coordenador científico da Liga Acadêmica de Oftalmologia, Vice-presidente da liga de Nutrologia, Presidente do Projeto de extensão diabetes eu cuido, monitor de ANATOMIA I e EMBRIOLOGIA 4 Estudante de Medicina na Universidade José do Rosário Vellano -Unifenas-atualmente acadêmico do 11º semestre.…”

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Síndrome De Takotsubo Induzida Por Inibidores De Checkpoint Imunológicos

Morais¹,

Rocha²,

Santos³

et al. 2022

RECIMA21

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Introdução: A síndrome de Takotsubo (ST) é uma síndrome cardíaca aguda caracterizada por anormalidades típicas da movimentação da parede regional que refletem o comprometimento da contratilidade cardíaca que leva à insuficiência cardíaca aguda na ausência de doença arterial coronariana epicárdica. A etiologia exata não é conhecida, porém, nota-se uma aparente relação entre o uso de inibidores de checkpoint imunológicos (ICIs) e o diagnóstico de ST. Objetivo: Esclarecer a relação entre ICIs e a ST, considerando ser um tema extremamente importante para os profissionais de saúde. Materiais e métodos: A busca na literatura se deu através da consulta na base de dados eletrônicos PubMed, a partir de “takotsubo syndrome” e “immune checkpoint inhibitor therapy”. Delimitaram-se artigos publicados entre os anos de 2003 e 2022, com estudos que respondam à questão norteadora previamente definida. Após aplicação dos critérios de inclusão e exclusão, obteve-se uma amostra final de 6 estudos para a revisão integrativa. Resultado e discussão: Os inibidores de checkpoint imunológico são cada vez mais utilizados para tratar certas doenças malignas devido à sua maior eficácia em comparação com a quimioterapia convencional. Os ICIs tornam-se tóxicos devido à remoção da autotolerância, que por sua vez induz processos autoimunes. Conclusão: Em resumo, esse estudo deixa claro que, com base na literatura disponível atualmente, pode-se concluir uma associação entre ICIs e ST, principalmente quando o ICI utilizado é o 5-fluorouracil.

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Takotsubo Syndrome: Uncovering Myths and Misconceptions

Cited by 16 publications

References 96 publications

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

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

Síndrome De Takotsubo Induzida Por Inibidores De Checkpoint Imunológicos

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