Complication Of Takotsubo Syndrome Research Articles

Prediction of in-hospital complications in takotsubo syndrome: prospective cohort study

BACKGROUND: Until recently, takotsubo syndrome (TS) was considered a fairly benign disease in both early and late periods. However, in recent years, in-hospital complications in the acute period of TS are common and can be life-threatening.
 AIM: Based on clinical and laboratory-instrumental data, this study aimed to build models for predicting the risk of developing in-hospital complications in patients with TS during the acute period.
 MATERIALS AND METHODS: This prospective cohort study included 60 patients with TS, with an average age of 65.5±13.4 years. In the acute period (7–14 days), standard clinical and laboratory examination, peripheral arterial tonometry using the «EndoPAT 2000» apparatus, and psychological testing using validated questionnaires (hospital anxiety and depression scale and Beck depression scale) were performed.
 RESULTS: The integrated model for predicting the risk of acute heart failure (AHF) development (pulmonary edema and cardiogenic shock) identified admission LVEF as the leading prognostic parameter. With LVEF ≤40.5%, the probability of AHF in patients with TS in the acute period was 62.5%, and in patients with TS and QTc interval 487 ms, the risk reached 100%. The sensitivity and specificity of the developed model were 72.7% and 97.4%, respectively. The integrated model for predicting the development of cardiovascular complications (CVCs) revealed that the number of leukocytes in the peripheral blood was the leading risk factor for adverse events in patients with TS in the acute period. With a leukocyte count 11.1×109/L, the risk of CVCs in patients with TS increased to 89.9%, and if the erythrocyte count was 4.69×1012/L or ≤4.29×1012/L, it could reach 100%. The sensitivity and specificity of the resulting model were 92.6 and 97.0%, respectively.
 CONCLUSION: The models proposed in this study for predicting the likelihood of developing severe AHF and the overall risk of CVCs in the acute period of TS are personalized and easy to use, allowing for the selection of optimized treatment techniques.

Rationale and design of BROKEN-SWEDEHEART: a registry-based, randomized, parallel, open-label multicenter trial to test pharmacological treatments for broken heart (takotsubo) syndrome

Takotsubo syndrome (TS) is a life-threatening acute heart failure syndrome without any evidence-based treatment options. No treatment for TS has been examined in a randomized trial. BROKEN-SWEDEHEART is a multicenter, randomized, open-label, registry-based 2×2 factorial clinical trial in patients with TS designed to test whether treatment with adenosine and dipyridamole accelerates cardiac recovery and improves clinical outcomes compared to standard care (study 1); and apixaban reduces the risk of thromboembolic events compared to no treatment with antithrombotic drugs (study 2). The trial will enroll 1,000 patients. Study 1 (adenosine hypothesis) will evaluate 2 coprimary end points: (1) wall motion score index at 48 to 96 hours (evaluated in the first 200 patients); and (2) the composite of death, cardiac arrest, need for mechanical assist device or heart failure hospitalization within 30 days or left ventricular ejection fraction <50% at 48 to 96 hours (evaluated in 1,000 patients). The primary end point in study 2 (apixaban hypothesis) is the composite of death or thromboembolic events within 30 days or the presence of intraventricular thrombus on echocardiography at 48 to 96 hours. BROKEN-SWEDEHEART will be the first prospective randomized multicenter trial in patients with TS. It is designed as 2 parallel studies to evaluate whether adenosine accelerates cardiac recovery and improves cardiac function in the acute phase and the efficacy of anticoagulation therapy for preventing thromboembolic complications in TS. If either of its component studies is successful, the trial will provide the first evidence-based treatment recommendation in TS. The trial has been approved by the Swedish Medicinal Product Agency and the Swedish Ethical Board and is registered at ClinicalTrials.gov (NCT04666454).

Cardiac rupture – the most serious complication of Takotsubo syndrome

Abstract Background The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p=0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p=0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p&amp;lt;0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p&amp;lt;0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG). Funding Acknowledgement Type of funding sources: None.

Long-term outcome in patients with Takotsubo syndrome: a single-center study from a city in Austria

Abstract Background There is an increasing amount of evidence suggesting multiple fatal complications in Takotsubo Syndrome. However, findings on the long-term outcome are scarce and show inconsistent evidence. Methods This is a single-center study of long-term prognosis in Takotsubo patients admitted from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with Takotsubo syndrome. Furthermore, survivors and non-survivors and patients with a different cause of death were compared. Results Overall, 147 patients were included in the study. The mean age was 70 years (±12,3), and 85% of the study population were women. Forty-nine Takotsubo patients (33,3%) died during the follow-up, with a median of 126 months. The most common cause of death was a non-cardiac cause (71,4% of all deaths), especially malignancies (26,5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Age showed to be the only independent prognostic factor of cardiovascular mortality (HR=1,11, CI: 0,99–1,25, p=0,05). Female gender (HR=0,32, CI: 0,16–0,64, p&amp;lt;0,001), cancer (HR=2,35, CI: 1,15–4,8, p=0,019) and chronic kidney disease (HR=2,61, CI: 1,11–6,14, p=0,028) showed to be independent predictors of non-cardiovascular mortality. Conclusion Long-term prognosis of TTS patients is not favourable, mainly due to non-cardiac comorbidities. Hence, consequent outpatient care in relatively short time intervals after TTS event based on risk factor control and early detection of malignancies seems mandatory. Funding Acknowledgement Type of funding sources: None.

Long-term outcome in patients with takotsubo syndrome : Asingle center study from Vienna.

There is an increasing amount of evidence suggesting multiple fatal complications in takotsubo syndrome; however, findings on the long-term outcome are scarce and show inconsistent evidence. This is asingle center study of long-term prognosis in takotsubo patients admitted to the Klinik Ottakring, Vienna, Austria, from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with takotsubo syndrome. Furthermore, survivors and non-survivors and patients with adifferent cause of death were compared. Overall, 147 patients were included in the study and 49 takotsubo patients (33.3%) died during the follow-up, with amedian of 126 months. The most common cause of death was anon-cardiac cause (71.4% of all deaths), especially malignancies (26.5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Adjusted analysis showed no feature of an independent predictor of cardiovascular mortality for takotsubo patients. Female gender (HR = 0.32, CI: 0.16-0.64, p < 0.001), cancer (HR = 2.35, CI: 1.15-4.8, p = 0.019) and chronic kidney disease (HR = 2.61, CI: 1.11-6.14, p = 0.028) showed to be independent predictors of non-cardiovascular mortality. Long-term prognosis of takotsubo patients is not favorable, mainly due to noncardiac comorbidities. Hence, consequent outpatient care in regular intervals after a takotsubo event based on risk factor control and early detection of malignancies seems justified.

Thromboembolic complications in Takotsubo Syndrome during Covid-19 outbreak. A review with case report

New coronavirus (COVID-19) outbreak, which started in Wuhan, China and spread rapidly all over the world, has become the most important cause of the emotional distress for susceptible people. Because the people also remained in fear and anxiety during the period when the elderly population in the whole country was desperate due to the COVID-19 outbreak and was asked to stay at home in fear of death. In addition, the fact that the patients were hospitalized together with COVID-19 patients caused his psychological distress to be experienced even more. Takotsubo Syndrome (TTS) is known as a distress-induced transient left ventricular dysfunction. In our patient with TTS, it was found that a new apical thrombus, which was not seen in the left ventricle, was seen in previous echo and computerized tomographic investigation, and that it was a source of thromboemboli, by stress triggering neurocardiac reactions. While under the medical treatment of viral pneumonia, under the Coronavirus transmission measures, thrombus in the LV was removed by being taken to the emergency open heart surgery. Our case is the first patient in the literature where a new thrombus developed in the LV and splenic infarction in TTS triggered by the pandemic. In this article; We have presented the experience of TTS triggered by pandemic, etiopathogenesis of left ventricular thrombus, open heart surgery indications when COVID-19 is suspected, coronavirus transmission measures in the surgical approach, the postoperative treatment and literature is reviewed.

Cardiac Rupture-The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review.

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

Takotsubo syndrome: Does “Diabetes Paradox” exist?

BackgroundPrevious small-scale studies have reported conflicting findings regarding the prevalence of diabetes mellitus (DM) and its association with outcomes in patients with takotsubo syndrome (TTS) ObjectiveWe sought to assess the prevalence of DM and its association with outcomes in TTS patients. MethodsNationwide inpatient sample (NIS) was queried to extract patient information from January 1, 2009 to September 30, 2015. Propensity score matching (PSM) was done to compare mortality and other in-hospital outcomes. ResultsA total of 40,327 hospitalizations for TTS were included. The prevalence of DM in TTS was 19.3% vs 23.1% (p-value < 0.01) in patients without TTS in the NIS from 2009 to 2015. In the PSM cohort, there was no difference in in-hospital mortality (1.1% vs 1.4%; p = 0.76), stroke (1.2% vs 0.9%; p = 0.09), cardiogenic shock (3.7% vs 3.9%; p = 0.61), cardiac arrest (1.2% vs 1.2%; p = 0.94), ventricular arrhythmias (3.7% vs 3.3%; p = 0.23), circulatory support (2.1% vs 1.8%; p = 0.17), and invasive mechanical ventilation (4.9% vs 4.7%; p = 0.54) in TTS patients with versus without diabetes. In sub-group analysis, diabetes with chronic complications patients were found to have lower mortality (0.7% vs 2.0%; p = 0.04) compared to patients without diabetes and those with uncomplicated diabetes (0.6% vs 2.6%; p = 0.002). ConclusionsPrevalence of DM was lower in TTS in comparison to patients without TTS. In addition, complicated DM patients were found to have lower in-hospital mortality. Further studies are needed to assess the mid and long-term outcomes of DM with and without chronic complications in TTS

Neutrophil/lymphocyte ratio predicts in-hospital complications in Takotsubo syndrome. Results from a prospective multi-center registry.

BackgroundSeveral hematological indices including subtypes of leukocytes populations have been associated with cardiovascular outcome. Takotsubo syndrome (TTS) is a form of acute heart failure syndrome featured by several in‐hospital complications (IHCs).HypothesisHematological indices at admission may predict IHCs in TTS patients.MethodsOne hundred and sixty consecutive patients with TTS were enrolled in a multicenter prospective registry. Clinical data, admission hemogram, and IHCs were recorded.ResultsIncidence of IHCs was 37%, including pulmonary edema 9%, cardiogenic shock 9%, need of invasive ventilation 10%, death 8%, stroke 2.5%, and left ventricular thrombi 6%.Patients with IHCs were older, more frequently male, with physical stressor‐induced TTS, lower left ventricular ejection fraction at admission. Neutrophil/lymphocyte ratio (NLr) (12 ± 12 vs 7 ± 8, P = .002) and white blood cells/mean platelet volume ratio (1.2 ± 0.5 vs 1.0 ± 0.5, P = .03) at admission were significantly higher in patients with IHCs.NLr values were predictor of IHCs (Odds ratios [OR] 1.07, 95% CI 1.03‐1.11, P < .01). When stratified according to NLr into tertiles, the rate of IHCs was from first to third tertile was, respectively, 22%, 31%, and 58%. NLr values in the higher tertile were independent predictors of IHCs even at multivariate analysis (OR 3.7, 95% CI 1.5‐9.4, P < .01).NLr values higher than 5 were able to predict IHCs with a sensitivity of 82% and specificity of 58%; negative predictive power was 84% (area under the ROC curve 0.73).ConclusionsNLr is an independent predictor of IHCs in patients admitted with TTS. Admission hemogram may represent a potential tool for prediction of IHCs in TTS.

ALARMINGLY RISING TRENDS IN VENOUS THROMBOEMBOLIC EVENTS AND RESPIRATORY FAILURE IN TAKOTSUBO SYNDROME-RELATED HOSPITALIZATIONS IN THE UNITED STATES

Venous thromboembolic events (VTE) and Respiratory failure (RF) are frequently encountered complications in takotsubo syndrome (TTS)-related hospitalizations; however, data pertaining to the shifting landscape of these complications in TTS remain scarce. The National Inpatient Sample (2007-2014)

Importance of sympathetic nervous system activity during left ventricular functional recovery and its association with in-hospital complications in Takotsubo syndrome.

The relationship between activation of the sympathetic nervous system (SNS) and improvement of left ventricular (LV) function and how this correlates with clinical outcomes are not fully explored in Takotsubo syndrome (TS). The purpose of this study is to evaluate the relationship between activation of the SNS and LV function improvement and how this correlates with clinical outcomes in TS. Patients with TS were retrospectively identified. Patients were divided into two groups according to the timing of LV function improvement: < 1month (S group) and ≥ 1month (L group). Activation of the SNS was assessed by plasma catecholamine measurement and Iodine-123 meta-iodobenzylguanidine (I123-MIBG) scintigraphy. In-hospital complications included heart failure, cardiogenic shock, the use of invasive or noninvasive ventilation, life-threatening arrhythmia, cerebrovascular event and all-cause death. A total of 90 patients with TS were enrolled. Of these, 39 patients were in the S group and 51 in the L group. There were no significant differences between the two groups in clinical demographics. The L group was characterized by enhanced SNS activation, including higher levels of catecholamines and lower late heart-mediastinum ratio followed by higher washout rate in I123-MIBG scintigraphy, compared with the S group. In-hospital complications were increased in the L group (56% vs. 33.3%, p = 0.03), including higher rates of heart failure (45% vs. 23%, p = 0.03) and in-hospital death (8.0% vs. 0%, p = 0.03). In patients with TS, high activity of the SNS was observed in patients with delayed LV function recovery, which was associated with in-hospital adverse outcomes.

Ventricular Septal Defect from Takotsubo Syndrome.

Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction with apical akinesis/dyskinesis and ballooning. Although the prognosis with medical management is excellent in most cases, rare cases of serious complications can occur. We present here a case of a 71-year-old woman presenting with acute decompensated heart failure with initial findings consistent with a myocardial infarction, who was found instead to have an acute ventricular septal defect as a complication of Takotsubo Syndrome.

008 Non invasive coronary flow reserve is a powerful independent predictor of in-hospital complications in Tako-Tsubo syndrome

Several in-hospital complications (HC) could impair the clinical course of tako-tsubo syndrome (TTS). to assess the clinical and echocardiographic predictors of HC in TTS. 37 consecutive patients (pts) (mean age, 69 ± 10 years, 35 women) with a typical TTS according to the Mayo Clinic criteria underwent prospectively a comprehensive transthoracic Doppler-echocardiography including the non invasive assessment of coronary flow reserve (CFR), measured in the distal part of the left anterior descending artery using intravenous adenosine infusion, at the acute phase (within 24–48 h of symptom onset) and after recovery (1 month apart). Clinical and biochemical parameters were also assessed. HC were defined as cardiogenic shock, or thrombo-embolic event. HC occurred in 8 cases (22%). Pts with HC, compared to pts without HC, were more frequently diabetics (63% vs. 21%, p < 0.05), and had at the acute phase a more severely impaired CFR (1.8 ± 0.5 vs. 2.3 ± 0.4, p<0.01), left ventricular (LV) ejection fraction (33 ± 8% vs. 41 ± 9%,), wall motion score index, and LV systolic volume/m 2 (all, p < 0.05), Age, frequency of ECG ST-segment elevation at presentation, troponin peak, and preexisting beta-blockers use, were not significantly different in pts with and without HC (all, p = NS). The in-hospital length of stay was longer in the former group (p < 0.05). After recovery, CFR improved significantly in both groups. However, the magnitude of improvement was higher in pts with HC as compared to pts without HC (74% vs. 27%, p < 0.05) leading to final value of CFR similar in both groups (2.9 ± 0.4 vs. 3.1 ± 0.6, p = NS). In multivariate analysis, the only independent predictor of HC was acute CFR (p = 0.028). Using a ROC curve analysis a CFR < 1.9 was the best cut-off to predict HC with a sensitivity of 75% and specificity of 86%, (AUC 0.76, p < 0.01). With a mean follow-up of 24 ± 10 months, one patient died in the group of HC vs. none in the other group. CFR is an independent predictor of HC, suggesting that the impairment of the coronary microcirculation is important at the acute phase of TTS.

Systemic embolism in takotsubo syndrome

A 57-year-old woman with acute left leg ischemia due to popliteal artery occlusion and deep T-wave inversion at ECG revealed she had suffered, the day before, from typical chest pain after a confrontational argument; yet, she had not sought medical assistance. Echocardiography showed left ventricular wall motion abnormalities consistent with the diagnosis of emotional stress-induced takotsubo syndrome. Coronary angiography ruled out obstructive atherosclerotic disease and left ventriculography confirmed apical ballooning with evolving thrombosis. Left leg angiography demonstrated diffuse embolisation of the popliteal artery. Ventricular thrombosis is a complication of takotsubo syndrome and has been associated with adverse events supposed to be due to a cardioembolic mechanism, in particular cerebro-vascular accidents. To the best of our knowledge, this is the first direct visualization of systemic cardiogenic embolism in takotsubo syndrome. Physicians should be aware that ventricular thrombosis may be present in the earliest stages of the disease and that emboli dislocation can occur even before wall motion normalization.