Prevalence Of Takotsubo Cardiomyopathy Research Articles

Takotsubo Cardiomyopathy: Narrative Review With Relation to COVID-19

Takotsubo cardiomyopathy (TC) is a unique heart disease which mimics the clinical symptoms and features of acute coronary syndrome (ACS) and is seen more commonly in postmenopausal females. In this condition, abnormal electrocardiographic findings like ST-segment elevation/depression, T wave inversion, and an abnormal/absence of Q wave, along with echocardiographic disturbances like regional wall motion abnormalities and a sudden decrease in the ejection fraction are observed. However, coronary angiography shows no coronary artery obstruction. Interestingly, the left ventricle in TC develops a characteristic appearance similar to that of a “Tako-tsubo” (Japanese pot). Such peculiar observations become important when diagnosing TC in a clinical setting. TC is often caused by a catecholamine surge due to mass sympathetic activation usually preceded by an emotional/physical trigger, however the exact etiology and mechanism of pathophysiology still remain unclear. With growing awareness and prevalence of TC, it becomes crucial for clinicians to differentially diagnose TC from other heart conditions with the help of well-known diagnostic tools. Moreover, amidst the ongoing pandemic, the cytokine storm associated with COVID-19 may be accompanied with a catecholamine surge in the body, which in turn might increase the risk and incidence of TC in patients.

Predisposing factors and health-care utilization in liver transplant recipients with takotsubo cardiomyopathy: A national analysis

Aims and Objectives: Takotsubo cardiomyopathy (TCMP) is an acquired cardiomyopathy associated with physical, emotional, and surgical stress. Current literature on TCMP in liver transplant recipients (LTRs) is limited to case reports and case series. Methods: The Nationwide Readmission Database was utilized to identify all adults with an index admission for LT between 2010 and 2014 who developed TCMP. The prevalence of TCMP at the LT admission or readmission within the calendar year was examined. Predictors of development and health-care utilization of patients with and without TCMP in LTR were compared. Multivariable regression analysis was performed. Results: The prevalence of TCMP in LTRs was found to be 0.5% (141/28,067). Most of these patients developed early TCMP on the index admission for LT (n = 115; 82%). Older (57.5 ± 1.3 vs. 55.1 ± 0.3 years, P < 0.001) females (adjusted odds ratio [aOR]: 2.27; confidence interval [CI]: 1.20–4.27; P = 0.01) with ≥4 Elixhauser comorbidity (aOR: 2.36; CI: 1.15–4.83; P = 0.02) were predisposed to develop TCMP in LTRs. LT at a medium-sized center (aOR: 0.17; CI: 0.03–0.88) has a protective effect on the development of TCMP. Increased health-care utilization in the form of mechanical ventilation, hemodialysis, vasopressors, and intra-aortic balloon pumps is observed in patients with TCMP. This resulted in increased length of stay and cost in patients with TCMP. Moreover, increased mortality was seen in patients who developed TCMP within the same calendar year. Conclusion: This is the first report showing the prevalence of TCMP in LTRs to be 0.5%. Older females with increased comorbidity are predisposed to TCMP. Patients who developed TCMP necessitate a higher acuity of medical care and cause an increased health-care burden and ultimately experience an increase in mortality.

TAKOTSUBO CARDIOMYOPATHY AS AN ADVERSE EVENT POST BRONCHOSCOPY

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome characterized by acute dilated cardiomyopathy following emotional or physical stress. It presents with sudden onset of cardiac symptoms with electrocardiogram(ECG) changes and left ventricular dysfunction. Echocardiogram findings are characteristic of apical ballooning with a wide base and long thin neck at end-diastole. The prevalence of TTC in patients with known vasculitis is not well described. CASE PRESENTATION: Our patient is a 46 Chinese lady with known history of migraine and anxiety. She first presented with non-resolving oto-mastoditis despite multiple courses of antibiotics. She subsequently developed bilateral cavitary lung lesions for which a bronchoscopy was performed. The work-up was negative for microbiology including mycobacterium and fungal organisms. Her antiPR3 antibodies were markedly raised and a diagnosis of Granulomatosis with Polyangiitis (GPA) was made. She was treated with intravenous pulsed steroids and cyclophosphamide. However, she developed fever and cough with worsening of bilateral cavitary lung lesions and neutrophilia. Bronchoscopy and transbronchial lung biopsy were repeated in view of concerns of infection in a immunocompromised host. 2 hours post procedure, she developed sinus tachycardia and type 1 respiratory failure requiring intubation and mechanical ventilation. Cardiac enzymes trended were not suggestive of myocarditis or acute myocardial infarct. ECG showed new T-wave inversions in the anterior leads. A bedside echocardiogram showed dilated cardiomyopathy with an ejection fraction(EF) of 10-15%. She was subsequently extubated and a repeat echocardiogram confirmed the characteristic findings of TTC with apical ballooning and akinesia and improvement in EF to 30-35%. DISCUSSION: One of the proposed pathophysiology behind TTC is the abnormally high levels of catecholamines resulting in catecholamine-associated cardiotoxicity post physical or emotional stressors. Previous papers have described TTC post bronchoscopy to be more common in post-menopausal women, history of asthma; and in more invasive procedures such as transbronchial lung biopsies and adrenaline administration intra-tracheally; therefore benefit-risk ratio for adrenaline administration needs to be considered in patients at risk. Treatment is usually supportive with treatment of heart failure and reassurance. CONCLUSIONS: TTC post bronchoscopy is an uncommon but life threatening adverse event. This case highlights the need to identify patients who are at risk of developing TTC post bronchoscopy and ensure preventive measures such as adequate counselling are carried out pre-procedure. The diagnosis of TTC should be suspected in high risk patients with cardiac symptoms and close monitoring post procedure should also be implemented as the complications of TTC can be severe and life threatening as demonstrated in our patient. Reference #1: Nyquist KE, Abramson DW, Huffman JC. Apical ballooning syndrome: the "broken heart" syndrome. Prim Care Companion J Clin Psychiatry. 2010;12(5):PCC.10r00949. Reference #2: Four cases of clinical analysis with Takotsubo cardiomyopathy associated with bronchoscopy: Manabu Suzuki et al. European Respiratory Journal 2017 50: PA3803; https://doi.org/10.1183/1393003.congress-2017.PA3803 Reference #3: Takotsubo Cardiomyopathy and Subsequent Seizures Induced by Flexible Bronchoscopy Shion Miyoshi MD, Yuichiro Takeda MD PhD, Shoki Ro MD, Haruna Masaki MD, Masayuki Hojo MD, and Haruhito Sugiyama MD PhD. DISCLOSURES: No relevant relationships by Adrian Kwok Wai Chan, source=Web Response No relevant relationships by Sandra HUI, source=Web Response No relevant relationships by Keng Leong TAN, source=Web Response

Gender Differences and Predictors of Mortality in Takotsubo Cardiomyopathy: Analysis from the National Inpatient Sample 2009-2010 Database

Objectives: Takotsubo cardiomyopathy (TC) is characterized by left-ventricle apical ballooning with elevated cardiac biomarkers and electrocardiographic changes similar to an acute coronary syndrome. We studied the prevalence, in-hospital mortality, and predictors of mortality in TC. Methods: All patients ≥18 years of age diagnosed with TC were identified in the Nationwide Inpatient Sample (NIS) 2009-2010 database using the 9th revision of the International Classification of Diseases (ICD) 429.83. Demographics, conventional risk factors (diabetes, hypertension, hyperlipidemia, and tobacco abuse), acute critical illnesses like sepsis, acute cerebrovascular disease (cerebrovascular accident; CVA), acute respiratory insufficiency, and acute renal failure, and chronic conditions (anxiety, depression, and malignancy) were studied. Results: The prevalence of TC was 0.02% (n = 7,510). The total in-hospital mortality rate was 2.4%, with a higher mortality in men (4.8%) than in women (2.1%). Sepsis (9 vs. 4.2%; p < 0.01) was more prevalent in men with an increased prevalence of other critical illness, although this was not statistically significant. Age (OR 1.05; 95% CI 1.01-1.09), malignancy (OR 3.38; 95% CI 1.35-8.41), acute renal failure (OR 5.4; 95% CI 2.2-13.7), acute CVA (OR 9.4; 95% CI 2.96-29.8), and acute respiratory failure (OR 11.1; 95% CI 3.9-31.1) predicted mortality in fully adjusted models. Conclusion: A higher mortality was seen in men, likely related to the increased prevalence of acute critical illnesses, ventricular arrhythmia, and sudden cardiac arrest. Acute CVA and respiratory failure were the strongest predictors of mortality.

Relatively High Prevalence of Takotsubo Cardiomyopathy (Stress-Induced Cardiomyopathy) in the Japanese Population—Contribution of Cardiac Imaging in the Identification of Takotsubo Cardiomyopathy and its Differentiation from Acute Coronary Syndrome

Apical ballooning syndrome, the so-called takotsubo cardiomyopathy (TTC), is characterized by wall-motion abnormality. The wall-motion abnormality includes hypokinesis in the mid and apical segments of the left ventricle (LV) with hyperkinesis in the mid LV segment. The LV dysfunction is reversible. TTC has been reportedly been found in 1 to 2 % of patients suspected of having acute coronary syndrome (ACS). Although the wall-motion abnormality of TTC is a significant feature, clinical presentation involving chest pain or ECG abnormalities is similar to that for ACS. Therefore, the diagnosis of TTC is still a challenge in emergency settings. Cardiovascular imaging may assist in the diagnosis and understanding of the pathophysiology of TTC.

Abstract 294: Decreased Plasma Omega-3 to Omega-6 Polyunsaturated Fatty Acid Ratio Associated with Apical Ballooning Syndrome (Tako-Tsubo cardiomyopathy -TTC)

Background: Eicosapentaenoic acid (EPA) of the omega-3 polyunsaturated fatty acids (ω-3 PUFA) family plays important roles in the prevention of cardiovascular disease, while, arachidonic acid (AA) of the ω-6 PUFA family promotes inflammatory and prothrombotic influences. Tako-Tsubo cardiomyopathy (TTC) is a heart syndrome associated with transient myocardial contractile dysfunction. Decreased endothelial function in response to acute mental stress has been reported in patients with a prior episode of TTC. However, the pathogenesis of TTC remains unclear and the relationship between TTC and EPA/AA ratio has not been elucidated. Methods and Results: This study consisted of 10 consecutive patients with clinically diagnosed TTC. The aim of this study was to investigate the association between the plasma EPA/AA ratio and the early stage of clinically diagnosed TTC. To examine the plasma fatty acid level, blood samples were obtained from control, old myocardial infarction, and clinically diagnosed TTC patients. A clinically diagnosed TTC patients revealed a lower plasma EPA/AA ratio [Control patients, 0.58 (n=18) vs OMI patients, 0.38 (n=22) vs TTC patients, 0.12 (n=10), p=0.011]. High-sensitivity CRP levels and a low plasma EPA/AA ratio could independently predict the prevalence of TTC on multivariate logistic regression analysis [odds ratio 1.83 (95%CI 1.03-3.25), p=0.036 and odds ratio 2.05 (95%CI 1.12-3.92), p=0.02)]. Conclusion: In patients with TTC, a low plasma EPA/AA ratio was significantly associated with the early stage of clinically diagnosed TTC. The findings implicate lower EPA/AA ratio and the following endothelial dysfunction as a potential mechanism involved in the pathogenesis of this unique cardiomyopathy.

Tako-tsubo cardiomyopathy

To describe the actual incidence, prevalence among acute coronary syndrome patients and rate of recurrences of tako-tsubo cardiomyopathy in an emergency department of a community hospital. We report the in-hospital and long-term clinical course (7.5 years follow-up) of 25 consecutive tako-tsubo cardiomyopathy patients (mean age 66.8 ± 11.76 years; F/M: 21/4) admitted to a community hospital (referring population: 97,000 inhabitants). The incidence rate of tako-tsubo cardiomyopathy was 0.03 cases per 1000 person-years; the prevalence was 3.0% among those with acute coronary syndrome and 7.6% among ST elevation myocardial infarction patients. Clinical presentations included mainly chest pain (n = 16, 64%) and dyspnea (n = 3, 12%). Precipitating conditions were emotional (n = 10, 40%), physical stress (n = 5, 20%) or both (n = 1, 4%); no stressors were recorded in nine patients (36%). Two patients died during hospitalization (8%). At the end of follow-up (mean time: 960.24 ± 724.34 days), all patients (n = 23) were alive and no major cardiovascular events were observed. Five patients had recurrences (22%). The mean time of recurrence was 105.4 ± 82.92 days and the clinical presentation was less severe compared with the first event: ECG had less ST involvement, ejection fraction was higher and cardiac injury biomarkers were lower. In our population incidence and prevalence of tako-tsubo cardiomyopathy among acute coronary syndrome patients, as well as the recurrence rate of tako-tsubo cardiomyopathy, were higher than previously reported, suggesting that probably this syndrome often passes undiagnosed.

Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TTC) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. Recent experimental and clinical observation has suggested a role for genetics in the pathogenesis of TTC. Ethnic as well as seasonal variation in the prevalence of TTC is well described, but it is only recently that familial cases of TTC have been reported. In recent years technological advances in exome capture and DNA sequencing have offered clinicians a new opportunity to discover genetics-related disease. This article explores the role of genetic mechanisms that might explain or modulate the pathogenesis of TTC.

Gender-Related Differences in Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TTC) predominantly occurs in elderly women. Men comprise 10% of the patients, with a similar clinical profile. In contrast to myocardial infarction, age distribution; symptoms, such as angina; and prehospital delay in TTC are not different between genders. In men, physical stress as a triggering event and shock or cardiac arrest on presentation are more frequent. Gender-related differences in TTC need to be carefully investigated at the clinical and experimental levels to explain the evident gender discrepancy in the prevalence of TTC, to clarify the pathogenetic background, and to develop preventive and therapeutic means against this life-threatening disease.

Scintigraphic Evaluation of Takotsubo Cardiomyopathy

The Takotsubo Cardiomyopathy (TC) also called broken heart syndrome, or stress-induced cardiomyopathy is characterized by the transient ballooning of the apex during systole as result of apical dyskinesia in conjunction with a compensatory hyperkinesia of the base of the left ventricle; in the absence of significant epicardial coronary artery dis- ease. We report a case of TC with the characteristic findings of apical dyskinesia and perfusion abnormalities on gated SPECT which was diagnosed in retrospect after coronary angiography and left ventriculography. This is followed by a brief review of the scintigraphic techniques that have been used in the evaluation of TC. As TC accounts for at least 1-2% of presentations of acute coronary syndromes, increased awareness on the part of interpreting physicians is required for earlier diagnosis in the subset of patients referred for myocardial perfusion imaging. TC can present with symptoms similar to CAD (Chest pain, shortness of breath, etc) in the presence of ECG changes and mild elevation of cardiac enzymes. It seems to be more frequent in women of post menopausal age (2) but the exact prevalence is unknown. Akashi and colleagues found that the prevalence of TC in their institution was around 2% (3) similar to what Bybee and co-workers re- ported (4). New cases of TC are reported every year around the world and nuclear medicine techniques have been used in evaluation of several of these cases. We present the follow- ing case in which gated SPECT contributed significantly to diagnosis followed by a brief review of the different scinti- graphic techniques that have been used in the evaluation of

Tako-tsubo cardiomyopathy

Tako-tsubo cardiomyopathy (transient left ventricular apical ballooning) is a reversible form of cardiomyopathy of unknown etiology. Tako-tsubo Cardiomyopathy (TTC) is typically precipitated by sudden emotional or physical stress, and is associated with excessive sympathetic stimulation and catecholamine release. Its clinical presentation is similar to that of acute coronary syndrome. The diagnosis of TTC must be considered in all patients who develop a transient left ventricular apical (or mid ventricular) ballooning in the absence of obstructive coronary artery disease. Although the prevalence of TTC remains unknown, approximately 2% of all patients presenting with a presumed diagnosis of acute myocardial infarction have been found to have this syndrome. An illustrative case report and literature review is provided.