Takotsubo Research Articles

Recurrent Takotsubo Syndrome with Contemporary Brady- and Tachyarrhythmic Presentation

Recurrent Takotsubo Syndrome with Contemporary Brady- and Tachyarrhythmic Presentation

Takotsubo Syndrome: Differences between Peripartum Period and General Population.

Takotsubo syndrome (TTS) was first described in postmenopausal women with transient regional wall motion abnormalities. The trigger is usually an emotional or physical stress. The catecholamine hypothesis seems to be the most prevailing. The main difference between TTS and acute coronary syndromes is that there is no obstructive coronary disease to explain the regional abnormalities. In this form, the left ventricle resembles the fishing jar which is used to trap octopus in Japan. However, to date more atypical forms are recognized. Also, the syndrome is not limited to older women. Nowadays, TTS is presented even in pregnancy and postpartum females. Our experience revealed cases of patients during these periods and some of them suffered from reverse Takotsubo. Additionally, the initial diagnosis in some patients was other than TTS. Due to these findings, we suggest that this type of TTS is not very rare but underestimated. For this reason, further studies are needed to support and explain this condition.

A Case of Takotsubo Cardiomyopathy

A Case of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy: A case of young male with Broken Heart

Takotsubo cardiomyopathy: A case of young male with Broken Heart

Racial Disparities in Clinical Outcomes of Takotsubo Cardiomyopathy: An Analysis of the National Inpatient Sample 2006 to 2018.

This study aimed to evaluate the impact of race on in-hospital outcomes of Takotsubo cardiomyopathy using the National Inpatient Sample. We conducted a retrospective study using data from the National Inpatient Sample database 2006 to 2018. We focused on Takotsubo cardiomyopathy hospitalizations, excluding those with acute coronary syndrome as the primary diagnosis. Two study groups consisted of White patients or Black patients. Univariate and multivariable logistic models evaluated race's effect on death, cardiac arrest, cardiogenic shock, length of stay, while adjusting for potential confounders. The Bayesian model averaging technique was used to further elucidate the factors influencing death within each racial group. Significant differences were observed between the 2 racial groups. Black patients presented at a younger age, had a higher proportion of men, a higher burden of comorbidities, and a lower median household income compared with their White counterparts. In the univariate model, the Black cohort showed an increased risk of cardiac arrest (odds ratio, 1.45 [95% CI, 1.15-1.82]). However, the difference did not reach statistical significance in the multivariable model. Black patients also had a significantly longer hospital stay in both the univariate model (risk ratio, 1.26 [95% CI, 1.22-1.31]) and the multivariable model (risk ratio, 1.06 [95% CI, 1.04-1.07]). No significant difference in all-cause death was observed between the racial groups. The outcome differences between 2 racial groups in our study are likely influenced by racial disparities in demographics, comorbidities, and socioeconomic factors. Individualized care based on racial group needs is crucial in clinical practice.

Abstract Tu067: ROCK2 Specific Inhibition Prevents Isoproterenol Induced Takotsubo Cardiomyopathy in Mice

Takotsubo Cardiomyopathy (TCM) is an acute, life-threatening condition characterized by a drop in ejection fraction (EF) and apical ballooning of the left ventricle (LV). TCM is most frequently observed in women and is associated with an emotional or physical stressor. Recent work has demonstrated that the Rho kinase ROCK2 contributes to heart failure phenotypes in mice in other models of heart failure. The role of ROCK2 in TCM is unknown. We tested the hypothesis that ROCK2 inhibition attenuates isoproterenol (ISO)-induced TCM in mice. To induce TCM, male and female mice were given a single dose of 200mg/kg ISO, i.p. and cardiac function was assessed by conscious echocardiography. The effect of ISO overdose on acute heart failure over a 7-day time course was determined followed by an intervention study in which mice were treated with the ROCK2 specific inhibitor KD025/belumosudil (50mg/kg, i.p.) concurrent with heart failure induction. Though ISO induced a drop in EF in both sexes after 24 hours, females exhibited lower EF (46.64±3.11%) than males (68.36±2.62, p<0.0001) mirroring the increased prevalence of clinically defined TCM in females in humans. Female mice were used for the remaining experiments. Invasive hemodynamics revealed reduced contraction and relaxation (dp/dt max and dp/dt min) as well as an increased relaxation time constant Tau 24 hours after ISO injection. A time course study demonstrated that EF begins to normalize by Day 3 and is restored to baseline levels by Day 7. Importantly, ROCK2-specific inhibition prevented ISO-induced drop in EF, thinning of the LV wall, and LV volume expansion. Here, we demonstrate that female mice are more susceptible to ISO-induced cardiac dysfunction. Furthermore, we show that ROCK2 activation is necessary for the development of TCM in mice. These results suggest that FDA-approved KD025/belumosudil could potentially be repurposed for treatment in TCM.

Abstract We128: Effect of Coronavirus Disease 2019 on the Incidence of Stress-induced Cardiomyopathy; A Single Center Experience

Introduction: Takotsubo Syndrome, or stress-induced cardiomyopathy (SIC) is a transient dysfunction of the left ventricle. Emerging data has shown a rise in the number of cases in recent times. In January of 2020 the Centers for Disease Control and Prevention (CDC) declared Coronavirus disease 2019 (COVID-19) a public healthcare emergency. Given the impact of the COVID-19 on economic and psychosocial factors in individuals across the globe, we sought to study the effect of COVID-19 on the incidence of SIC at our institution. Research Question: Has economic and psychosocial stress associated with COVID-19 led to an increase in the incidence of stress-induced cardiomyopathy? Aim: To study the impact of COVID-19 on the incidence of stress-induced cardiomyopathy. Methods: A retrospective review of cardiac catheterization laboratory data was performed from January 2011 to August 2022. We identified a total of (n=121) cases of stress induced cardiomyopathy. Diagnosis was adjudicated based on the findings on cardiac catheterization, left ventriculography, and echocardiography. Clinical and demographic data of interest was obtained from individual patient electronic medical records into a secure database management tool. Additional data of interest was obtained by performing a post-discharge questionnaire via a telephone survey. Results: The mean age of the population was 69 years (SD± 11.5). 93% (112) of the study population were females. A preceding physical stressor as a triggering factor was present in 59% (72) of individuals, 25% (31) individuals reported a preceding emotional stressor. An increase in the number of cases of SIC was noticed from January of 2020. Only 11% (8) of the patients who were admitted from Janurary 2020 had COVID-19 [Figure 1]. 36% (44) patients participated in the survery. Patients graded their disability from SIC as the following: Mild in 11% (4) , moderate in 7% (3) and severe in 2% (1) of the individuals [Figure 2]. All the patients were referred to Cardiac Rehabilitation at the Medical Center; a American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) certified program that provides patients with educational, preventional and rehabilitative resources. Conclusion: A rise in the incidence of SIC was noted in our single center retrospective study when the CDC declared COVID-19 a healthcare emergency. This suggests an indirect economic and psychosocial stress related process from COVID-19; the "Long COVID" that is not talked about.

Cardiovascular toxicities of immune therapies for cancer-a scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Council of Cardio-Oncology.

The advent of immunological therapies has revolutionized the treatment of solid and haematological cancers over the last decade. Licensed therapies which activate the immune system to target cancer cells can be broadly divided into two classes. The first class are antibodies that inhibit immune checkpoint signalling, known as immune checkpoint inhibitors (ICIs). The second class are cell-based immune therapies including chimeric antigen receptor T lymphocyte (CAR-T) cell therapies, natural killer (NK) cell therapies, and tumour infiltrating lymphocyte (TIL) therapies. The clinical efficacy of all these treatments generally outweighs the risks, but there is a high rate of immune-related adverse events (irAEs), which are often unpredictable in timing with clinical sequalae ranging from mild (e.g. rash) to severe or even fatal (e.g. myocarditis, cytokine release syndrome) and reversible to permanent (e.g. endocrinopathies).The mechanisms underpinning irAE pathology vary across different irAE complications and syndromes, reflecting the broad clinical phenotypes observed and the variability of different individual immune responses, and are poorly understood overall. Immune-related cardiovascular toxicities have emerged, and our understanding has evolved from focussing initially on rare but fatal ICI-related myocarditis with cardiogenic shock to more common complications including less severe ICI-related myocarditis, pericarditis, arrhythmias, including conduction system disease and heart block, non-inflammatory heart failure, takotsubo syndrome and coronary artery disease. In this scientific statement on the cardiovascular toxicities of immune therapies for cancer, we summarize the pathophysiology, epidemiology, diagnosis, and management of ICI, CAR-T, NK, and TIL therapies. We also highlight gaps in the literature and where future research should focus.

Takotsubo syndrome in the setting of hypertrophic cardiomyopathy: Mechanical versus neurohumoral factors.

Takotsubo syndrome in the setting of hypertrophic cardiomyopathy: Mechanical versus neurohumoral factors.

Metabolomic insights into plant-derived cyclolinopeptides as natural therapeutics for management of paroxysmal hypertension: an in-silico approach

Paroxysmal hypertension is a type of response exerted by the body towards external stimulus like physical, mental, or emotional stress which leads to chemical changes in the body that accelerates the physiological parameters like stress hyper-glycemia, obesity, stress cardiomyopathy, hemorrhagic stroke etc. Due to ill effects of chemical drugs administered by the clinicians, there is need of natural anti-depressant products which may serve as an alternative medicine. Compounds like cyclolinopeptides, cyclosporin A, and curcacyclines have exhibited potential immunosuppressive activity. With objective of drug discovery, this study investigates the role of sub-types of cyclolinopeptides as potential drugs against paroxysmal hypertension and predict their mode of action in biochemical pathways and their role in mitigation of stress induced hyper response.

A left humerus fracture-induced Takotsubo syndrome

A left humerus fracture-induced Takotsubo syndrome

Prognostic Value of Secondary Prevention Medical Therapy in Patients With Takotsubo Cardiomyopathy: A Bayesian Network Meta-Analysis

Prognostic Value of Secondary Prevention Medical Therapy in Patients With Takotsubo Cardiomyopathy: A Bayesian Network Meta-Analysis

Takotsubo Syndrome and Eating Disorder

Takotsubo Syndrome and Eating Disorder

Post Caesarean Section Takotsubo Cardiomyopathy: A Case Report and Systematic Review of the Literature

Post Caesarean Section Takotsubo Cardiomyopathy: A Case Report and Systematic Review of the Literature

Finding a Trap With the Help of a Map: Parametric Mapping to Aid the Diagnosis of Takotsubo Cardiomyopathy

Finding a Trap With the Help of a Map: Parametric Mapping to Aid the Diagnosis of Takotsubo Cardiomyopathy

Stroke and takotsubo syndrome as the initial presentation of Takayasu arteritis.

Stroke and takotsubo syndrome as the initial presentation of Takayasu arteritis.

Adverse drug events associated with fluorouracil use in patients with metastatic colorectal cancer: a real-world pharmacovigilance study based on the FDA adverse event reporting system

ABSTRACT Background Fluorouracil (5-FU) is widely used to treat metastatic colorectal cancer (mCRC), but real-world safety data is limited. Our study aimed to evaluate 5-FU’s safety profile in a large mCRC population using the FAERS database. Research design and methods We conducted disproportionality analyses to identify adverse drug events associated with 5-FU use in mCRC patients from 2004 to 2023. Subgroup analyses, gender difference analyses, and logistic regression were also performed. Results We identified 1,458 reports with 5-FU as the primary suspected drug, with males accounting for 48.8% of reports. Gastrointestinal disorders were the most common adverse event (864 cases), while pregnancy-related conditions showed the strongest signal intensity (ROR = 2.97). We found 19 preferred terms with positive signals, including ischemic hepatitis (ROR = 59.32), blood iron increased (ROR = 59.32), and stress cardiomyopathy (ROR = 51.94). Males were more susceptible to weight loss and skin toxicity. Most adverse events occurred within the first month of 5-FU administration. Conclusion Our study provides a comprehensive analysis of 5-FU’s safety profile in mCRC patients, helping healthcare professionals mitigate risks in clinical practice.

Non-Atherosclerosis Acute Coronary Syndrome: A Review Article

Non-atherosclerotic acute coronary syndrome (ACS) refers to a group of conditions that cause myocardial damage and clinical symptoms like traditional ACS but are not primarily caused by coronary artery plaque rupture or obstruction. This abstract provides an overview of the etiology, clinical presentation, diagnosis, and management of non-atherosclerotic ACS. Several etiologies can lead to non-atherosclerotic ACS, including coronary artery vasospasm, connective tissue disorders, stress-induced cardiomyopathy (Takotsubo syndrome), and vasculitis. The clinical presentation can mimic traditional ACS, with chest pain being the most common symptom. Diagnostic tools such as electrocardiography (ECG), laboratory biomarkers, echocardiography, coronary angiography, cardiac magnetic resonance imaging (MRI), and nuclear imaging play a crucial role in distinguishing non-atherosclerotic ACS from traditional ACS. Treatment strategies for non-atherosclerotic ACS are often based on expert consensus and clinical experience due to the lack of specific guidelines. Management approaches depend on the underlying etiology and may include pharmacological therapy, invasive interventions such as percutaneous coronary intervention (PCI) or surgery, and risk factor modification. Prompt diagnosis and appropriate management are crucial for improving patient outcomes. Further research and prospective studies are needed to enhance our understanding of non-atherosclerotic ACS and optimize its management. Keyword: Coronary Artery Spasm, Coronary Syndrome, Non-Atherosclerosis Acute Myocardial Injury, Takotsubo Syndrome, Vasculitis.

Reverse takotsubo induced cardiogenic shock in the peripartum period: A case report and literature review.

Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2-3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care.

Exercise-Induced Сardiomyopathy. New Foreign and Old Domestic Representations

The review provides a historical background on the dynamics of representations about the pathology of the heart of athletes induced by intense physical activity in the domestic and the foreign literature. Evidence of the existence of a specific pathology of the myocardium in athletes, which has different names: myocardial dystrophy due to chronic physical overstrain, stress cardiomyopathy in athletes, exercise-induced arrhythmogenic cardiomyopathy, Phidippides cardiomyopathy. However, the authors agree in describing the clinical picture of heart pathology in athletes: metabolic, electrical, functional and morphological changes in the myocardium under the influence of intense physical activity within a separate nosological unit and its pathogenetic mechanisms.