Takotsubo Stress Cardiomyopathy Research Articles

Clinical predictors of late left ventricle recovery in tako-tsubo syndrome

Abstract Funding Acknowledgements None. Introduction Tako-Tsubo syndrome (TTS) or stress cardiomyopathy is characterized by transient dysfunction of the left ventricle (LV) and a clinical presentation that can mimic an acute coronary syndrome. Recovery from contraction abnormalities may occur hours to weeks after the acute event. Although traditionally considered a disease with a favorable prognosis, it has been observed to have a complication rate during hospitalization similar to acute myocardial infarction and a significant mortality rate during follow-up (greater than 5% per patient-year). The recovery time of LV function has demonstrated important prognostic value. Purpose The aim of this work was to determine the clinical predictors of late left ventricular recovery in TTS. Methods Data from the multicenter national registry on Takotsubo Syndrome (RETAKO) were utilized. Clinical, laboratory, echocardiographic, and other imaging test characteristics, as well as events during hospitalization and follow-up, were collected. Recovery within the first days after the acute event was considered early recovery. Patients who died within the first 10 days after the acute event were excluded. Results A total of 1,463 patients were analyzed, of whom 373 (25.5%) had late recovery. The mean age was 71 years, and 86.6% were women. In the late recovery group, factors more common were age over 75 years, male gender, neurological disease, lung disease, peripheral arterial disease, active cancer, physical trigger, initial presentation as dyspnea or syncope, presence of shock, greater left ventricular dysfunction at diagnosis, and higher levels of proBNP. In multivariate analysis, the presence of neurological disease, active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger were associated with late recovery. Conclusions Patients with TTS showing late recovery of LV function have different clinical characteristics and disease presentation compared to those with early recovery. Late recovery was associated with the presence of neurological disease or active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger.

Takotsubo pathophysiology and complications: what we know and what we do not know.

Takotsubo cardiomyopathy or stress cardiomyopathy (SCM), was first described in 1990 and initially, it was thought to be only associated with short-term complications and mortality with a benign long-term prognosis comparable to a healthy population. However recent investigations have proven otherwise and have shown SCM patients might have comparable long-term morbidity and mortality to ST-elevation myocardial infarction (STEMI) patients. Many emotional, or physical stressors can trigger SCM, and have been able to describe an interplay of neurohormonal and inflammatory mechanisms as the pathophysiology of this disease. Additionally, given the significantly higher prevalence of SCM in post-menopausal women, estrogen levels have been thought to play a role in the pathogenesis of this disease. Furthermore, there is an elusive disparity in prognosis depending upon different triggers. Currently, many questions remain unanswered regarding the long-term management of these patients to reduce morbidity, mortality, and improve quality of life, such as the need for long-term anticoagulation. In this paper, we review the findings of most recent published investigations regarding etiologies, pathophysiology, diagnostic criteria, prognosis, short-term and in more detail, long-term complications of SCM. Finally, we will discuss what future research is needed to learn more about this disease to improve the long-term prognosis, even though as of now, data for long-term management is still lacking.

Sex Differences in the Clinical Outcomes of Patients With Takotsubo Stress Cardiomyopathy: A Meta-Analysis of Observational Studies

BackgroundThe incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared to females. Sex-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether sex-based differences are observed in TSCM clinical outcomes. MethodA comprehensive literature search of Pubmed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between males versus females in TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, and occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. ResultsTwelve observational studies involving 51,213 patients (4,869 males, and 46,344 females) were included in the meta-analysis. Male sex was associated with statistically significant higher in-hospital all-cause mortality when compared to females in patients with TSCM (RR 2.17; 95% CI 1.77–2.67; P < 0.001) The rate of cardiogenic shock was significantly higher in males with TSCM as compared to females (RR 1.66; 95% CI 1.29-2.12; P < 0.001). ConclusionOur meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Males sex was associated with a two-fold greater in-hospital all-cause mortality risk compared to female sex. The higher mortality risk associated with male sex deserves further study, and particularly whether it represents later recognition of the condition and disparities in treatments.

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Global reports of takotsubo (stress) cardiomyopathy following COVID-19 vaccination: A systematic review and meta-analysis

Concerns have been raised recently about takotsubo cardiomyopathy (TCM) after receiving COVID-19 vaccines, particularly the messenger RNA (mRNA) vaccines. The goal of this study was to compile case reports to provide a comprehensive overview of takotsubo cardiomyopathy (TCM) associated with COVID-19 vaccines. A systematic literature search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar between 2020 and June 1, 2022. The study included individuals who developed cardiac takotsubo cardiomyopathy from receiving COVID-19 vaccinations. Ten studies, including 10 cases, participated in the current systematic review. The mean age was 61.8 years; 90 % were female, while 10 % were male. 80 % of the patients received the mRNA COVID-19 vaccine, while 20 % received other types. In addition, takotsubo cardiomyopathy (TCM) occurred in 50 % of patients receiving the first dose and another 40 % after the second dose of COVID-19 vaccines. Moreover, the mean number of days to the onset of symptoms was 2.62 days. All cases had an elevated troponin test and abnormal ECG findings. The left ventricular ejection fraction (LVEF) was lower than 50 % in 90 % of patients. In terms of the average length of hospital stay, 50 % stayed for 10.2 days, and all cases recovered from their symptoms. In conclusion, takotsubo (stress) cardiomyopathy (TCM) complications associated with COVID-19 vaccination are rare but can be life-threatening. Chest pain should be considered an alarming symptom, especially in those who have received the first and second doses of the COVID-19 vaccine.

Case Report: Steroid-Responsive Takotsubo Cardiomyopathy Associated With Cytokine Storm and Obstructive Shock

A growing body of evidence suggests that inflammation may play a key role in the development of Takotsubo stress cardiomyopathy. Here, we report the case of a 63-year-old woman who presented with chest pain and was diagnosed with this cardiomyopathy. After an initial improvement, the patient experienced a systemic inflammatory response of unclear origin and deteriorated rapidly into obstructive shock. Her presentation was considered consistent with cytokine storm. She was, therefore, treated with steroids with rapid improvement in her clinical picture. She relapsed after the taper. Endomyocardial biopsy soon after initiation of pulse dose steroids showed macrophage and lymphocytic infiltration. This case highlights the potential intimate connection between systemic inflammatory response and Takotsubo stress cardiomyopathy and contributes to the evolving understanding of inflammation in the pathogenesis of this disease.

Takotsubo stress cardiomyopathy, a great mimicker of myocardial infarction in post-operative period: what surgeons should know? a case series

Takotsubo stress cardiomyopathy (TCM) is a rare disorder of the myocardium precipitated mainly by physical, mental stress or sometimes due to non-specific factors. The clinical presentation of takotsubo cardiomyopathy is an eidetic image of CAD and myocardial infarction (MI), but unlike the later takotsubo cardiomyopathy in most cases is reversible. Coronary angiographic evidence showing the absence of narrowing of coronary vessels is the only definitive way to distinguish this from MI. This condition is a less familiar entity to the surgeons and knowing this will help in arriving at the diagnosis early and have an optimistic attitude towards management because the condition is a self-limiting and good recovery is seen generally with supportive management. In this series, 1056 HPB cases and 101 liver transplant cases done from January 2016 to February 2021 and among them we describe four cases who developed TCM in post-operative period and discuss the relevant literature.

Investigating changes in β-adrenergic gene expression (ADRB1 and ADRB2) in Takotsubo (stress) cardiomyopathy syndrome; a pilot study.

BackgroundTakotsubo Cardiomyopathy (TC) is a rare disorder that is mostly caused by stress and is often misdiagnosed. We aimed to analyze Takotsubo Syndrome at the molecular level by using the Oxford Nanopore Minion Device and its protocol.Methods and resultsTen patients who were previously diagnosed with Takotsubo Syndrome (increased after decrease in ejection fraction and without critical stenosis in coronary arteries) and 10 healthy individuals in the control group were included in our project. The mean age was 53 ± 12.2 for the patient group and 52.4 ± 9.9 for the control group, and the left ventricular ejection fraction was 50.3 ± 11.5 for the patient group and 64.2 ± 2.8 for the control group (p < 0.05). Peripheral blood of patients and healthy individuals was taken and their DNA was obtained. By making long reads throughout the genome, the most studied regions responsible for β-adrenergic signaling pathways; The gene expression level of cardiac β-1 ADRB1 (rs1801253-ENST00000369295.4), G > C, (Gly389Arg) and cardiac β-2 ADRB2 (rs1800888-ENSG00000169252), C > T, (Thr165Ile) adrenoceptors was investigated. As a result; no structural variation was detected leading to Takotsubo Cardiomyopathy. The results obtained from the bioinformatics analysis were also checked from the VarSome Tools and similar results were found.ConclusionsMany publications in TC susceptibility have that may lead to adrenergic pathway dysregulation, most studied adrenergic receptor genes in the similar literatures too. We searched for genetic variants in b1AR and b2AR genes in our study and however we could not find any variants in this study, we think larger numbers of cohort studies are needed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11033-021-06816-w.

VENTRICULAR TACHYCARDIA ELECTRICAL STORM AS A MANIFESTATION OF REVERSE VARIANT TAKOTSUBO CARDIOMYOPATHY

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Takotsubo cardiomyopathy (TTC) is a syndrome with transient systolic dysfunction in the absence of obstructive coronary arteries with the reverse variant being a rare entity (1,2). Here, we report a case of reverse TTC presenting with monomorphic ventricular tachycardia (VT) electrical storm. CASE PRESENTATION: A 76 year-old female with a history of recently diagnosed Stage IIIB lung adenocarcinoma presented to the emergency room with shortness of breath. On presentation, her vitals were: BP 134/82, pulse 120 beats/min, SPO2 93% in room air. Initial EKG showed no significant ST-T wave changes and normal QTc. Labs were significant for uptrending troponin from 0.8 to 4 ng/mL. Aspirin and heparin infusion were started for possible NSTEMI with a plan for catheterization. That night, she developed unstable, monomorphic VT (Figure 1). Consecutive synchronized cardioversions and amiodarone boluses were unsuccessful. Patient's VT terminated with repeated boluses of lidocaine followed by lidocaine infusion. Stat echocardiogram showed an ejection fraction of 25-30% with anterior and anteroseptal hypokinesis. Emergency cardiac catheterization revealed non-obstructive coronary arteries with akinesis of the basal wall and sparing of the apex suggesting reverse TTC (Figure 2). She was transferred to the critical care unit where she was transitioned to amiodarone infusion with no further VT episodes and was initiated on guideline-directed medical therapy. DISCUSSION: TTC usually occurs due to a surge of catecholamines leading to myocardial damage. The typical variant demonstrates apical ballooning with basal hypokinesis. Rarely, there may be basal hypokinesis with apical sparing, the reverse variant (2). Arrhythmias are uncommon in typical TTC and prior studies have indicated a low incidence of VT (3.2%) (3). There is sparse literature describing the incidence of VT or VT storm in the reverse variant. One of the postulated mechanisms for VT in TTC is transient QTc prolongation, however this remains controversial. (3). The incidence of arrhythmias is thought to be more prevalent during the acute phase leading to increased in-hospital mortality (3). Additionally, it remains uncertain whether prophylactic antiarrhythmics are beneficial in this population subset. Further studies are warranted to understand which variants of TTC develop critical arrhythmias. CONCLUSIONS: Reverse variant is a rare subset of TTC which can present with critical arrhythmias including VT storm. Awareness of this manifestation can help clinicians with early recognition and management of these critical arrhythmias. REFERENCE #1: Bybee KA., Prasad A. Stress-related cardiomyopathy syndromes. Circulation 2008;118(4):397–409. Doi: 10.1161/CIRCULATIONAHA.106.677625. REFERENCE #2: Templin C., Ghadri JR., Diekmann J., et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. New England Journal of Medicine 2015;373(10):929–38. Doi: 10.1056/NEJMoa1406761. REFERENCE #3: Pant S, Deshmukh A, Mehta K, et al. Burden of arrhythmias in patients with Takotsubo Cardiomyopathy (Apical Ballooning Syndrome). International Journal of Cardiology [Internet] 2013;170(1):64–68. Available from: https://doi.org/10.1016/j.ijcard.2013.10.041 DISCLOSURES: No relevant relationships by Anneka Hutton, source=Web Response No relevant relationships by Gagan Neupane, source=Web Response No relevant relationships by Enoemem Okpokpo, source=Web Response No relevant relationships by Bharadwaj Satyavolu, source=Web Response No relevant relationships by Raksha Sharma, source=Web Response No relevant relationships by Tracey Topacio, source=Web Response

Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy

BackgroundCardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of ‘takotsubo’ stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit.Case summaryAn intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing.ConclusionThis case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.

Recurrent Takotsubo Cardiomyopathy Presenting With Anterior Wall ST-Elevation Myocardial Infarction

Takotsubo cardiomyopathy (TC) or stress cardiomyopathy with the presence of transient apical ballooning of the left ventricle in the absence of obstructive coronary artery disease. The recurrence of TC is extremely rare, with an annual recurrence risk of 1.5% and approximately 5% recurrence risk after six years. We present a case of a patient with a history of TC who presented with chest pain and ST-segment elevation in her electrocardiogram and was found to have normal coronaries and diagnosed with recurrent TC.

Takotsubo stress cardiomyopathy following explantation of sEEG electrodes.

ObjectiveTakotsubo stress cardiomyopathy is characterized by dysfunction of the left ventricle of the heart including apical ballooning and focal wall‐motion abnormalities. Although reported in association with seizures and intracerebral hemorrhage, there are no studies reporting its occurrence in patients having stereoelectroencephalography (sEEG).MethodsA 38‐year‐old lady with no prior history of cardiac disease experienced sudden onset chest pain and acute left ventricular failure 4 hours following explantation of stereoelectroencephalogram electrodes.ResultsA small parenchymal hematoma related to the right posterior temporal electrode had been noted postelectrode insertion but was asymptomatic. Focal‐onset seizures from nondominant mesial temporal structures were recorded during sEEG. Following the presentation with LVF, new‐onset anterolateral T‐wave inversion with reciprocal changes in leads II, III, and aVF was noted on electrocardiogram (ECG) and the chest X‐ray findings were consistent with pulmonary edema. Echocardiography demonstrated hypokinesis of the cardiac apex and septum consistent with Takotsubo stress cardiomyopathy.SignificanceAwareness of the possible complication of Takotsubo stress cardiomyopathy is required in an epilepsy surgery program.

Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock Secondary to Left Ventricular Outflow Tract Obstruction and Severe Mitral Regurgitation

Takotsubo (stress) cardiomyopathy typically presents mimicking acute myocardial infarction. Left ventricular outflow tract (LVOT) obstruction is an uncommon complication, characterised by a more severe clinical presentation including cardiogenic shock.

PANCREATITIS-INDUCED ACUTE ST SEGMENT ELEVATION AND REGIONAL WALL MOTION ABNORMALITY

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute myocardial infarction (AMI) mimics causing ST segment elevation present a diagnostic conundrum for physicians. Recognition of uncommon causes of AMI mimics is essential in reducing patient exposure to unnecessary intervention. CASE PRESENTATION: A 49-year-old male with a past medical history of hypertension presented to the emergency with a chief complaint of severe epigastric pain radiating to his back. He had undergone ERCP earlier in the day for removal of a common bile duct (CBD) stone. Severe epigastric tenderness was observed on physical exam. Laboratory evaluation revealed WBC count of 25700/mcL, Hb 19.8 g/L, BUN 25 mg/dL, creatinine 1.3 mg/dL, alkaline phosphatase 188 IU/L, AST 42 IU/L, ALT 89 IU/L, total bilirubin 1.4 mg/dL, amylase 1059 IU/ L, lipase 21,417 units/L and troponin < 0.015 ng/mL. CT scan of the abdomen revealed an enlarged pancreas with surrounding fat stranding and the presence of a distal CBD stone. EKG was unremarkable (figure 1). The following day, the patient developed tachycardia and reported recurrent epigastric pain. He denied chest pain. EKG evidenced sinus tachycardia, 2-3mm convex ST segment elevation in inferior leads, 1-2mm ST depression in the anterolateral leads was also observed (figure 2). Serial troponin I levels were within the undetectable range. Repeat EKG after 3 hours showed tachycardia with no ST segment elevation (figure 3). Echocardiography revealed a small area of dyskinesia in the inferoseptal wall of the left ventricle. Patient was managed without percutaneous coronary intervention (PCI), thrombolysis or anticoagulation. Patient’s hospital stay was complicated by pancreatic necrosis, abscess, pseudocyst formation, and sepsis. He was discharged on day 19 after recovery. DISCUSSION: The most common EKG changes in pancreatitis are secondary to metabolic derangements such as hypocalcemia, hyponatremia, hypokalemia, hypomagnesemia, and insulin-induced hypoglycemia. QT prolongation, ST depression, U waves, and low amplitude T wave changes are frequently seen. On the other hand, ST elevation is rarely seen. Proposed mechanisms for ST elevation and wall motion abnormality include the cytotoxic effect of proteolytic enzymes on cardiac myocytes, a cardiobiliary reflex resulting in increased vagal tone, coronary vasospasm, exacerbation of underlying coronary artery disease, or coronary thrombus formation from increased platelet adhesiveness and/or pancreatic enzyme induced coagulopathy [1,2,3]. Takotsubo stress cardiomyopathy has been linked to pancreatitis in several reports. Hypothesized pathomechanisms for this transient myocardial dysfunction include catecholamine excess and sympathetic stimulation [2]. CONCLUSIONS: Acute pancreatitis may mimic EKG and echocardiography findings of AMI. In selected cases, knowing this can help avoid unnecessary PCI, thrombolysis or anticoagulation which may lead to serious hemorrhagic complications. Reference #1: Coppola G, Carità P, Corrado E, Borrelli A, Rotolo A, Guglielmo M, et al. ST segment elevations: Always a marker of acute myocardial infarction? Indian Heart Journal. 2013 Jul;65(4):412–23. Reference #2: Yu ES, Lange JJ, Broor A, Kutty K. Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review. Case Rep Gastroenterol. 2019 Aug;13(2):321–35. Reference #3: Ro TK, Lang RM, Ward RP. Acute pancreatitis mimicking myocardial infarction: evaluation with myocardial contrast echocardiography. Journal of the American Society of Echocardiography. 2004 Apr;17(4):387–90. DISCLOSURES: No relevant relationships by Maryam Moghareh, source=Web Response No relevant relationships by Prashank Neupane, source=Web Response No relevant relationships by Zed Seedat, source=Web Response No relevant relationships by Touqir Zahra, source=Web Response

Midventricular type of Takotsubo (stress) cardiomyopathy concurrent to severe coronary vasospasm

Midventricular type of Takotsubo (stress) cardiomyopathy concurrent to severe coronary vasospasm

TORSADES DE POINTES COMPLICATING TAKOTSUBO STRESS CARDIOMYOPATHY IN A CANCER PATIENT

Takotsubo stress cardiomyopathy (TSCM) is a cardiac syndrome of transient left ventricular wall motion abnormalities precipitated by an emotional or physiologic stressor, which can include cancers and chemotherapeutics. It can mimic an acute coronary syndrome and carries a similar mortality risk in

553 Smoke but No Fire: Increased MINOCA and Takotsubo Acute Coronary Syndromes in the Australian Bushfires

The 2020 Australian bushfires led to declaration of a state of emergency in multiple states. Concerns have previously been raised that smoke exposure may trigger increased rates of acute coronary syndrome, Takotsubo (stress) cardiomyopathy, and cardiac arrest. Our hospital is a major tertiary receiving hospital for Albury-Wodonga and East Gippsland, two areas most affected by the 2019/2020 bushfires. We performed a case-control analysis of acute coronary syndrome patients transferred from these regions between 29th December 2019 to 10th January 2020. Cases were compared to acute coronary syndrome cases in the identical date range from the two years prior. 11 patients were transferred from the bushfire-affected regions, representing an increase of 24.5% in case volume from previous years. All bushfire-affected patients had chest pain and elevated troponin level, with median troponin value 1,271ng/L (interquartile range 546 - 6,807ng/L, normal <16ng/L). In comparison with the control group, bushfire-affected patients were more commonly female (45.5% from bushfire areas vs 14.8% in the control group, p=0.044) and received a diagnosis of myocardial infarction with normal coronaries (MINOCA) or Takotsubo cardiomyopathy (45.5% vs 7.4%, p=0.021). There was no difference between groups in median age, presence of smoking history, median number of cardiovascular risk factors, median troponin level, or electrocardiogram appearance. Our experience demonstrates that the greatest increase in case volume was in middle-aged females (median age 62.4 years) experiencing either a MINOCA event or Takotsubo cardiomyopathy in the context of high levels of community stress.

Takotsubo (stress) cardiomyopathy in childhood.

Takotsubo cardiomyopathy (TC) is a significant cause of acute heart failure in adults. However, triggering factors, ECG and echocardiographic findings, and prognosis of TC have not been well studied in children. Therefore, this study aimed to evaluate the demographic characteristics, signs and symptoms, laboratory findings, and prognosis of children with TC. We analyzed demographic characteristics of childhood TC cases (aged < 18 years) treated at our university hospital from 2014 to 2019. The triggering factors of TC; outcomes of the disease; and laboratory, ECG, and echocardiographic findings at presentation were also examined. A total of 17 patients (mean age 9.71 ± 5.03 years, 52.9% female) were included in the study. Chest pain, palpitation, and dyspnea were the most common presenting symptoms. The most common triggering factor was emotional stress (47%) in our study population. Ten patients (58.8%) had a classical form of TC, with apical left ventricular wall motion abnormalities. None of the patients died, and 15 (88.2%) had complete recovery of left ventricular systolic function. Only two patients (11.8%) had a left ventricular ejection fraction < 50% at the end of follow-up.Conclusion: This is the first retrospective data on childhood TC. The majority of patients with TC experienced an emotional stress as a trigger of the disease, and nearly 90% of the patients completely recovered.What is Known? • The occurrence of acute heart failure following an emotional or physical stress is called Takotsubo cardiomyopathy (TC). • Takotsubo cardiomyopathy is rarely reported in childrenWhat is New? • The present study is the first case series of children with TC. • In contrast to the female predominance in adult population, TC was almost equally distributed between boys and girls in the pediatric age group.

Time Course of Functional Recovery in Takotsubo (Stress) Cardiomyopathy: A Serial Speckle Tracking Echocardiography and Electrocardiography Study.

BACKGROUNDAlthough rapid recovery of cardiac contraction is a hallmark of Takotsubo cardiomyopathy (TTC), the time course of recovery is still ill-defined. We aimed to investigate the time course of left ventricular (LV) functional recovery using 2D speckle tracking echocardiography and electrocardiography (ECG).METHODSThirty-two consecutive patients (65 ± 16 years, 26 women) with TTC were prospectively recruited. ECG and echocardiography were performed at baseline (No. 1), before discharge (No. 2), and at 1 week (No. 3) and 5 weeks (No. 4) after discharge. Echocardiographic images and ECGs were analyzed to measure ejection fraction (LVEF), global and regional longitudinal strain (GLS, RLS), and T wave inversion (TWI) scores.RESULTSAt baseline, LVEF, GLS, and TWI score were 39 ± 8.8%, -11 ± 4.3%, and 1.8 ± 3.0, respectively. Both LVEF and GLS continued to improve from baseline at the No. 2, No. 3, and No. 4 timepoints (49 ± 9.3%, 56 ± 7.5%, 58 ± 6.8%, respectively, for LVEF and -15 ± 4.2%, -17 ± 3.9%, -19 ± 3.4%, respectively, for GLS). TWI score was decreased at the No. 3 ECG relative to baseline and then increased (No. 2: -2.5 ± 3.0, No. 3: -2.9 ± 5.2, No. 4: -0.3 ± 4.4). In the apical subgroup, the reverse base-to-apex gradient of RLS had disappeared by the No. 3 echocardiography.CONCLUSIONSContractile function as assessed by LVEF and GLS recovered continuously in patients with TTC throughout the acute and subacute phases, with rapid recovery in the acute phase. Negative T wave progressed during the acute phase and recovered more slowly during the subacute phase.