Elisabeth Coupez1, Romain Eschalier2, Bruno Pereira3, Romain Pierrard4, Géraud Souteyrand1, Guillaume Clerfond1, Bernard Citron4, Jean-René Lusson1, Nicolas Mansencal5, Pascal Motreff1. 1. Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France. 2. Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France. Electronic address: reschalier@chuclermontferrand.fr. 3. Biostatistics Unit (Clinical Research and Innovation Direction), CHU de Clermont-Ferrand, Clermont-Ferrand, France. 4. Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 5. Department of Cardiology, Université de Versailles-Saint-Quentin, Ambroise-Paré Hospital, Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
Abstract
BACKGROUND: Takotsubo cardiomyopathy (TTC) continues to be under-diagnosed, due to its varying presentation, with potentially serious consequences if treatment is delayed. AIMS: To demonstrate the consistent involvement of catecholaminergic stress in TTC, regardless of the trigger. METHODS: Between 01 July 2009 and 31 August 2013, patients managed in our centre for thoracic pain syndrome, with or without troponin release, were followed up prospectively. TTC was diagnosed from the apical ballooning seen on left ventricular imaging (angiography or transthoracic echocardiography) in the absence of a significant coronary artery lesion. Triggers (emotional trauma, surgical stress and β2-mimetic intoxication) were recorded; catecholamine-secreting tumours were screened for with a urinary methoxylate-derivative assay. RESULTS: TTC was diagnosed in 40 out of 2754 (1.5%) patients with thoracic pain syndrome, with or without troponin release. Triggers were emotional trauma (n=29, 72.5%), surgical stress (n=5, 12.5%), adrenergic intoxication (n=3, 7.5%) and catecholaminergic tumour (n=3, 7.5%). Mean left ventricular ejection fraction at admission was 38.0 ± 15.7%. Eight (20%) patients initially showed cardiogenic shock. In-hospital mortality was 7.5%, with no deaths from cardiogenic causes. Thirty-five (94.6%) of the survivors had recovered a normal left ventricular ejection fraction (> 55%) by discharge. CONCLUSION: Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early.
BACKGROUND:Takotsubo cardiomyopathy (TTC) continues to be under-diagnosed, due to its varying presentation, with potentially serious consequences if treatment is delayed. AIMS: To demonstrate the consistent involvement of catecholaminergic stress in TTC, regardless of the trigger. METHODS: Between 01 July 2009 and 31 August 2013, patients managed in our centre for thoracic pain syndrome, with or without troponin release, were followed up prospectively. TTC was diagnosed from the apical ballooning seen on left ventricular imaging (angiography or transthoracic echocardiography) in the absence of a significant coronary artery lesion. Triggers (emotional trauma, surgical stress and β2-mimetic intoxication) were recorded; catecholamine-secreting tumours were screened for with a urinary methoxylate-derivative assay. RESULTS: TTC was diagnosed in 40 out of 2754 (1.5%) patients with thoracic pain syndrome, with or without troponin release. Triggers were emotional trauma (n=29, 72.5%), surgical stress (n=5, 12.5%), adrenergic intoxication (n=3, 7.5%) and catecholaminergic tumour (n=3, 7.5%). Mean left ventricular ejection fraction at admission was 38.0 ± 15.7%. Eight (20%) patients initially showed cardiogenic shock. In-hospital mortality was 7.5%, with no deaths from cardiogenic causes. Thirty-five (94.6%) of the survivors had recovered a normal left ventricular ejection fraction (> 55%) by discharge. CONCLUSION: Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early.
Authors: M Yashar S Kalani; Ashley L Siniard; Jason J Corneveaux; Ryan Bruhns; Ryan Richholt; James Forseth; Joseph M Zabramski; Peter Nakaji; Robert F Spetzler; Matthew J Huentelman Journal: Neurosurgery Date: 2016-06 Impact factor: 4.654
Authors: Cameron J Lacey; Kit Doudney; Paul G Bridgman; Peter M George; Roger T Mulder; Julie J Zarifeh; Bridget Kimber; Murray J Cadzow; Michael A Black; Tony R Merriman; Klaus Lehnert; Vivienne M Bickley; John F Pearson; Vicky A Cameron; Martin A Kennedy Journal: Sci Rep Date: 2018-05-15 Impact factor: 4.379