Jin-Man Jung1, Jae-Gyum Kim1, Jung Bin Kim1, Kyung-Hee Cho1, Sungwook Yu1, Kyungmi Oh1, Yong-Hyun Kim1, Jeong-Yoon Choi1, Woo-Keun Seo2. 1. From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.). 2. From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.). mcastenosis@gmail.com.
Abstract
BACKGROUND AND PURPOSE: We investigated clinical and radiological characteristics of ischemic stroke patients with Takotsubo-like myocardial dysfunction. METHODS: From multicenter stroke registry database, ischemic stroke patients who underwent transthoracic echocardiography were found. Among these, patients were classified if they had specific ventricular regional wall motion abnormalities discording with coronary artery distribution, such as apical (typical pattern) or nonapical ballooning (atypical pattern), considered as echocardiographic findings of Takotsubo cardiomyopathy. Patients with ischemic heart disease history, myocarditis, or pheochromocytoma were excluded. We compared patients with Takotsubo-like myocardial dysfunction with those without and further performed systematic literature review on those with Takotsubo cardiomyopathy. RESULTS: This study included 23 patients (0.42%). The mean age was 70.7±13.9 years, with predominance of women (73.9%) and typical pattern of Takotsubo-like myocardial dysfunction (91.3%). They were associated with short-term poor functional outcomes, including high mortality, neurological deterioration, and functional status at discharge, compared with those without (39.1% versus 2.4%, 47.8% versus 7.4%; and median [interquartile range], 5 [5-6] versus 3 [2-4]; all P<0.001). They had a higher inflammatory marker level and lower triglyceride level. Ischemic lesions were more commonly found in the right anterior circulation with specific dominant regions being the insula and peri-insular areas. In addition, a trend toward a remarkable mortality rate and higher prevalence of insular involvement was observed in the propensity-score matching, subgroup fulfilling the strict Takotsubo cardiomyopath criteria, and was as reported in literature review. CONCLUSION: Stroke patients with Takotsubo-like myocardial dysfunction may differ from those without in clinical outcomes, laboratory findings, and radiological features.
BACKGROUND AND PURPOSE: We investigated clinical and radiological characteristics of ischemic strokepatients with Takotsubo-like myocardial dysfunction. METHODS: From multicenter stroke registry database, ischemic strokepatients who underwent transthoracic echocardiography were found. Among these, patients were classified if they had specific ventricular regional wall motion abnormalities discording with coronary artery distribution, such as apical (typical pattern) or nonapical ballooning (atypical pattern), considered as echocardiographic findings of Takotsubo cardiomyopathy. Patients with ischemic heart disease history, myocarditis, or pheochromocytoma were excluded. We compared patients with Takotsubo-like myocardial dysfunction with those without and further performed systematic literature review on those with Takotsubo cardiomyopathy. RESULTS: This study included 23 patients (0.42%). The mean age was 70.7±13.9 years, with predominance of women (73.9%) and typical pattern of Takotsubo-like myocardial dysfunction (91.3%). They were associated with short-term poor functional outcomes, including high mortality, neurological deterioration, and functional status at discharge, compared with those without (39.1% versus 2.4%, 47.8% versus 7.4%; and median [interquartile range], 5 [5-6] versus 3 [2-4]; all P<0.001). They had a higher inflammatory marker level and lower triglyceride level. Ischemic lesions were more commonly found in the right anterior circulation with specific dominant regions being the insula and peri-insular areas. In addition, a trend toward a remarkable mortality rate and higher prevalence of insular involvement was observed in the propensity-score matching, subgroup fulfilling the strict Takotsubo cardiomyopath criteria, and was as reported in literature review. CONCLUSION:Strokepatients with Takotsubo-like myocardial dysfunction may differ from those without in clinical outcomes, laboratory findings, and radiological features.
Authors: Nicholas A Morris; Abhinaba Chatterjee; Oluwayemisi L Adejumo; Monica Chen; Alexander E Merkler; Santosh B Murthy; Hooman Kamel Journal: Neurocrit Care Date: 2019-02 Impact factor: 3.210
Authors: Denise Battaglini; Chiara Robba; Adriana Lopes da Silva; Cynthia Dos Santos Samary; Pedro Leme Silva; Felipe Dal Pizzol; Paolo Pelosi; Patricia Rieken Macedo Rocco Journal: Crit Care Date: 2020-04-21 Impact factor: 9.097