L Christian Napp1, Victoria L Cammann2, Milosz Jaguszewski3, Konrad A Szawan2, Manfred Wischnewsky4, Sebastiano Gili5, Maike Knorr6, Susanne Heiner6, Rodolfo Citro7, Eduardo Bossone8, Fabrizio D'Ascenzo9, Michael Neuhaus10, Jennifer Franke11, Ioana Sorici-Barb11, Michel Noutsias12, Christof Burgdorf13, Wolfgang Koenig14,15, Behrouz Kherad16, Annahita Sarcon17, Lawrence Rajan18, Guido Michels19, Roman Pfister19, Alessandro Cuneo20, Claudius Jacobshagen21, Mahir Karakas22,23, Alexander Pott24, Philippe Meyer25, Jose D Arroja25, Adrian Banning26, Florim Cuculi27, Richard Kobza27, Thomas A Fischer28, Tuija Vasankari29, K E Juhani Airaksinen29, Christian Hauck30, Carla Paolini31, Claudio Bilato31, Yoichi Imori32, Ken Kato33, Yoshio Kobayashi33, Grzegorz Opolski34, Monika Budnik34, Rafal Dworakowski35, Philip MacCarthy35, Christoph Kaiser36, Stefan Osswald36, Leonarda Galiuto37, Wolfgang Dichtl38, Christina Chan39, Paul Bridgman39, Daniel Beug40,41, Clément Delmas42, Olivier Lairez42, Ibrahim El-Battrawy43,44, Ibrahim Akin43,44, Ekaterina Gilyarova45, Alexandra Shilova45, Mikhail Gilyarov45, John D Horowitz46, Karolina Polednikova47, Petr Tousek47, Petr Widimský47, David E Winchester48, Jan Galuszka49, Christian Ukena50, Gregor Poglajen51, Pedro Carrilho-Ferreira52, Carlo Di Mario53, Abhiram Prasad54, Charanjit S Rihal54, P Christian Schulze55, Matteo Bianco56, Filippo Crea37, Martin Borggrefe43,44, Lars S Maier30, Fausto J Pinto52, Ruediger C Braun-Dullaeus57, Wolfgang Rottbauer24, Hugo A Katus11, Gerd Hasenfuß21, Carsten Tschöpe16, Burkert M Pieske16,58, Holger Thiele59, Heribert Schunkert14,15, Michael Böhm50, Stephan B Felix40,41, Thomas Münzel6, Jeroen J Bax60, Johann Bauersachs1, Eugene Braunwald61, Thomas F Lüscher62,63, Frank Ruschitzka2, Jelena R Ghadri2, Christian Templin. 1. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. 2. University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. 3. First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland. 4. FB Mathematics and Computer Science, University of Bremen, Bremen, Germany. 5. Centro cardiologico Monzino, IRCCS, Milan, Italy. 6. Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany. 7. Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. 8. Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy. 9. Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy. 10. Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland. 11. Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany. 12. Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 13. Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany. 14. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. 15. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. 16. Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany. 17. Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA. 18. TJ Health Partners Heart and Vascular, Glasgow, KY, USA. 19. Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany. 20. Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany. 21. Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany. 22. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. 23. DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany, Hamburg. 24. Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany. 25. Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 26. Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK. 27. Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland. 28. Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland. 29. Heart Center, Turku University Hospital and University of Turku, Turku, Finland. 30. Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany. 31. Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy. 32. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. 33. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 34. Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 35. Department of Cardiology, King's College Hospital, London, UK. 36. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 37. Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 38. University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria. 39. Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand. 40. Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany. 41. DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. 42. Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France. 43. First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany. 44. DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany. 45. Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia. 46. Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia. 47. Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic. 48. Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA. 49. Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic. 50. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 51. Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia. 52. Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal. 53. Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy. 54. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. 55. Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany. 56. Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy. 57. Department of Internal Medicine, Cardiology and Angiology, Magdeburg University, Magdeburg, Germany. 58. DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany. 59. Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Germany, Leipzig. 60. Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands. 61. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 62. Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland. 63. Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK.
Abstract
AIMS: Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. METHODS AND RESULTS: Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. CONCLUSIONS: Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT01947621. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. METHODS AND RESULTS: Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndromepatients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. CONCLUSIONS:Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT01947621. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Trisha Singh; Hilal Khan; David T Gamble; Caroline Scally; David E Newby; Dana Dawson Journal: Circulation Date: 2022-03-28 Impact factor: 29.690
Authors: Vojtech Brazdil; Petr Kala; Martin Hudec; Martin Poloczek; Jan Kanovsky; Roman Stipal; Petr Jerabek; Otakar Bocek; Martin Pail; Milan Brazdil Journal: Clin Auton Res Date: 2022-01-08 Impact factor: 4.435