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Takotsubo Syndrome

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 September 2021) | Viewed by 16831

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Dr. Thomas Stiermaier

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1. Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, 23538 Lübeck, Germany
2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23538 Lübeck, Germany
Interests: acute coronary syndrome; takotsubo syndrome; interventional cardiology; cardiac magnetic resonance
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Dear Colleagues,

Takotsubo syndrome (TS) is an increasingly recognized form of acute heart failure and important differential diagnosis in patients presenting with suspected acute coronary syndrome. It is characterized by transient left and/or right ventricular dysfunction due to a typical pattern of wall motion abnormalities causing regional ballooning. TS is predominantly found in postmenopausal women and frequently triggered by physical or emotional stress. Research efforts over the last few decades have led to a comprehensive characterization of the epidemiology, clinical features, and, most recently, prognostic implications of the disease. Despite complete recovery of systolic function and the absence of irreversible myocardial damage, patients with TS exhibit a substantial risk of adverse events and considerable short- and long-term mortality rates. Further research is required to elucidate the still-unknown pathophysiology of TS and develop specific treatment approaches in order to potentially improve the outcome of patients with TS.

The present Special Issue aims to overview the current knowledge, latest evidence, and unresolved issues in the field of TS. Therefore, I welcome the submission of innovative original research papers and in-depth review articles dealing with the pathophysiology, diagnosis, treatment, and prognosis of TS.

Dr. Thomas Stiermaier
Guest Editor

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Keywords

Takotsubo syndrome
stress cardiomyopathy
broken-heart syndrome
pathophysiology
diagnosis
diagnostic criteria
treatment
complications
prognosis

Published Papers (5 papers)

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Research

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9 pages, 811 KiB

Open AccessArticle

Microcirculation in Patients with Takotsubo Syndrome—The Prospective CIRCUS-TTS Study

by Christian Möller, Thomas Stiermaier, Moritz Meusel, Christian Jung, Tobias Graf and Ingo Eitel

J. Clin. Med. 2021, 10(10), 2127; https://doi.org/10.3390/jcm10102127 - 14 May 2021

Cited by 10 | Viewed by 1513

Abstract

The pathophysiology of Takotsubo syndrome (TTS) is incompletely understood. A sympathetic overdrive with coronary microvascular dysfunction might play a central role. The aim of our study was to assess the status of the systemic microcirculation (MC) of patients with TTS, compared to patients with myocardial infarction (MI) and healthy subjects. The systemic microvascular function of 22 TTS patients, 20 patients with MI and 20 healthy subjects was assessed via sublingual sidestream dark-field imaging. In TTS and MI patients, measurements were performed during the acute phase (day 1, 3 and 5) and after 3 months. The measurement in healthy subjects was performed once. The assessed parameters were number of vessel crossings, number of perfused vessel crossings, proportion of perfused vessels, total vessel density and perfused vessel density. The results did not show relevant differences between the investigated groups. Some minor, albeit statistically significant, differences occurred rather randomly. The MC parameters of the TTS group did not show any relevant changes in the temporal course. A systemic microvascular dysfunction could not be identified as a contributing factor in the pathogenesis of TTS. A possible microvascular dysfunction might instead be caused by a local effect restricted to the coronary microvascular bed. Full article

(This article belongs to the Special Issue Takotsubo Syndrome)

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13 pages, 1967 KiB

Open AccessArticle

Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome

by Thomas Stiermaier, Kira Busch, Torben Lange, Toni Pätz, Moritz Meusel, Sören J. Backhaus, Alex Frydrychowicz, Jörg Barkhausen, Matthias Gutberlet, Holger Thiele, Andreas Schuster and Ingo Eitel

J. Clin. Med. 2020, 9(12), 3882; https://doi.org/10.3390/jcm9123882 - 29 Nov 2020

Cited by 13 | Viewed by 2272

Abstract

Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS −11.28%, TT-GLS −11.45%, and fast manual LAS −10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > −11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > −11.45% (20.0% versus 5.4%; p = 0.016), and LAS > −10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities. Full article

(This article belongs to the Special Issue Takotsubo Syndrome)

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16 pages, 5707 KiB

Open AccessArticle

Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome

by Charlotte Dagrenat, Jean Jacques Von Hunolstein, Kensuke Matsushita, Lucie Thebaud, Stéphane Greciano, Nicolas Tuzin, Nicolas Meyer, Annie Trinh, Laurence Jesel, Patrick Ohlmann and Olivier Morel

J. Clin. Med. 2020, 9(9), 2985; https://doi.org/10.3390/jcm9092985 - 15 Sep 2020

Cited by 10 | Viewed by 2082

Abstract

Background: Bedside diagnosis between Takotsubo syndrome (TTS) and ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction remains challenging. We sought to determine a cardiac biomarker profile to enable their early distinction. Methods: 1100 patients (TTS n = 314, STEMI n = 452, NSTEMI n = 334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. Results: At admission, cut-off values of BNP (B-type natriuretic peptide)/TnI (Troponin I) ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation was obtained by the use of BNP/TnI ratio at peak (cut-of values of 6 and 115 discriminated respectively STEMI from NSTEMI, and NSTEMI from TTS). We developed a score including five parameters (age, gender, history of psychiatric disorders, LVEF, and BNP/TnI ratio at admission) enabling good distinction between TTS and STEMI (77% specificity and 92% sensitivity, AUC 0.93). For the distinction between TTS and NSTEMI, a four variables score (gender, history of psychiatric disorders, LVEF, and BNP at admission) achieved a good diagnostic performance (89% sensitivity, 85% specificity, AUC 0.94). Conclusion: A distinctive cardiac biomarker profile enables at an early stage a differentiation between TTS and ACS. A four (NSTEMI) or five variables score (STEMI) permitted a better discrimination. Full article

(This article belongs to the Special Issue Takotsubo Syndrome)

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Review

Jump to: Research

23 pages, 20095 KiB

Open AccessReview

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1—Pathophysiology and Diagnosis

by Elias Rawish, Thomas Stiermaier, Francesco Santoro, Natale D. Brunetti and Ingo Eitel

J. Clin. Med. 2021, 10(3), 479; https://doi.org/10.3390/jcm10030479 - 28 Jan 2021

Cited by 28 | Viewed by 6124

Abstract

First recognized in 1990, takotsubo syndrome (TTS) constitutes an acute cardiac condition that mimics acute myocardial infarction commonly in the absence of obstructive coronary artery disease; it is characterized by temporary left ventricular dysfunction, regularly in a circumferential apical, midventricular, or basal distribution. Considering its acute clinical presentation, coronary angiography with left ventriculography constitutes the gold standard diagnostic tool to exclude or confirm TTS. Frequently, TTS is related to severe emotional or physical stress and a subsequent increased adrenergic stimulation affecting cardiac function. Beyond clinical presentation, epidemiology, and novel diagnostic biomarkers, this review draws attention to potential pathophysiological mechanisms for the observed reversible myocardial dysfunction such as sympathetic overdrive-mediated multi-vessel epicardial spasms, microvascular dysfunction, the direct toxicity of catecholamines, lipotoxicity, and inflammation. Considering the long-term prognosis, further experimental and clinical research is indispensable to elucidate further pathophysiological mechanisms underlying TTS before randomized control trials with evidence-based therapeutic management can be performed. Full article

(This article belongs to the Special Issue Takotsubo Syndrome)

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9 pages, 890 KiB

Open AccessReview

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 2—Treatment and Prognosis

by Francesco Santoro, Adriana Mallardi, Alessandra Leopizzi, Enrica Vitale, Elias Rawish, Thomas Stiermaier, Ingo Eitel and Natale D. Brunetti

J. Clin. Med. 2021, 10(3), 468; https://doi.org/10.3390/jcm10030468 - 26 Jan 2021

Cited by 20 | Viewed by 4000

Abstract

Takotsubo syndrome (TTS) represents a form of acute heart failure featured by reversible left ventricular systolic dysfunction. The management during the acute phase is mainly performed with supportive pharmacological (diuretics, ACE-inhibitors/angiotensin-receptor blockers (ARBs), anticoagulants, antiarrhythmics, non-catecholamine inotropics (levosimendan), and non-pharmacological (mechanical circulatory and respiratory support) therapy, due to the wide clinical presentation and course of the disease. However, there is a gap in evidence and there are no randomized and adequately powered studies on clinical effectiveness of therapeutic approaches. Some evidence supports the use ACE-inhibitors/ARBs at long-term. A tailored approach based on cardiovascular and non-cardiovascular risk factors is strongly suggested for long-term management. The urgent need for evidence-based treatment approaches is also reflected by the prognosis following TTS. The acute phase of the disease can be accompanied by various cardiovascular complications. In addition, long term outcome of TTS patients is also related to non-cardiovascular comorbidities. Physical triggers such as hypoxia and acute neurological disorders in TTS are associated with a poor outcome. Full article

(This article belongs to the Special Issue Takotsubo Syndrome)

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