ktd

Kocatepe Tıp Dergisi

3061-9904

Afyonkarahisar Sağlık Bilimleri Üniversitesi

10.18229/kocatepetip.1122741

Clinical Sciences

Klinik Tıp Bilimleri

TAKOTSUBO SENDROMUNA GÜNCEL BİR BAKIŞ

A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME

https://orcid.org/0000-0001-7086-4988

Kılıccalan

Ibrahim

University of Health Sciences, Gulhane Faculty of Medicine

https://orcid.org/0000-0001-6634-7849

Gül

Sedat

KOCAELI UNIVERSITY, SCHOOL OF MEDICINE

10 21 2024

25 4 540 549 05 31 2022 09 05 2022

1999

Kocatepe Tıp Dergisi

Takotsubo sendromu, kalbin sol ventrikülünün geçici işlev bozukluğu ile karakterize akut, geri dönüşümlü bir hastalıktır. Takotsubo sendromunun patogenezi tam olarak bilinmemektedir. Ancak Takotsubo sendromununpatogenezi ile ilgili çeşitli hipotezler ileri sürülmüştür. Takotsubo sendromunun patogenezi ile ilgili hipotezler; koroner mikrovasküler disfonksiyon, koroner arter spazmı, katekolamin kaynaklı miyokardiyal sersemleme, akut koroner sendromdan sonrası reperfüzyon hasarı, miyokardiyal mikroinfarktüs, endotel disfonksiyonu ve östrojen eksikliği ve kardiyak yağ asidi metabolizmasındaki anormallikler şeklinde adlandırılabilir. Takotsubo sendromu ile ilgili hipotez ve teoriler arasında en sık olarak katekolamin kaynaklı kardiyotoksisite ve koroner mikrovasküler disfonksiyon üzerinde durulmaktadır. Takotsubo sendromu bazı klinik semptom ve bulgularla kendini gösterir. Takotsubo sendromunda, başvuru sırasında görülen semptomlar, en yaygından en aza doğru göğüs ağrısı, nefes darlığı ve senkoptur. Klinik olarak akut göğüs ağrısı ve nefes darlığı gibi şikayetlere neden olduğu için akut miyokard enfarktüsü veya akut koroner sendrom ile karıştırılabilir. Bu nedenle bu hastalıklardan ayırt edilmesi önemlidir. Ayırıcı tanıda anamnez, fizik muayene, kardiyak troponin, kreatin kinaz, troponin, elektrokardiyografi (EKG), koroner anjiyografi kullanılır. Takotsubo sendromunun ayırıcı tanısında fiziksel veya duygusal stresin varlığı önemli bir rol oynar. Takotsubo sendromu için spesifik bir tedavi yoktur. Ancak tedavi akut ve kronik dönemler olarak ikiye ayrılabilir. Akut dönemde Takotsubo sendromuna bağlı gelişen komplikasyonlara yönelik tedaviler uygulanırken, kronik dönemde beta blokerler, anjiyotensin dönüştürücü enzim (ACE) inhibitörleri, anjiyotensin II reseptör blokerleri gibi ilaçlar kullanılmaktadır. Takotsubo sendromu yoğun bakım hastalarında da görülebilmektedir. Yoğun bakım hastalarında sıklıkla hemodinamik bozukluklar ve solunum yetmezliği ile kendini gösterir. Bu nedenle yoğun bakım hastalarında hemodinamik ve solunumsal değişiklikler gözlendiğinde Takotsubo sendromu düşünülmeli ve hastalar bu yönde takip edilmelidir.

Takotsubo syndrome is an acute, reversible disease characterized by transient dysfunction of the left ventricle of the heart. The pathogenesis of Takotsubo syndrome is not known precisely. However, various hypotheses regarding pathogenesis have been put forward. These hypotheses; coronary microvascular dysfunction, coronary artery spasm, catecholamine-induced myocardial stunning, reperfusion injury after acute coronary syndrome, myocardial microinfarction, endothelial dysfunction and estrogen deficiency, and abnormalities in cardiac fatty acid metabolism. Among these hypotheses and theories, catecholamine-induced cardiotoxicity and coronary microvascular dysfunction are most frequently emphasized. Takotsubo syndrome manifests itself with some clinical symptoms and signs. In Takotsubo syndrome, symptoms seen at presentation are chest pain, shortness of breath, and syncope, from the most common to the least. Clinically, it can be confused with acute myocardial infarction or acute coronary syndrome because it causes complaints such as acute chest pain and shortness of breath. Therefore, it is important to differentiate from these diseases. Anamnesis, physical examination, cardiac troponin, creatine kinase, troponin, electrocardiography (ECG), coronary angiography are used in the differential diagnosis. The presence of physical or emotional stress plays an important role in the differential diagnosis of Takotsubo syndrome. There is no specific treatment for Takotsubo syndrome. However, treatment can be divided into two parts as acute and chronic phases. While treatments for complications arising due to Takotsubo syndrome are applied in the acute phase, drugs such as beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers are used in the chronic phase. Takotsubo syndrome can also be seen in intensive care patients. In intensive care patients, it often manifests itself with hemodynamic disturbances and respiratory failure. Therefore, Takotsubo syndrome should be considered in intensive care patients when hemodynamic and respiratory changes are observed and patients should be followed up in this direction.

Takotsubo syndrome Intensive care Stress Acute Disease.

Takotsubo Sendromu Yoğun Bakım Stres Akut Hastalık.

1. Ansari U, El-Battrawy I, Fastner C, et al. Clinical outcomes associated with catecholamine use in patients diagnosed with Takotsubo cardiomyopathy. BMC Cardiovascular Disorders. 2018;20(18):54.

2. Pelliccia F, Kaski JC, Crea F, et al. Pathophysiology of Takotsubo Syndrome. Circulation. 2017;135(24):2426– 41.

3. Hurst RT, Prasad A, Askew JW, et al. Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 2010;3(6):641–9.

4. Medeiros K, O’Connor MJ, Baicu CF, et al. Systolic and diastolic mechanics in stress cardiomyopathy. Circulation. 2014;22(16):1659–67.

5. Prasad A. Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation. 2007;115(5):56-9.

6. Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16.

7. Haghi D, Athanasiadis A, Papavassiliu T, et al. Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J. 2006;27(20):2433–9.

8. Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007;132(3):809–16.

9. Ennezat PV, Rossi DP, Aubert JM, et al. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005;22(7):599–602.

10. Van de Walle SOA, Gevaert SA, Gheeraert PJ, et al. Transient stress-induced cardiomyopathy with an ‘inverted takotsubo’ contractile pattern. Mayo Clin Proc. 2006;81(11):1499–502.

11. Cacciotti L, Camastra GS, Beni S, et al. A new variant of Tako-tsubo cardiomyopathy: transient mid- ventricular ballooning. J Cardiovasc Med (Hagerstown). 2007;8(12):1052–4.

12. Veillet-Chowdhury M, Hassan SF, Stergiopoulos K. Takotsubo cardiomyopathy: A review. Acute Cardiac Care. 2014;16(1):15–22.

13. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. American Heart Journal. 2008;155(3):408–17.

14. Doyen D, Moschietto S, Squara F, et al. Incidence, clinical features and outcome of Takotsubo syndrome in the intensive care unit. Archives of Cardiovascular Diseases. 2020;113(3):176–88.

15. Sharkey SW, Maron BJ. Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy. Circ J. 2014;78(9):2119–28.

16. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929–38.

17. Minhas AS, Hughey AB, Kolias TJ. Nationwide Trends in Reported Incidence of Takotsubo Cardiomyopathy from 2006 to 2012. The American Journal of Cardiology. 2015;116(7):1128–31.

18. Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12(7):387–97.

19. Y-Hassan S. Clinical Features and Outcome of Pheochromocytoma-Induced Takotsubo Syndrome: Analysis of 80 Published Cases. The American Journal of Cardiology. 2016;117(11):1836–44.

20. De Angelis F, Savino K, Oliva V, et al. Over the exceptions: Psychiatric disorder, medical stress, and takotsubo cardiomyopathy. J Cardiovasc Echography. 2017;27(2):66.

21. Ashfaq A, Ullah W, Khanal S, et al. Takotsubo cardiomyopathy: a rare complication of acute viral gastroenteritis. Journal of Community Hospital Internal Medicine Perspectives. 2020;10(3):258–61.

22. Muratsu A, Muroya T, Kuwagata Y. Takotsubo cardiomyopathy in the intensive care unit. Acute Med Surg. 2019;6(2):152–7.

23. Park J-H, Kang S-J, Song J-K, et al. Left Ventricular Apical Ballooning Due to Severe Physical Stress in Patients Admitted to the Medical ICU. Chest. 2005;128(1):296–302.

24. Rowell AC, Stedman WG, Janin PF, et al. Silent left ventricular apical ballooning and Takotsubo cardiomyopathy in an Australian intensive care unit. ESC Heart Failure. 2019;6(6):1262–5.

25. Oras J, Lundgren J, Redfors B, et al. Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit - a retrospective study. Acta Anaesthesiol Scand. 2017;61(8):914–24.

26. Salah HM, Mehta JL. Takotsubo cardiomyopathy and COVID-19 infection. European Heart Journal - Cardiovascular Imaging. 2020;21(11):1299–300.

27. Shah RM, Shah M, Shah S, et al. Takotsubo Syndrome and COVID-19: Associations and Implications. Current Problems in Cardiology. 2021;46(3):100763.

28. Dweck MR, Bularga A, Hahn RT, et al. Global evaluation of echocardiography in patients with COVID-19. European Heart Journal - Cardiovascular Imaging. 2020;21(9):949–58.

29. Giustino G, Croft LB, Oates CP, et al. Takotsubo Cardiomyopathy in COVID-19. Journal of the American College of Cardiology. 2020;76(5):628–9.

30. Bathina J, Weiss S, Weintraub WS. Understanding the pathophysiology of apical ballooning syndrome: a step closer. Expert Rev Cardiovasc Ther. 2015;13(1):5–8.

31. Komamura K, Fukui M, Iwasaku T, et al. Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment. World J Cardiol. 2014;6(7):602–9.

32. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol. 2001;38(1):11–8.

33. Lyon AR, Rees PSC, Prasad S, et al. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5(1):22–9.

34. Abe Y, Kondo M, Matsuoka R, et al. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003;41(5):737–42.

35. Abe Y, Kondo M. Apical ballooning of the left ventricle: a distinct entity? Heart. 2003;89(9):974–6.

36. Akashi YJ, Nakazawa K, Sakakibara M, et al. 123I-MIBG myocardial scintigraphy in patients with ‘takotsubo’ cardiomyopathy. J Nucl Med. 2004;45(7):1121–7.

37. Wittstein IS, Thiemann DR, Lima JAC, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352(6):539–48.

38. Abraham J, Mudd JO, Kapur NK, et al. Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol. 2009;53(15):1320–5.

39. Marcovitz PA, Czako P, Rosenblatt S, et al. Pheochromocytoma presenting with Takotsubo syndrome. J Interv Cardiol. 2010;23(5):437–42.

40. Vitale C, Rosano GMC, Kaski JC. Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy. Circ J. 2016;80(2):299–305.

41. Camici PG, Crea F. Microvascular angina: a women’s affair? Circ Cardiovasc Imaging. 2015;8(4):e003252.

42. Vitale C, Mendelsohn ME, Rosano GMC. Gender differences in the cardiovascular effect of sex hormones. Nat Rev Cardiol. 2009;6(8):532–42.

43. Kaski JC. Cardiac syndrome X in women: the role of oestrogen deficiency. Heart. 2006;92(3):5–9.

44. Ueyama T, Ishikura F, Matsuda A, et al. Chronic estrogen supplementation following ovariectomy improves the emotional stress-induced cardiovascular responses by indirect action on the nervous system and by direct action on the heart. Circ J. 2007;71(4):565–73.

45. Kurisu S, Inoue I, Kawagoe T, et al. Prevalence of incidental coronary artery disease in tako-tsubo cardiomyopathy. Coron Artery Dis. 2009;20(3):214–8.

46. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol. 2004;94(3):343–6.

47. Akashi YJ, Nakazawa K, Sakakibara M, et al. The clinical features of takotsubo cardiomyopathy. QJM. 2003;96(8):563–73.

48. Ono R, Falcão LM. Takotsubo cardiomyopathy systematic review: Pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy. International Journal of Cardiology. 2016;209:196–205.

49. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005;111(4):472–9.

50. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. NEJM. 2015;373(10):929-38.

51. Bybee KA, Kara T, Prasad A, et al. Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction. Ann Intern Med. 2004;141(11):858–65.

52. Gianni M, Dentali F, Grandi AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006;27(13):1523–9.

53. Kurisu S, Kihara Y. Tako-tsubo cardiomyopathy: Clinical presentation and underlying mechanism. Journal of Cardiology. 2012;60(6):429–37.

54. Yamasa T, Ikeda S, Ninomiya A, et al. Characteristic clinical findings of reversible left ventricular dysfunction. Intern Med. 2002;41(10):789–92.

55. Elesber AA, Prasad A, Bybee KA, et al. Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement. J Am Coll Cardiol. 2006;47(5):1082–3.

56. Haghi D, Fluechter S, Suselbeck T, et al. Takotsubo Cardiomyopathy (Acute Left Ventricular Apical Ballooning Syndrome) Occurring in the Intensive Care Unit. Intensive Care Med. 2006;32(7):1069–74.

57. Gomez JMD, Nair G, Nanavaty P, et al. COVID-19-associated takotsubo cardiomyopathy. BMJ Case Rep. 2020;13(12):e236811.

58. Madias C, Fitzgibbons TP, Alsheikh-Ali AA, et al. Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm. 2011;8(4):555–61.

59. Nguyen TH, Neil CJ, Sverdlov AL, et al. N-Terminal Pro-Brain Natriuretic Protein Levels in Takotsubo Cardiomyopathy. The American Journal of Cardiology. 2011;108(9):1316–21.

60. Conte J, Yoo MJ, Larson NP. Seizure-Associated Takotsubo Cardiomyopathy. Cureus. 2020 Sep 22; [accessed 17 Mar 2021] Available from: https://www.cureus.com/articles/38176-seizure-associated- takotsubo-cardiomyopathy.

61. Rodríguez M, Rzechorzek W, Herzog E, et al. Misconceptions and Facts About Takotsubo Syndrome. The American Journal of Medicine. 2019;132(1):25–31.

62. Finsterer J, Bersano A. Seizure-triggered Takotsubo syndrome rarely causes SUDEP. Seizure. 2015;31:84–7.

63. Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz. 2010;35(4):240–4.

64. Redfors B, Shao Y, Lyon AR, et al. Diagnostic criteria for takotsubo syndrome: A call for consensus. International Journal of Cardiology. 2014;176(1):274–6.

65. Parodi G, Citro R, Bellandi B, et al. Revised clinical diagnostic criteria for Tako-tsubo syndrome: The Tako- tsubo Italian Network proposal. International Journal of Cardiology. 2014;172(1):282–3.

66. Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 2011;306(3):277–86.

67. Kato K, Lyon AR, Ghadri J-R, et al. Takotsubo syndrome: aetiology, presentation and treatment. Heart. 2017;103(18):1461–9.

68. Amin HZ, Amin LZ, Pradipta A. Takotsubo Cardiomyopathy: A Brief Review. J Med Life. 2020;13(1):3–7.

69. Citro R, Rigo F, D’Andrea A, et al. Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy. JACC: Cardiovascular Imaging. 2014;7(2):119–29.

70. Medina de Chazal H, Del Buono MG, Keyser-Marcus L, et al. Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2018;72(16):1955–71.

71. Milinis K, Fisher M. Takotsubo cardiomyopathy: pathophysiology and treatment. Postgraduate Medical Journal. 2012;88(1043):530–8.

72. Yoshioka T, Hashimoto A, Tsuchihashi K, et al. Clinical implications of midventricular obstruction and intravenous propranolol use in transient left ventricular apical ballooning (Tako-tsubo cardiomyopathy). Am Heart J. 2008;155(3):526.e1-7.

73. De Santis V, Vitale D, Tritapepe L, et al. Use of levosimendan for cardiogenic shock in a patient with the apical ballooning syndrome. Ann Intern Med. 2008;149(5):365–7.

74. Intractable cardiogenic shock in stress cardiomyopathy with left ventricular outflow tract obstruction: is extra‐corporeal life support the best treatment? - Bonacchi - European Journal of Heart Failure - Wiley Online Library (2009). Available from: https://onlinelibrary.wiley.com/doi/full/10.1093/eurjhf/hfp068 (accessed 31 Jan 2021).

75. Isogai T, Matsui H, Tanaka H, et al. Early β-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy. Heart. 2016;102(13):1029–35.

76. Kurisu S, Inoue I, Kawagoe T, et al. Incidence and treatment of left ventricular apical thrombosis in Tako- tsubo cardiomyopathy. International Journal of Cardiology. 2011;146(3):e58–60.

77. Bietry R, Reyentovich A, Katz S. Clinical Management of Takotsubo Cardiomyopathy. Heart failure clinics. 2013;9:177–86.

78. Kurisu S, Kihara Y. Clinical management of takotsubo cardiomyopathy. Circ J. 2014;78(7):1559–66.

79. Santoro F, Ieva R, Musaico F, et al. Lack of efficacy of drug therapy in preventing takotsubo cardiomyopathy recurrence: a meta-analysis. Clin Cardiol. 2014;37(7):434–9.

80. Singh K, Carson K, Usmani Z, et al. Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy. Int J Cardiol. 2014;174(3):696–701.