Our clinical experience and case series of Takotsubo cardiomyopathy

Yıl 2023, Cilt: 16 Sayı: 1, 149 - 155, 31.01.2023

Abdi Sağcan Mustafa Zungur Murat Mustafa Tumuklu S. Hamed Moghanchi Zadeh

https://doi.org/10.31362/patd.1117425

Öz

Objective: In this study we aimed to evaluate the clinical course and prognosis of Takotsubo Cardiomyopathy cases diagnosed and treated in our clinic.
Cases: Takotsubo Cardiomyopathy was first described in 1990 by Dote et al. The reason why it is called Tako-tsubo cardiomyopathy; This is due to the appearance of the left ventricle resembling the narrow-necked, broad-bottomed container used by Japanese fishermen to catch octopuses. In addition to Takotsubo cardiomyopathy, this syndrome is also called ampulla cardiomyopathy, Human stress cardiomyopathy and Broken heart syndrome. In this study, a series of 7 cases of Takotsubo Cardiomyopathy diagnosed and treated in our clinic are presented and the clinical course and prognosis of the disease are examined.
Results: The age range of the series, consisting of six female and one male patients, ranged from 57 to 81 years (median age 70). All of the female patients were in the postmenopausal period and physical or emotional stress was found in four of them. Moderate-to-moderate cardiac enzyme elevation was found in all of the patients. While noncritical plaques were detected in the angiography of six patients who underwent coronary angiography and ventriculography, one patient had normal coronaries. During the follow-up, in-hospital death due to non-cardiac causes (Acute Myeloblastic Leukemia) was observed in one of the patients. In the echocardiographic follow-up of six surviving patients, it was observed that the LV ejection fraction was normalized and ballooning regressed within two months.
Conclusion: The awareness of Takotsubo Cardiomyopathy among cardiology physicians in the world and in our country is increasing. However, information about its prevalence, clinical course and short-term prognosis in our country is insufficient. In the study, a new series was presented in addition to the first data of our country. It is thought that there may be some different physical risk factors that have not yet been identified.

Anahtar Kelimeler

Acute myocardial infarction, emotinal stress, takotsubo cardiomyopathy

Takotsubo kardiyomiyopati üzerine klinik deneyimimiz ve vaka serimiz

Öz

Amaç: Bu çalışmada kliniğimizde teşhis ve tedavi edilen Takotsubo Kardiyomiyopati olgularının klinik seyrini ve prognozunu değerlendirmeyi amaçladık.
Vakalar: Takotsubo Kardiyomiyopati ilk olarak 1990 yılında Dote ve ark. Tako-tsubo kardiyomiyopati olarak adlandırılmasının nedeni; sol ventrikülün görünüşünün, Japon balıkçılarının ahtapot yakalamak için kullandığı dar boyunlu, geniş tabanlı kaba benzemesinden dolayıdır. Bu sendroma Takotsubo kardiyomiyopatisinin yanı sıra ampulla kardiyomiyopatisi, insan stres kardiyomiyopatisi ve kırık kalp sendromu da denir. Bu çalışmada kliniğimizde teşhis ve tedavi edilen 7 Takotsubo Kardiyomiyopati olgusu sunulmakta ve hastalığın klinik seyri ve prognozu incelenmektedir.
Bulgular: Altı kadın ve bir erkek hastadan oluşan serinin yaş aralığı 57 ile 81 yıl (ortalama yaş 70) arasında değişmekteydi. Kadın hastaların tamamı postmenopozal dönemdeydi ve dördünde fiziksel veya emosyonel stres saptandı. Tüm hastalarda orta-orta düzeyde kardiyak enzim yüksekliği saptandı. Koroner anjiyografi ve ventrikülografi yapılan altı hastanın anjiyografisinde kritik olmayan plaklar tespit edilirken, bir hastada koroner arterler normaldi. Takiplerde hastalardan birinde kalp dışı nedenlere bağlı hastane içi ölüm (Akut Miyeloblastik Lösemi) gözlendi. Yaşayan altı hastanın ekokardiyografik takibinde iki ay içinde LV ejeksiyon fraksiyonunun normale döndüğü ve balonlaşmanın gerilediği görüldü.
Sonuç: Dünyada ve ülkemizde kardiyoloji hekimleri arasında Takotsubo Kardiyomiyopati farkındalığı giderek artmaktadır. Ancak ülkemizde prevalansı, klinik seyri ve kısa dönem prognozu ile ilgili bilgiler yetersizdir. Çalışmada ülkemizin ilk verilerine ek olarak yeni bir seri sunulmuştur. Henüz tanımlanmamış bazı farklı fiziksel risk faktörlerinin olabileceği düşünülmektedir.

Anahtar Kelimeler

Akut miyokard enfarktüsü, duygusal stres, takotsubo kardiyomiyopati

Kaynakça

• 1. Giancarla Scalone, Giampaolo Niccoli , Filippo Crea. Editor's Choice- Pathophysiology, diagnosis and management of MINOCA: an update. Eur Heart J Acute Cardiovasc Care 2019 ;8:54-62. PMID:29952633
• 2. Shimizu M, Kato Y, Masai H, Shima T, Miwa Y. Recurrent episodes of takotsubo-like transient left ventricular ballooning occurring in different regions: a case report.J Cardiol 2006;48:101-7. PMID:16948453
• 3. Bybee KA, Kara T, Prasad A, Lerman A, BarsnessGW, Wright RS, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Int Med 2004;141:858–65.PMID:15583228
• 4. Prasad A. Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation 2007;115:e56–e59.PMID:17283269 5. Sadamatsu K, Tashiro H, Maehira N, Yamamoto K. Coronary microvasculer abnormality in the reversible systolic dysfunction observed after non cardiac disease. Jpn Circ J 2000;64:789-92.PMID:11059622
• 6. Akashi Y, Nakazawa K, Sakakibara M, Miyake F, Koike H, Sasaka K, et al. The clinical features of takotsubo cadiomyopathy. QJMed 2003:96:563-73. PMID:12897341
• 7. Peripheral Arterial Embolism due to Takotsubo Cardiomyopathy.Ali Kemal Gür, Esra Eker, Arzu Esen Tekeli .Journal of the Society of Anesthesia and Intensive Care 2018;24.183-86. DOI: 10.5222/GKDAD.2018.38039
• 8. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008;155:408–17.PMID:18294473
• 9. Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004;94:343-6.PMID:15276100
• 10. Pernicova I, Garg S, Bourantas CV, Alamgir F, Hoye A. Takotsubo cardiomyopathy: a review of the literature. Angiology 2010;61:166-73. PMID:19625263
• 11. Zekeriya Küçükdurmaz, Hekim Karapınar, Mehmet Burhan Oflaz, İbrahim Gül, Gülay Aydın, Hakan Güneş, Ahmet Yılmaz Our clinical experience of Takotsubo cardiomyopathy and the first case series from Turkey Türk Kardiyol Dern Arş – Arch Turk Soc Cardiol 2013;41:212-17. PMID:23703556
• 12. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006;27:1523-9. PMID:16720686
• 13. Maekawa Y, Kawamura A, Yuasa S, Nesto RW, Fukuda K. Direct comparison of Takotsubo cardiomyopathy between Japan and USA: 3-year follow-up study. Intern Med 2012;51:257-62. PMID:22293799
• 14. Nault M, Baranchuk A, Simpson C, Redfearn D. Takotsubo cardiomyopathy: a novel “proarrhythmic” disease-Case report . Anatol J Cardiol 2007:7(Suppl 1):101-3. PMID:17584696
• 15. Stollberger C, Finsterer J, Schneider B. Tako-tsubo-like left ventricular dysfunction: clinical presentation, instrumental findings, additional cardiac and noncardiac diseases and potential pathomechanisms. Minerva Cardioangiol 2005;53:139-45. PMID:15986008
• 16. Grégoire Albenque , Yohann Bohbot Quentin Delpierre , Christophe Tribouilloy. Basal Takotsubo syndrome with transient severe mitral regurgitation caused by drug use: a case report. Eur Heart J Case Rep 2020;4:1-6. PMID:32864562
• 17. Eshtehardi P, Koestner SC, Adorjan P, Windecker S, Meier B, Hess OM, et al. Transient apical ballooning syndrome-clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int J Cardiol 2009;135:370-5. PMID:18599137
• 18. Regnante RA, Zuzek RW, Weinsier SB, Latif SR, Linsky RA, Ahmed HN, et al. Clinical characteristics and four-year outcomes of patients in the Rhode Island Takotsubo Cardiomyopathy Registry. Am J Cardiol 2009;103:1015-9. PMID:19327433 19. Kodama S, Miyoshi K, Shiga Y, Maruyama S, Sumi S, Tojou H, et al. Takotsubo cardiomyopathy complicated by high-grade atrioventricular block: A report of two cases . Exp Clin Cardiol 2009;14:e35-8.PMID:19675818
• 20. Zeb M, Sambu N, Scott P, Curzen N. Takotsubo cardiomyopathy: a diagnostic challenge. Postgrad Med J 2011;87:51-9.PMID:21059600
• 21. Lipiecki J, Durel N, DecalfV, Soubeyrand P, Moisa A, Citron B, et al. Transient left ventricular apical ballooning or the tako-tsubo syndrome. Arch Mal CoeruVaiss 2005;98:275-80. PMID:15881841
• 22. Desmet W, Adriaenssens B, Dens J. Apikal balooning of the left ventricle: first series in white patients. Heart 2003;89:1027-31. PMID:12923018
• 23. Park JH, Kang SJ, Song JK, Kim HK, Lim CM, Kong DH, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005;128:296-02. PMID:16002949
• 24. Iván J Núñez-Gil , Oscar Vedia , Manuel Almendro-Delia , et al.Takotsubo syndrome and cancer, clinical and prognostic implications, insights of RETAKO Med Clin (Barc) 2020 ;155:521-28. PMID:32430206