Novel Imaging and Genetic Risk Markers in Takotsubo Syndrome.
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ABSTRACT:
SUBMITTER: Arcari L
PROVIDER: S-EPMC8415918 | biostudies-literature | 2021
REPOSITORIES: biostudies-literature
Publications
Novel Imaging and Genetic Risk Markers in Takotsubo Syndrome.
Arcari Luca L Limite Luca Rosario LR Adduci Carmen C Sclafani Matteo M Tini Giacomo G Palano Francesca F Cosentino Pietro P Cristiano Ernesto E Cacciotti Luca L Russo Domitilla D Rubattu Speranza S Volpe Massimo M Autore Camillo C Musumeci Maria Beatrice MB Francia Pietro P
Frontiers in cardiovascular medicine 20210817
Takotsubo syndrome (TTS) is an increasingly recognized condition burdened by significant acute and long-term adverse events. The availability of novel techniques expanded the knowledge on TTS and allowed a more accurate risk-stratification, potentially guiding clinical management. The present review aims to summarize the recent advances in TTS prognostic evaluation with a specific focus on novel imaging and genetic markers. Parametric deformation analysis by speckle-tracking echocardiography, as ...[more]
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Project description:Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9-14.8, HR = 7.8 95% CI 2.4-25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6-52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE.
| S-EPMC8368165 | biostudies-literature
Project description:Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, with a hospital-mortality rate similar to acute coronary syndrome (ACS). However, the aetiology of TTS is still unknown. In the present study, a multivariate pattern analysis using machine learning with multimodal magnetic resonance imaging (MRI) data of the human brain of TTS patients and age- and gender-matched healthy control subjects was performed. We found consistent structural and functional alterations in TTS patients compared to the control group. In particular, anatomical and neurophysiological measures from brain regions constituting the emotional-autonomic control system contributed to a prediction accuracy of more than 82%. Thus, our findings demonstrate homogeneous neuronal alterations in TTS patients and substantiate the importance of the concept of a brain-heart interaction in TTS.
| S-EPMC5511237 | biostudies-literature
Project description:BackgroundTakotsubo syndrome is an acute cardiac emergency characterized by transient left ventricular systolic dysfunction typically following a stressful event. Despite its rapidly rising incidence, its pathophysiology remains poorly understood. Takotsubo syndrome may pass unrecognized, especially if timely diagnostic imaging is not performed. Defective myocardial calcium homeostasis is a central cause of contractile dysfunction and has not been explored in takotsubo syndrome. We aimed to investigate myocardial calcium handling using manganese-enhanced magnetic resonance imaging during the acute and recovery phases of takotsubo syndrome.MethodsTwenty patients with takotsubo syndrome (63±12 years of age; 90% female) and 20 volunteers matched on age, sex, and cardiovascular risk factors (59±11 years of age; 70% female) were recruited from the Edinburgh Heart Centre between March 2020 and October 2021. Patients underwent gadolinium and manganese-enhanced magnetic resonance imaging during index hospitalization with repeat manganese-enhanced magnetic resonance imaging performed after at least 3 months.ResultsCompared with matched control volunteers, patients had a reduced left ventricular ejection fraction (51±11 versus 67±8%; P<0.001), increased left ventricular mass (86±11 versus 57±14 g/m2; P<0.001), and, in affected myocardial segments, elevated native T1 (1358±49 versus 1211±28 ms; P<0.001) and T2 (60±7 versus 38±3 ms; P<0.0001) values at their index presentation. During manganese-enhanced imaging, kinetic modeling demonstrated a substantial reduction in myocardial manganese uptake (5.1±0.5 versus 8.2±1.1 mL/[100 g of tissue ·min], respectively; P<0.0001), consistent with markedly abnormal myocardial calcium handling. After recovery, left ejection fraction, left ventricular mass, and T2 values were comparable with those of matched control volunteers. Despite this, native and postmanganese T1 and myocardial manganese uptake remained abnormal compared with matched control volunteers (6.6±0.5 versus 8.2±1.1 mL/[100 g of tissue ·min]; P<0.0001).ConclusionsIn patients with takotsubo syndrome, there is a profound perturbation of myocardial manganese uptake, which is most marked in the acute phase but persists for at least 3 months despite apparent restoration of normal left ventricular ejection fraction and resolution of myocardial edema, suggesting abnormal myocardial calcium handling may be implicated in the pathophysiology of takotsubo syndrome. Manganese-enhanced magnetic resonance imaging has major potential to assist in the diagnosis, characterization, and risk stratification of patients with takotsubo syndrome.RegistrationURL: https://www.Clinicaltrialsgov; Unique identifier: NCT04623788.
| S-EPMC7613919 | biostudies-literature
Project description:BackgroundEthnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes.MethodsTTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients.ResultsA total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients.ConclusionDifferences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.Trial registrationURL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01947621.
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Project description:BackgroundTakotsubo syndrome (TTS) causes angina with ventricular dysfunction that can mimic acute coronary syndrome. Normal coronary angiography leads to cardiovascular magnetic resonance imaging (CMR) in the diagnostic pathway. Historically, TTS was thought to be associated with the absence of late gadolinium enhancement on CMR. This case report highlights the presence of late gadolinium enhancement in a case of TTS while demonstrating the other characteristic findings, including quantitative parametric T1/T2 mapping.Case summaryA 69-year-old lady was admitted with chest pain and shortness of breath. She was found to have classical TTS with the characteristic wall motion abnormalities on echocardiogram, left ventricular angiogram, and CMR. Her CMR also demonstrated strongly positive myocardial T1/T2 mapping that matched the wall motion abnormalities and the less frequently described positive early and late gadolinium enhancement.DiscussionThis case highlights the diagnostic pathway in TTS and the ability of CMR to make a diagnosis in myocardial infarction with non-obstructed coronary arteries. We describe the characteristic cardiac imaging features of TTS while discussing the positive late gadolinium enhancement patterns that may help confirm the diagnosis.
| S-EPMC10903182 | biostudies-literature
Project description:Takotsubo syndrome (TTS), recognized as stress's cardiomyopathy, or as left ventricular apical balloon syndrome in recent years, is a rare pathology, described for the first time by Japanese researchers in 1990. TTS is characterized by an interindividual heterogeneity in onset and progression, and by strong predominance in postmenopausal women. The clear causes of these TTS features are uncertain, given the limited understanding of this intriguing syndrome until now. However, the increasing frequency of TTS cases in recent years, and particularly correlated to the SARS-CoV-2 pandemic, leads us to the imperative necessity both of a complete knowledge of TTS pathophysiology for identifying biomarkers facilitating its management, and of targets for specific and effective treatments. The suspect of a genetic basis in TTS pathogenesis has been evidenced. Accordingly, familial forms of TTS have been described. However, a systematic and comprehensive characterization of the genetic or epigenetic factors significantly associated with TTS is lacking. Thus, we here conducted a systematic review of the literature before June 2021, to contribute to the identification of potential genetic and epigenetic factors associated with TTS. Interesting data were evidenced, but few in number and with diverse limitations. Consequently, we concluded that further work is needed to address the gaps discussed, and clear evidence may arrive by using multi-omics investigations.
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Project description: Not available
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Project description:Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic. Case summary: A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 μg/kg/min). Troponin T was elevated (637 ng/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal. Conclusion: Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19.
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Project description:AimsAtrial fibrillation (AF) is associated with adverse outcome. Whether recently discovered genetic risk markers improve AF risk prediction is unknown.Methods and resultsWe derived and validated a novel AF risk prediction model from 32 possible predictors in the Women's Health Study (WHS), a cohort of 20 822 women without cardiovascular disease (CVD) at baseline followed prospectively for incident AF (median: 14.5 years). We then created a genetic risk score (GRS) comprised of 12 risk alleles in nine loci and assessed model performance in the validation cohort with and without the GRS. The newly derived WHS AF risk algorithm included terms for age, weight, height, systolic blood pressure, alcohol use, and smoking (current and past). In the validation cohort, this model was well calibrated with good discrimination [C-index (95% CI) = 0.718 (0.684-0.753)] and improved all reclassification indices when compared with age alone. The addition of the genetic score to the WHS AF risk algorithm model improved the C-index [0.741 (0.709-0.774); P = 0.001], the category-less net reclassification [0.490 (0.301-0.670); P < 0.0001], and the integrated discrimination improvement [0.00526 (0.0033-0.0076); P < 0.0001]. However, there was no improvement in net reclassification into 10-year risk categories of <1, 1-5, and 5+% [0.041 (-0.044-0.12); P = 0.33].ConclusionAmong women without CVD, a simple risk prediction model utilizing readily available risk markers identified women at higher risk for AF. The addition of genetic information resulted in modest improvements in predictive accuracy that did not translate into improved reclassification into discrete AF risk categories.
| S-EPMC3730133 | biostudies-literature
Project description:BackgroundTakotsubo syndrome (TTS) is a multifactorial disease contributed to by several pathological factors. It is characterized by transient left ventricular dysfunction, and patients with TTS can spontaneously recover within days or weeks. This study's objective was to investigate the ultrasonic characteristics of TTS during different periods and assess the clinical application value of real-time 3-dimensional echocardiography (RT-3DE) and speckle tracking imaging (STI) in TTS.MethodsIn this prospective cohort study, the patients with apical TTS were evaluated by echocardiography on admission (within 1-3 days) and after 4 and 8 weeks. RT-3DE was performed to observe the structure and function of the left ventricle (LV). LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV), and ejection fraction (LVEF) were calculated. The longitudinal peak systolic strain (LPSS) of all LV myocardial segments was acquired by 2D STI. For comparison, 20 healthy individuals were included as normal controls.ResultsA total of 16 patients with TTS were included. Their LV was characterized as an "octopus pot" in morphology with obvious hypokinesis on admission. The LVEDV, LVESV, LVSV, and LVEF were 84.23±10.67, 55.94±8.51, 28.31±8.06 mL, and 33.59%±4.12%, respectively, in patients with TTS on admission with a significant difference from those of the controls (P=0.005, P<0.001, P<0.001, and P<0.001, respectively). A definite improvement was found upon follow-up, with these parameters even returning to normal morphology after 8 weeks. The LVEDV, LVESV, LVSV, and LVEF were 75.79±6.86, 28.05±4.33, 47.81±3.57 mL, and 63.02%±3.92%, respectively, in TTS patients after 8 weeks with no significant difference from those of the controls (P=0.907, P=0.235, P=0.162, and P=0.052, respectively). A significant decrease in LPSS was also found in patients with TTS on admission. In the eighth week of follow-up, the LPSS of the apical and middle segments in TTS patients remained significantly decreased compared with that of the normal controls (-18.54%±4.69% vs. -24.29%±3.46%, P<0.001; -19.38%±2.88% vs. -22.36%±3.23%, P<0.001), but that of the basal segments in TTS patients returned to normal and there was no significant differences from the normal controls (-20.75%±2.91% vs. -21.51%±2.85%; P=0.055).ConclusionsRT-3DE and STI played an indispensable role in visually and quantitatively inspecting the abnormalities of patients with TTS, including in diagnosis and follow-up.
| S-EPMC10006141 | biostudies-literature