Cardiology Multiple Choice Questions: Volume 2Available at Amazon Kindle Store

Long term sequelae of takotsubo cardiomyopathy

Long term sequelae of takotsubo cardiomyopathy

Generally everyone thinks of takotsubo cardiomyopathy (stress cardiomyopathy or broken heart syndrome) as a cause of reversible left ventricular dysfunction in response to a major lifetime stress. Initial reports which caught attention were in elderly women who had lost their spouses and hence the term broken heart syndrome. As it involved the apical segments of the left ventricle, not conforming to any single vascular territory, another eponym was apical ballooning syndrome. Recent work has questioned the complete reversal of cardiac pathology in this condition [1,2,3], though left ventricular ejection fraction rapidly returns to normal. They have noted long term mortality comparable to that of myocardial infarction. Hence Caroline Scally and colleagues [4] in the current issue of Circulation, studied the long term functional and metabolic changes after stress cardiomyopathy. Thirty seven of their patients who had stress cardiomyopathy one year or more earlier completed the Minnesota Living with Heart Failure Questionnaire. They also underwent detailed clinical evaluation, biomarker estimation, echocardiography, cardiac magnetic resonance imaging and 31P magnetic resonance spectroscopy. They demonstrated long lasting symptomatic and functional impairment in cardiac status after takotsubo cardiomyopathy even though left ventricular ejection fraction improved. This would suggest persistent long term subclinical cardiac dysfunction.

References

  1. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929–938.
  2. Ghadri JR, Cammann VL, Napp LC, Jurisic S, Diekmann J, Bataiosu DR, Seifert B, Jaguszewski M, Sarcon A, Neumann CA, Geyer V, Prasad A, Bax JJ, Ruschitzka F, Lüscher TF, Templin C; International Takotsubo (InterTAK) Registry. Differences in the clinical profile and outcomes of typical and atypical takotsubo syndrome: data from the International Takotsubo Registry. JAMA Cardiol. 2016;1:335–340.
  3. Tornvall P, Collste O, Ehrenborg E, Järnbert-Petterson H. A case-control study of risk markers and mortality in takotsubo stress cardiomyopathy. J Am Coll Cardiol. 2016;67:1931–1936.
  4. Scally C, Rudd A, Mezincescu A, Wilson H, Srivanasan J, Horgan G, Broadhurst P, Newby DE, Henning A, Dawson DK. Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy. Circulation. 2018 Mar 6;137(10):1039-1048. doi: 10.1161/CIRCULATIONAHA.117.031841. Epub 2017 Nov 11.