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      Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy

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          Abstract

          Supplemental Digital Content is available in the text.

          Abstract

          Background:

          Takotsubo cardiomyopathy is an increasingly recognized acute heart failure syndrome precipitated by intense emotional stress. Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction, the long-term clinical and functional consequences of takotsubo cardiomyopathy are ill-defined.

          Methods:

          In an observational case-control study, we recruited 37 patients with prior (>12-month) takotsubo cardiomyopathy, and 37 age-, sex-, and comorbidity-matched control subjects. Patients completed the Minnesota Living with Heart Failure Questionnaire. All participants underwent detailed clinical phenotypic characterization, including serum biomarker analysis, cardiopulmonary exercise testing, echocardiography, and cardiac magnetic resonance including cardiac 31P-spectroscopy.

          Results:

          Participants were predominantly middle-age (64±11 years) women (97%). Although takotsubo cardiomyopathy occurred 20 (range 13–39) months before the study, the majority (88%) of patients had persisting symptoms compatible with heart failure (median of 13 [range 0–76] in the Minnesota Living with Heart Failure Questionnaire) and cardiac limitation on exercise testing (reduced peak oxygen consumption, 24±1.3 versus 31±1.3 mL/kg/min, P<0.001; increased VE/V co 2 slope, 31±1 versus 26±1, P=0.002). Despite normal left ventricular ejection fraction and serum biomarkers, patients with prior takotsubo cardiomyopathy had impaired cardiac deformation indices (reduced apical circumferential strain, −16±1.0 versus −23±1.5%, P<0.001; global longitudinal strain, −17±1 versus −20±1%, P=0.006), increased native T1 mapping values (1264±10 versus 1184±10 ms, P<0.001), and impaired cardiac energetic status (phosphocreatine/γ-adenosine triphosphate ratio, 1.3±0.1 versus 1.9±0.1, P<0.001).

          Conclusions:

          In contrast to previous perceptions, takotsubo cardiomyopathy has long-lasting clinical consequences, including demonstrable symptomatic and functional impairment associated with persistent subclinical cardiac dysfunction. Taken together our findings demonstrate that after takotsubo cardiomyopathy, patients develop a persistent, long-term heart failure phenotype.

          Clinical Trial Registration:

          URL: https://clinicaltrials.gov. Unique identifier: NCT02989454.

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          Most cited references33

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          2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

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            Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

            New England Journal of Medicine, 373(10), 929-938
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              Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.

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                Author and article information

                Journal
                Circulation
                Circulation
                CIR
                Circulation
                Lippincott Williams & Wilkins
                0009-7322
                1524-4539
                6 March 2018
                05 March 2018
                : 137
                : 10
                : 1039-1048
                Affiliations
                [1 ]1 Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.).
                [2 ]2 Department of Biomathematics and Statistics Scotland, Aberdeen, United Kingdom (G.H.).
                [3 ]3 Department of Cardiovascular Sciences, University of Edinburgh, United Kingdom (D.E.N.).
                [4 ]4 Department of Biomedical Imaging, University of Greifswald, Germany (A.H.).
                Author notes
                Caroline Scally, MBChB, Department of Cardiovascular Medicine, University of Aberdeen, Polwarth Bldg, Foresterhill, Aberdeen, United Kingdom. E-mail carolinescally@ 123456abdn.ac.uk
                Article
                00008
                10.1161/CIRCULATIONAHA.117.031841
                5841855
                29128863
                bfb58738-8033-483d-9af5-d799a1b234b1
                © 2017 The Authors.

                Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.

                History
                : 22 September 2017
                : 23 October 2017
                Categories
                10090
                10094
                Original Research Articles
                Custom metadata
                TRUE

                broken heart syndrome,cardiac energetics,cardiopulmonary exercise testing,stress-induced cardiomyopathy,takotsubo

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