International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

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Abstract

The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.

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Most cited references 120

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Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.

Scott W Sharkey, Denise Windenburg, John Lesser … (2010)

This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event. Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning. Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients. Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were 2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year. In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male,

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Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan.

K Tsuchihashi, K. Ueshima, T Uchida … (2001)

To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study. Only several case presentations have been reported with regard to this syndrome. We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies. Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 months, two patients showed recurrence, and one died suddenly. A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.

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Four-year recurrence rate and prognosis of the apical ballooning syndrome.

Ahmad Elesber, Abhiram Prasad, Ryan Lennon … (2007)

This study sought to assess the long-term prognosis of patients with apical ballooning syndrome (ABS). Apical ballooning syndrome is a recently described acute cardiac syndrome of uncertain etiology and prognosis. We retrospectively identified 100 unselected patients with a confirmed diagnosis of ABS by angiography. Recurrences of ABS and mortality were recorded. Over a mean follow-up of 4.4 +/- 4.6 years, 31 patients continued to have episodes of chest pain and 10 patients had recurrence of ABS, for a recurrence rate of 11.4% over the first 4 years. Seventeen patients died in 4.7 +/- 4.8 years of follow-up. There was no difference in survival or in cardiovascular survival to an age- and gender-matched population. The recurrence rate for ABS was 11.4% over 4 years after initial presentation. Recurrence of chest pain is common. Four-year survival was not different from that in an age-matched and gender-matched population.

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Journal

Journal ID (nlm-ta): Eur Heart J

Journal ID (iso-abbrev): Eur. Heart J

Journal ID (publisher-id): eurheartj

Title: European Heart Journal

Publisher: Oxford University Press

ISSN (Print): 0195-668X

ISSN (Electronic): 1522-9645

Publication date (Print): 07 June 2018

Publication date (Electronic): 29 May 2018

Publication date PMC-release: 29 May 2018

Volume: 39

Issue: 22 , Focus Issue on Takotsubo

Pages: 2047-2062

Affiliations

[1 ]University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland

[2 ]Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

[3 ]Division of Cardiovascular Diseases Mayo Clinic, Rochester, MN, USA

[4 ]Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA

[5 ]Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan

[6 ]Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

[7 ]Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy

[8 ]Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium

[9 ]Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

[10 ]Department of Cardiovascular Medicine, Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan

[11 ]Clinica Medica, Department of Medical Sciences, University of Ferrara, Ferrara, Italy

[12 ]University Heart Center Luebeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Luebeck, Luebeck, Germany

[13 ]Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

[14 ]Department of Cardiology, University Hospital Giessen, Giessen, Germany

[15 ]Heart Department, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy

[16 ]Department of Anatomy and Cell Biology, Wakayama Medical University School of Medicine, Wakayama, Japan

[17 ]Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Padova, Italy

[18 ]Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

[19 ]Division of Cardiovascular Disease, Department of Medicine, University of Florida, Gainesville, FL, USA

[20 ]NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK

[21 ]National Heart and Lung Institute, Imperial College, London, UK

[22 ]Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden

[23 ]Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

[24 ]Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

[25 ]Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France

[26 ]Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden

[27 ]Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia

[28 ]Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

[29 ]Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland

[30 ]Department of Cardiology, Royal Brompton & Harefield Hospital and Imperial College, London, UK

Author notes

The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

This paper was guest edited by Bernard J. Gersh (Mayo Clinic, gersh.bernard@mayo.edu).

Corresponding author. Tel: +41 44 255 9585, Fax: +41 44 255 4401, Email: christian.templin@ 123456usz.ch

Deceased.

Article

Publisher ID: ehy077

DOI: 10.1093/eurheartj/ehy077

PMC ID: 5991205

PubMed ID: 29850820

SO-VID: c44cf62d-0c81-4e01-8399-7a0b1552ade2

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 01 June 2017

Date revision received : 23 November 2017

Date accepted : 11 April 2018

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Pages: 16

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International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

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Cardiovascular Innovations and Applications

Most cited references 120

Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.

Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan.

Four-year recurrence rate and prognosis of the apical ballooning syndrome.

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Cited by 245

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