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      Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry

      research-article
      1 , 2 , 1 , 1 , 1 , 2 , 1 , 1 , 1 , 1 , 1 , 1 , 1 , 3 , 1 , 4 , 1 , 5 , 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 12 , 12 , 8 , 13 , 14 , 15 , 16 , 9 , 17 , 17 , 18 , 19 , 19 , 20 , 21 , 22 , 22 , 23 , 14 , 15 , 24 , 25 , 25 , 26 , 27 , 27 , 28 , 29 , 29 , 30 , 31 , 31 , 32 , 32 , 33 , 33 , 34 , 35 , 36 , 35 , 36 , 37 , 37 , 38 , 39 , 38 , 39 , 38 , 39 , 40 , 40 , 40 , 41 , 42 , 42 , 42 , 43 , 44 , 2 , 45 , 46 , 47 , 48 , 44 , 1 , 49 , 50 , 1 , 1
      European Heart Journal
      Oxford University Press
      Takotsubo syndrome, Broken heart syndrome, Cardiac arrest, Acute heart failure, Outcome

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          Abstract

          Aims

          We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS).

          Methods and results

          We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission.

          Conclusions

          Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

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          Most cited references30

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          Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning.

          This study investigated the effect of prolonged cardiac arrest and subsequent cardiopulmonary resuscitation on left ventricular systolic and diastolic function. Cardiac arrest from ventricular fibrillation results in cessation of forward blood flow, including myocardial blood flow. During cardiopulmonary resuscitation, myocardial blood flow remains suboptimal. Once the heart is defibrillated and successful resuscitation achieved, reversible myocardial dysfunction, or "stunning," may occur. The magnitude and time course of myocardial stunning from cardiac arrest is unknown. Twenty-eight domestic swine (26 +/- 1 kg) were studied with both invasive and noninvasive measurements of ventricular function before and after 10 or 15 min of untreated cardiac arrest. Contrast left ventriculograms, ventricular pressures, cardiac output, isovolumetric relaxation time (tau) and transthoracic Doppler-echocardiographic studies were obtained. Twenty-three of 28 animals were successfully resuscitated and postresuscitation data obtained. Left ventricular ejection fraction showed a significant reduction 30 min after resuscitation (p By 24 h, these invasive and noninvasive variables of systolic and diastolic left ventricular function had begun to improve. At 48 h, all measures of left ventricular function had returned to baseline levels. Myocardial systolic and diastolic dysfunction is severe after 10 to 15 min of untreated cardiac arrest and successful resuscitation. Full recovery of this postresuscitation myocardial stunning is seen by 48 h in this experimental model of ventricular fibrillation cardiac arrest.
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            Prevalence and Clinical Significance of Life-Threatening Arrhythmias in Takotsubo Cardiomyopathy.

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              ECMO in cardiac arrest and cardiogenic shock

              Cardiogenic shock is an acute emergency, which is classically managed by medical support with inotropes or vasopressors and frequently requires invasive ventilation. However, both catecholamines and ventilation are associated with a worse prognosis, and many patients deteriorate despite all efforts. Mechanical circulatory support is increasingly considered to allow for recovery or to bridge until making a decision or definite treatment. Of all devices, extracorporeal membrane oxygenation (ECMO) is the most widely used. Here we review features and strategical considerations for the use of ECMO in cardiogenic shock and cardiac arrest.
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                Author and article information

                Journal
                Eur Heart J
                Eur. Heart J
                eurheartj
                European Heart Journal
                Oxford University Press
                0195-668X
                1522-9645
                01 July 2019
                16 May 2019
                16 May 2019
                : 40
                : 26
                : 2142-2151
                Affiliations
                [1 ]Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
                [2 ]Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
                [3 ]Keck School of Medicine, University of Southern California, Los Angeles CA, USA
                [4 ]Division of Biological Sciences, University of California San Diego, San Diego, CA, USA
                [5 ]Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
                [6 ]Division of Cardiology ‘Antonio Cardarelli’ Hospital, Naples, Italy
                [7 ]Heart Department, University Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’, Salerno, Italy
                [8 ]Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
                [9 ]Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
                [10 ]First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
                [11 ]Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
                [12 ]Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
                [13 ]Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany
                [14 ]Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
                [15 ]DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
                [16 ]Department of Internal Medicine/Cardiology, University of Leipzig—Heart Center, Leipzig, Germany
                [17 ]Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
                [18 ]TJ Health Partners Heart and Vascular, Glasgow, KY, USA
                [19 ]Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
                [20 ]Krankenhaus ‘Maria Hilf’ Medizinische Klinik, Stadtlohn, Germany
                [21 ]Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
                [22 ]Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
                [23 ]DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
                [24 ]Department of Internal Medicine II—Cardiology, University of Ulm, Medical Center, Ulm, Germany
                [25 ]Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
                [26 ]Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
                [27 ]Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
                [28 ]Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
                [29 ]Heart Center, Turku University Hospital and University of Turku, Turku, Finland
                [30 ]Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
                [31 ]Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
                [32 ]Department of Cardiology, University Hospital Basel, Basel, Switzerland
                [33 ]Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
                [34 ]University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
                [35 ]Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
                [36 ]DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
                [37 ]Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
                [38 ]First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany
                [39 ]DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
                [40 ]Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
                [41 ]Discipline of Medicine, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
                [42 ]Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
                [43 ]Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
                [44 ]Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
                [45 ]Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
                [46 ]FB Mathematics and Computer Science, University of Bremen, Bremen, Germany
                [47 ]Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
                [48 ]Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
                [49 ]Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
                [50 ]Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
                Author notes
                Corresponding author. Tel: +41 (0)44 255 9585, Email: christian.templin@ 123456usz.ch
                Article
                ehz170
                10.1093/eurheartj/ehz170
                6612368
                31098611
                e789e7ea-84d9-4c59-bc71-e43ea58826f6
                © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.

                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
                : 15 March 2018
                : 11 September 2018
                : 12 March 2019
                Page count
                Pages: 10
                Funding
                Funded by: Sheikh Khalifa bin Hamad Al-Thani Research Programme
                Funded by: Swiss Heart Foundation
                Funded by: Biss Davies Charitable Trust
                Categories
                Clinical Research
                Editorial
                Editor's Choice

                Cardiovascular Medicine
                takotsubo syndrome,broken heart syndrome,cardiac arrest,acute heart failure,outcome

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