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A single pathophysiological pathway in Takotsubo cardiomyopathy: Catecholaminergic stress.
MedLine Citation:
PMID:  24796853     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Takotsubo cardiomyopathy (TTC) continues to be under-diagnosed, due to its varying presentation, with potentially serious consequences if treatment is delayed.
AIMS: To demonstrate the consistent involvement of catecholaminergic stress in TTC, regardless of the trigger.
METHODS: Between 01 July 2009 and 31 August 2013, patients managed in our centre for thoracic pain syndrome, with or without troponin release, were followed up prospectively. TTC was diagnosed from the apical ballooning seen on left ventricular imaging (angiography or transthoracic echocardiography) in the absence of a significant coronary artery lesion. Triggers (emotional trauma, surgical stress and β2-mimetic intoxication) were recorded; catecholamine-secreting tumours were screened for with a urinary methoxylate-derivative assay.
RESULTS: TTC was diagnosed in 40 out of 2754 (1.5%) patients with thoracic pain syndrome, with or without troponin release. Triggers were emotional trauma (n=29, 72.5%), surgical stress (n=5, 12.5%), adrenergic intoxication (n=3, 7.5%) and catecholaminergic tumour (n=3, 7.5%). Mean left ventricular ejection fraction at admission was 38.0±15.7%. Eight (20%) patients initially showed cardiogenic shock. In-hospital mortality was 7.5%, with no deaths from cardiogenic causes. Thirty-five (94.6%) of the survivors had recovered a normal left ventricular ejection fraction (> 55%) by discharge.
CONCLUSION: Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early.
Authors:
Elisabeth Coupez; Romain Eschalier; Bruno Pereira; Romain Pierrard; Géraud Souteyrand; Guillaume Clerfond; Bernard Citron; Jean-René Lusson; Nicolas Mansencal; Pascal Motreff
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-2
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  -     ISSN:  1875-2128     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Masson SAS. All rights reserved.
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