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Multidisciplinary assessment of takotsubo cardiomyopathy: a prospective case study
Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-4262-6373
Department of Psychiatry, Örebro University Hospital, Örebro, Sweden.
Department of Radiology, Orebro University Hospital, Orebro, Sweden.
Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
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2011 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, p. 14-Article in journal (Refereed) Published
Abstract [en]

Background: The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined.

Methods: Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Asberg depression rating scale, self rated version, MADRS-S).

Results: During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01).

Conclusions: Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.

Place, publisher, year, edition, pages
2011. Vol. 11, p. 14-
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-38886DOI: 10.1186/1471-2261-11-14ISI: 000290201700001PubMedID: 21477336Scopus ID: 2-s2.0-79953741085OAI: oai:DiVA.org:oru-38886DiVA, id: diva2:765045
Note

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2018-02-07Bibliographically approved
In thesis
1. Echocardiographic measurements at Takotsubo cardiomyopathy: transient left ventricular dysfunction
Open this publication in new window or tab >>Echocardiographic measurements at Takotsubo cardiomyopathy: transient left ventricular dysfunction
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles.

Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated.

By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction.

Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2014. p. 106
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 111
Keywords
Echocardiography, takotsubo, annulus motion, cardiac autonomic function, broken heart, diastolic, ventricular mass, concentric wall motion
National Category
Other Basic Medicine
Research subject
Medicine; Biomedicine
Identifiers
urn:nbn:se:oru:diva-35798 (URN)978-91-7529-049-2 (ISBN)
Public defence
2014-11-28, Universitetssjukhuset, hörsal C3, Södra Grev Rosengatan, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2014-07-24 Created: 2014-07-24 Last updated: 2018-02-07Bibliographically approved

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Waldenborg, MicaelEmilsson, KentFröbert, Ole

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