Takotsubo Syndrome (TC): Updates and Clinical Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 December 2023) | Viewed by 5877

Special Issue Editor

Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
Interests: clinical cardiology; autoimmune diseases; non-ischemic cardiomyopathy; cardiovascular magnetic resonance imaging (CMR)
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Special Issue Information

Dear Colleagues,

TC is a transient and reversible cardiomyopathy with generally favorable prognosis. The main feature of TC is apical ballooning in LV similar to the so-called ‘Takotsubo’, which is a pot for octopus fishing used in Japan. Due to its similar presentation with myocardial infarction, a careful differential diagnosis and management is needed.

Catecholamine levels play a vital role in the pathogenesis and pathophysiology of TC. Therefore, it is also called stress cardiomyopathy. TC risk factors include estrogen deficiency, emotional and physical stress, and genetic factors. The main therapy includes supportive medication that seems to be effective as TC patients’ LV function generally starts to improve in several days and recovers completely in 3–4 weeks.

In this issue of JCM, we plan to include an update to the current literature regarding pathophysiology, diagnostic imaging /blood biomarkers, effect of treatment and follow-up evaluation of TC patients. We hope that this issue will provide new perspectives and motivate further research in this field.

Dr. Sophie I. Mavrogeni
Guest Editor

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Keywords

  • takotsubo cardiomyopathy
  • transient cardiomyopathy
  • reversible cardiomyopathy
  • stress cardiomyopathy

Published Papers (2 papers)

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12 pages, 2517 KiB  
Article
Limbic Responses to Aversive Visual Stimuli during the Acute and Recovery Phase of Takotsubo Syndrome
by Ruth Steiger, Noora Tuovinen, Agne Adukauskaite, Thomas Senoner, Philipp Spitaler, Valentin Bilgeri, Agnieszka Dabkowska-Mika, Christian Siedentopf, Axel Bauer, Elke Ruth Gizewski, Alex Hofer, Fabian Barbieri and Wolfgang Dichtl
J. Clin. Med. 2022, 11(16), 4891; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11164891 - 20 Aug 2022
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Abstract
The role of the limbic system in the acute phase and during the recovery of takotsubo syndrome needs further clarification. In this longitudinal study, anatomical and task-based functional magnetic resonance imaging of the brain was performed during an emotional picture paradigm in 19 [...] Read more.
The role of the limbic system in the acute phase and during the recovery of takotsubo syndrome needs further clarification. In this longitudinal study, anatomical and task-based functional magnetic resonance imaging of the brain was performed during an emotional picture paradigm in 19 postmenopausal female takotsubo syndrome patients in the acute and recovery phases in comparison to sex- and aged-matched 15 healthy controls and 15 patients presenting with myocardial infarction. Statistical analyses were performed based on the general linear model where aversive and positive picture conditions were included in order to reveal group differences during encoding of aversive versus positive pictures and longitudinal changes. In the acute phase, takotsubo syndrome patients showed a lower response in regions involved in affective and cognitive emotional processes (e.g., insula, thalamus, frontal cortex, inferior frontal gyrus) while viewing aversive versus positive pictures compared to healthy controls and patients presenting with myocardial infarction. In the recovery phase, the response in these brain regions normalized in takotsubo syndrome patients to the level of healthy controls, whereas patients 8–12 weeks after myocardial infarction showed lower responses in the limbic regions (mainly in the insula, frontal regions, thalamus, and inferior frontal gyrus) compared to healthy controls and takotsubo syndrome patients. In conclusion, compared to healthy controls and patients suffering from acute myocardial infarction, limbic responses to aversive visual stimuli are attenuated during the acute phase of takotsubo syndrome, recovering within three months. Reduced functional brain responses in the recovery phase after a myocardial infarction need further investigation. Full article
(This article belongs to the Special Issue Takotsubo Syndrome (TC): Updates and Clinical Perspectives)
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Review

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27 pages, 2167 KiB  
Review
Broken Heart Syndrome: Evolving Molecular Mechanisms and Principles of Management
by Yashendra Sethi, Hamsa Murli, Oroshay Kaiwan, Vidhi Vora, Pratik Agarwal, Hitesh Chopra, Inderbir Padda, Manasa Kanithi, Mihaela Simona Popoviciu and Simona Cavalu
J. Clin. Med. 2023, 12(1), 125; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12010125 - 24 Dec 2022
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Abstract
Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it [...] Read more.
Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. It can be classified into two main types: Primary and Secondary TS. Primary TS occurs when the symptoms of myocardial damage, which is typically preceded by emotional stress, are the reason for hospitalization. Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions, and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines. The etiopathogenesis is now proposed to include adrenergic hormones/stress, decreased estrogen levels, altered microcirculation, endothelial dysfunction, altered inflammatory response via cardiac macrophages, and disturbances in the brain-heart axis. The role of genetics in disease progression is becoming the focus of several upcoming studies. This review focuses on potential pathophysiological mechanisms for reversible myocardial dysfunction observed in TS, and comprehensively describes its epidemiology, clinical presentation, novel diagnostic biomarkers, and evolving principles of management. We advocate for more research into molecular mechanisms and promote the application of current evidence for precise individualized treatment. Full article
(This article belongs to the Special Issue Takotsubo Syndrome (TC): Updates and Clinical Perspectives)
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