Takotsubo Syndrome: Finally Emerging From the Shadows?

Autor: Ong GJ; Basil Hetzel Institute, Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, North Terrace, Adelaide, SA, Australia; Central Adelaide Local Health Network, Adelaide, SA, Australia., Nguyen TH; Basil Hetzel Institute, Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, North Terrace, Adelaide, SA, Australia., Kucia A; University of South Australia, North Terrace, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia., Liu SF; University of Adelaide, North Terrace, Adelaide, SA, Australia; Central Adelaide Local Health Network, Adelaide, SA, Australia; University of South Australia, North Terrace, Adelaide, SA, Australia., Surikow SY; Basil Hetzel Institute, Queen Elizabeth Hospital, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia., Girolamo O; Basil Hetzel Institute, Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, North Terrace, Adelaide, SA, Australia., Chong CR; Central Adelaide Local Health Network, Adelaide, SA, Australia; University of Adelaide, North Terrace, Adelaide, SA, Australia., Chirkov YY; Basil Hetzel Institute, Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, North Terrace, Adelaide, SA, Australia., Schenck-Gustafsson K; Karolinska Institute, Stockholm, Sweden., Frenneaux MP; Imperial College, London, UK., Horowitz JD; Basil Hetzel Institute, Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, North Terrace, Adelaide, SA, Australia. Electronic address: john.horowitz@adelaide.edu.au.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2021 Jan; Vol. 30 (1), pp. 36-44. Date of Electronic Publication: 2020 Nov 06.
DOI: 10.1016/j.hlc.2020.10.006
Abstrakt: It is now 30 years since Japanese investigators first described Takotsubo Syndrome (TTS) as a disorder occurring mainly in ageing women, ascribing it to the impact of multivessel coronary artery spasm. During the intervening period, it has become clear that TTS involves relatively transient vascular injury, followed by prolonged myocardial inflammatory and eventually fibrotic changes. Hence symptomatic recovery is generally slow, currently an under-recognised issue. It appears that TTS is induced by aberrant post-β 2 -adrenoceptor signalling in the setting of "surge" release of catecholamines. Resultant activation of nitric oxide synthases and increased inflammatory vascular permeation lead to prolonged myocardial infiltration with macrophages and associated oedema formation. Initially, the diagnosis of TTS was made via exclusion of relevant coronary artery stenoses, plus the presence of regional left ventricular hypokinesis. However, detection of extensive myocardial oedema on cardiac MRI imaging offers a specific basis for diagnosis. No adequate methods are yet available for definitive diagnosis of TTS at hospital presentation. Other major challenges remaining in this area include understanding of the recently demonstrated association between TTS and antecedent cancer, the development of effective treatments to reduce risk of short-term (generally due to shock) and long-term mortality, and also to accelerate symptomatic recovery.
(Copyright © 2020. Published by Elsevier B.V.)
Databáze: MEDLINE
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