Perioperative Takotsubo Cardiomyopathy: a Review Article
Keywords:
stress-induced cardiomyopathy, Takotsubo cardiomyopathyAbstract
Perioperative Takotsubo cardiomyopathy, acute transient left ventricular dysfunction without significant coronary artery obstruction, can occur during intraoperative period and within 30-days postoperative period. It is found to be more common and more fatal than non- perioperative type. Neither the understanding of clear pathogenesis nor tools to predict the occurrence and recurrence, it is reasonable to diminish any possible triggers such as patient’s anxiety, light anesthesia, inadequate pain control and residual paralysis. In patients with history of Takotsubo cardiomyopathy, the operation should be performed with available intensive care unit and percutaneous coronary intervention. A multidisciplinary team approach is needed. The assessment of the echocardiogram and complications must be noted. The supportive management to preserve organ perfusion is still the mainstream of management while the inotrope and intra-aortic balloon pump must be cautious.
References
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo
syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018;39:2032-46.
Hessel EA, 2nd. Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review. Can J Anaesth. 2016;63:1059-74.
Guzzo MEG, Novas DS, Iglesias FA, Bisurgi DD, Domenech G, Terrasa SA. Anesthetic implications of perioperative Takotsubo syndrome: a retrospective cohort study. Can J Anaesth. 2021;68:1747-55.
Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003;41:737-42.
Kawai S, Kitabatake A, Tomoike H. Guidelines for diagnosis of Takotsubo (ampulla) cardiomyopathy. Circ J. 2007;71:990-2.
Wittstein IS. Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning? Cell Mol Neurobiol. 2012;32:847-57.
Schultz T, Shao Y, Redfors B, et al. Stress-induced cardiomyopathy in Sweden: evidence for different ethnic predisposition and altered cardio-circulatory status. Cardiology. 2012;122:180-6.
Ghadri J-R, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo syndrome (Part II): diagnostic workup, outcome, and management. Eur Heart J. 2018;39:2047-62.
Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929-38.
Brinjikji W, El-Sayed AM, Salka S. In-hospital mortality among patients with Takotsubo cardiomyopathy: a study of the National Inpatient Sample 2008 to 2009. Am Heart J. 2012;164:215-21.
Hessel EAI. The brain and the heart. Anesth Analg. 2006;103:522-6.
Lüscher TF, Templin C. Is Takotsubo syndrome a microvascular acute coronary syndrome? Towards of a new definition. Eur Heart J. 2016;37:2816-20.
Paur H, Wright PT, Sikkel MB, et al. High levels of circulating epinephrine trigger apical cardiodepression in a b2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation. 2012;126:697-706.
Izumo M, Akashi YJ, Suzuki K, Omiya K, Miyake F, Ohtaki E. Recurrent Takotsubo cardiomyopathy with variant forms of left ventricular dysfunction. J Cardiol Cases. 2010;2:e37-40.
Scally C, Abbas H, Ahearn T, et al. Myocardial and systemic inflammation in acute stress-induced (Takotsubo) cardiomyopathy. Circulation. 2019;139:1581-92.
Assad J, Femia G, Pender P, Badie T, Rajaratnam R. Takotsubo syndrome: a review of presentation, diagnosis and management. Clin Med Insights Cardiol. 2022;16:11795468211065782.
Deshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J. 2012;164:66-71.e1.
Spinelli L, Trimarco V, Di Marino S, Marino M, Iaccarino G, Trimarco B. L41Q polymorphism of the G protein coupled receptor kinase 5 is associated with left ventricular apical ballooning syndrome. Eur J Heart Fail. 2010;12:13-6.
Borchert T, Hübscher D, Guessoum CI, et al. Catecholamine-dependent b-adrenergic signaling in a pluripotent stem cell model of Takotsubo cardiomyopathy. J Am Coll Cardiol. 2017;70:975-91.
Pelliccia F, Parodi G, Greco C, et al. Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients. Am J Med. 2015;128:654.e11-9.
Izumo M, Akashi YJ. Role of echocardiography for Takotsubo cardiomyopathy: clinical and prognostic implications. Cardiovasc Diagn Ther. 2018;8:90-100.
Ghadri JR, Cammann VL, Napp LC, et al. Differences in the clinical profile and outcomes of typical and atypical Takotsubo syndrome: data from the International Takotsubo Registry. JAMA Cardiol. 2016;1:335-40.
Agarwal S, Sanghvi C, Odo N, Castresana MR. Perioperative Takotsubo cardiomyopathy: implications for anesthesiologist. Ann Card Anaesth. 2019;22:309-15.
Muthachen NR, Sethuraman M. Anesthetic management of a patient with Takotsubo cardiomyopathy presenting for surgical clipping of intracranial aneurysm. J Anaesthesiol Clin Pharmacol. 2017;33:547-8.
Mohammedzein A, Taha A, Salwan A, Nambiar R. Impella use in cardiogenic shock due to Takotsubo cardiomyopathy with left ventricular outflow tract obstruction. JACC: Case Reports. 2019;1:161-5.
Ludbrook GL, Webb RK, Currie M, Watterson LM. Crisis management during anaesthesia: myocardial ischaemia and infarction. Qual Saf Health Care. 2005;14:e13.
Lyon AR, Bossone E, Schneider B, et al. Current state of knowledge on Takotsubo syndrome: a position statement from the taskforce on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2016;18:8-27.
Cholley B, Levy B, Fellahi JL, et al. Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper. Crit Care. 2019;23:385.
Mukhtar A, Moharam H, Sarhan K, Hosni H, Salah M. Liver transplantation using dexmedetomidine in a patient with a history of Takotsubo cardiomyopathy. A A Case Rep. 2016;6:14-6.
Wang K, Wu M, Xu J, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019;123:777-94.
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