Predicting the risk of developing long-term complications in takotsubo syndrome


DOI: https://dx.doi.org/10.18565/therapy.2023.5.61-70

Evdokimov D.S., Feoktistova V.S., Semenov A.P., Boldueva S.A., Plavinsky S.L.

I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia, Saint Petersburg
Abstract. In recent years, the course of the late period of takotsubo syndrome (TS) has been actively studied, since most patients, despite the restoration of the left ventricular (LV) ejection fraction, still have complaints characteristic of chronic heart failure (CHF).
Objective: on the basis of clinical and laboratory-instrumental data, to build models for predicting the risk of complications in the long-term period in patients who have undergone TS.
Material and methods. The study included 60 patients with TS. In the acute period of the disease (7–14 days), a standard clinical and laboratory examination was performed, endothelial function was assessed by peripheral arterial tonometry (PAT) before and after the mental stress test (MST). After 1 year, patients underwent a standard clinical examination, echocardiography using the speckle-tracking technique, blood was taken to determine the level of endothelin-1 (ET-1) and circulating endothelial cells (CEC), PAT before and after MCT. The severity of symptoms of CHF was assessed using a scale for assessing the clinical condition. Algorithms for assessing the risk of complications were built by medical and mathematical modeling using the method of classification trees; multivariate analysis was carried out by binary logistic regression with stepwise inclusion of features.
Results. Most often, TS in the examined patients was provoked by negative stress; there were no cases of the development of the disease against the background of positive experiences. When constructing ROC curves and univariate analysis, predictors of CHF progression and reduced LV deformity after 1 year were indicators reflecting the presence of endothelial dysfunction. Models were constructed to predict the risk of CHF progression (sensitivity 81,1%), low LV deformity parameters (95,5% sensitivity) and death (96,5% sensitivity) 1 year after the onset of TS.
Conclusion. Knowledge of the predictors of CHF progression and death in the long-term period of the disease in patients with TS and the possibility of predicting their development using risk models will allow more targeted selection of therapy after discharge from the hospital.
Keywords: complication risk assessment model, long-term course, Takotsubo syndrome
Read entire article

Literature

1. Ghadri J.R., Wittstein I.S., Prasad A. et al. International Expert Consensus document on takotsubo syndrome (part i): Clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018; 39(22): 2032–46. https://dx.doi.org/10.1093/eurheartj/ehy076.


2. Lyon A.R., 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(1): 8–27. https://dx.doi.org/10.1002/ejhf.424.


3. Ribeiro V.F., Vasconcelos M., Melao F. et al. Short and long-term outcome of stress-induced cardiomyopathy: What can we expect? Arq Bras Cardiol. 2014; 102(1): 80–85. https://dx.doi.org/10.5935/abc.20130228.


4. Ghadri J.R., Wittstein I.S., Prasad A. et al. International Expert Consensus document on takotsubo syndrome (part II): Diagnostic workup, outcome, and management. Eur Heart J. 2018; 39(22): 2047–62. https://dx.doi.org/10.1093/eurheartj/ehy077.


5. Болдуева С. А., Евдокимов Д. С. Кардиомиопатия такоцубо. Обзор данных литературы: понятие, эпидемиология, патогенез. Часть I. Российский кардиологический журнал. 2022; 27(3S): 108–119. [Boldueva S.A., Evdokimov D.S. Takotsubo cardiomyopathy. Literature review: Concept, epidemiology, pathogenesis. Part I. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2022; 27(3S): 108–119 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2022-4993. EDN: BQQYSD.


6. Sethi Y., Murli H., Kaiwan O. et al. Broken heart syndrome: Evolving molecular mechanisms and principles of management. J Clin Med. 2022; 12(1): 125. https://dx.doi.org/10.3390/jcm12010125.


7. Болдуева С.А., Евдокимов Д.С. Кардиомиопатия такоцубо. Обзор данных литературы: клиническая картина, алгоритм диагностики, лечение, прогноз. Часть II. Российский кардиологический журнал. 2022; 27(3S): 120–128. [Boldueva S.A., Evdokimov D.S. Takotsubo cardiomyopathy. Literature review: Clinical performance, diagnostic algorithm, treatment, prognosis. Part II. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2022; 27(3S): 120–128 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2022-4994. EDN: BVVIKY.


8. Neil C.J., Nguyen T.H., Singh K. et al. Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life. Am J Cardiol. 2015; 115(8): 1085–89. https://dx.doi.org/10.1016/j.amjcard.2015.01.541.


9. Scally C., Rudd A., Mezincescu A. et al. Persistent long-term structural, functional, and metabolic changes after stress-induced (takotsubo) cardiomyopathy. Circulation. 2018; 137(10): 1039–48. https://dx.doi.org/10.1161/CIRCULATIONAHA.117.031841.


10. Stiermaier T., Moeller C., Oehler K. et al. Long-term excess mortality in takotsubo cardiomyopathy: Predictors, causes and clinical consequences. Eur J Heart Fail. 2016; 18(6): 65 –56. https://dx.doi.org/10.1002/ejhf.494.


11. User’s manual Itamar Medical. URL: https://www.itamar-medical.com/wp-content/uploads/2019/07/OM1695214.pdf (date of access= – 01.06.2023).


12. Алексеева Д.Ю., Цуринова Е.А., Солнцев В.Н. с соавт. Роль ментальных проб при обследовании больных с желудочковой аритмией. Трансляционная медицина. 2016; 3(2): 6–16. [Alekseeva D.Yu., Tsurinova E.A., Solntsev V.N. et al. The role of the mental stress-tests examination of patients with ventricular arrhythmia. Translyatsionnaya meditsina = Translational Medicine. 2016; 3(2): 6–16 (In Russ.)]. https://dx.doi.org/10.18705/2311-4495-2016-3-2-6-16. EDN: XBHQPH.


13. Никифоров В.С., Никищенкова Ю.В. Современные возможности speckle tracking эхокардиографии в клинической практике. Рациональная фармакотерапия в кардиологии. 2017; 13(2): 248–255. [Nikiforov V.S., Nikishchenkova I.V. Modern possibilities of speckle tracking echocardiography in clinical practice. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2017; 13(2): 248–255 (In Russ.)]. https://dx.doi.org/10.20996/1819-6446-2017-13-2-248-255. EDN: YOCTIR.


14. Евдокимов Д.С., Болдуева С.А., Феоктистова В.С. Снижение глобальной тканевой деформации левого желудочка как причина сердечной недостаточности и ухудшения качества жизни больных с синдромом такоцубо в отдаленном периоде заболевания: проспективное когортное исследование. CardioСоматика. 2022; 13(3): 132–138. [Evdokimov D.S., Boldueva S.A., Feoktistova V.S. Reduction of global tissue deformation of the left ventricle as a cause of heart failure and worse quality of life in patients with takotsubo syndrome in the long period of the disease: prospective cohort study. CardioSomatika = CardioSomatics. 2022; 13(3): 132–138 (In Russ.)]. https://dx.doi.org/10.17816/CS133707. EDN: AOMNQG.


15. Barton M. The discovery of endothelium-dependent contraction: The legacy of Paul M. Vanhoutte. Pharmacol Res. 2011; 63(6): 455–62. https://dx.doi.org/10.1016/j.phrs.2011.02.013.


16. Васина Л.В., Петрищев Н.Н., Власов Т.Д. Эндотелиальная дисфункция и ее основные маркеры. Регионарное кровообращение и микроциркуляция. 2017; 16(1): 4–15. [Vasina L.V., Petrishchev N.N., Vlasov T.D. Markers of endothelial dysfunction. Regionarnoye krovoobrashcheniye i mikrotsirkulyatsiya = Regional Blood Circulation and Microcirculation. 2017; 16(1): 4–15 (In Russ.)]. https://dx.doi.org/10.24884/1682-6655-2017-16-1-4-15. EDN: YOCUJF.


17. Widemann A., Sabatier F., Arnaud L. et al. CD146-based immunomagnetic enrichment followed by multiparameter flow cytometry: A new approach to counting circulating endothelial cells. J Thromb and Haemost. 2008; 6(5): 869–76. https://dx.doi.org/10.1111/j.1538-7836.2008.02931.x.


18. Nayeri A., Rafla-Yuan E., Farber-Eger E. et al. Pre-existing psychiatric illness is associated with increased risk of recurrent takotsubo cardiomyopathy. Psychosomatics. 2017; 58(5): 527–32. https://dx.doi.org/10.1016/j.psym.2017.04.008.


19. Campos F.A.D., Ritt L.E.F., Costa J.P.S. et al. Factors associated with recurrence in takotsubo syndrome: A systematic review. Arq Bras Cardiol. 2020; 114(3): 477–83. https://dx.doi.org/10.36660/abc.20180377.


20. Almendro-Delia M., Nunez-Gil I.J., Lobo M. et al. Short- and long-term prognostic relevance of cardiogenic shock in takotsubo syndrome: Results from the RETAKO Registry. JACC Heart Fail. 2018; 6(11): 928–36. https://dx.doi.org/10.1016/j.jchf.2018.05.015.


21. Lu X., Li P., Teng C. et al. Prognostic factors of takotsubo cardiomyopathy: A systematic review. ESC Heart Fail. 2021; 8(5): 3663–89. https://dx.doi.org/10.1002/ehf2.13531.


22. Uribarri A., Nunez-Gil I.J., Conty D.A. et al. Short- and long-term prognosis of patients with takotsubo syndrome based on different triggers: Importance of the physical nature. J Am Heart Assoc. 2019; 8(24): e013701. https://dx.doi.org/10.1161/JAHA.119.013701.


23. Galiuto L., Crea F. Primary and secondary takotsubo syndrome: Pathophysiological determinant and prognosis. Eur Heart J Acute Cardiovasc Care. 2020; 9(7): 690–93. https://dx.doi.org/10.1177/2048872620963493.


24. Gaede L., Herchenbach A., Trobs M. et al. Left ventricular contraction patterns in takotsubo syndrome and their correlation with long-term clinical outcome. Int J Cardiol Heart Vasc. 2021; 32: 100708. https://dx.doi.org/10.1016/j.ijcha.2020.100708.


25. Покровский А.В., Кульбак В.А., Федоров Е.Е. Оценка индекса реактивной гиперемии, как индикатора степени эндотелиальной дисфункции у больных с атеросклеротическим поражением периферических артерий. Высокотехнологическая медицина. 2016; 3(4): 5–11. [Pokrovsky A.V., Kulbak V.A., Fedorov E.E. Evaluation of the index of reactive hyperemia as an indicator of the degree of endothelial dysfunction in patients with atherosclerotic lesions of peripheral arteries. Vysokotekhnologicheskaya meditsina = High-Tech Medicine. 2016; 3(4): 5–11 (In Russ.)]. EDN: YTBGOF.


26. Bonetti P.O., Pumper G.M., Higano S.T. et al. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol. 2004; 44(11): 2137–41. https://dx.doi.org/10.1016/j.jacc.2004.08.062.


27. Zilberman L., Zalik A., Fugenfirov I. et al. Residual alterations of cardiac and endothelial function in patients who recovered from Takotsubo cardiomyopathy. Clin Cardiol. 2021; 44(6): 797–804. https://dx.doi.org/10.1002/clc.23604.


28. Yang J.H., Obokata M., Reddy Y.N.V. et al. Endothelium-dependent and independent coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction. Eur J Heart Fail. 2020; 22(3): 432–41. https://dx.doi.org/10.1002/ejhf.1671.


29. Crea F., Bairey Merz C.N., Beltrame J.F. et al. The parallel tales of microvascular angina and heart failure with preserved ejection fraction: A paradigm shift. Eur Heart J. 2017; 38(7): 473–77. https://dx.doi.org/10.1093/eurheartj/ehw461.


30. Tremamunno S., DeVita A., Villano A. et al. Relation of endothelial and cardiac autonomic function with left ventricle diastolic function in patients with type 2 diabetes mellitus. Diabetes Metab Res Rev. 2022; 38(2): e3484. https://dx.doi.org/10.1002/dmrr.3484.


31. Sara J.D.S., Toya T., Ahmad A. et al. Mental stress and its effects on vascular health. Mayo Clin Proc. 2022; 97(5): 951–90. https://dx.doi.org/10.1016/j.mayocp.2022.02.004.


32. Евдокимов Д.С., Феоктистова В.С., Болдуева С.А. с соавт. Дисфункция эндотелия у больных с синдромом такоцубо и ее роль в остром и отдаленном периодах заболевания. Кардиология. 2023; 63(3): 21–27. [Evdokimov D.S., Feoktistova V.S., Boldueva S.A. et al. Endothelial dysfunction in patients with takotsubo syndrome and its role in acute and long terms of the disease. Kardiologiya = Cardiology. 2023; 63(3): 21–27 (In Russ.)]. https://dx.doi.org/cardio.2023.3.n2364. EDN: VKWKSY.


33. Cammann V.L., Szawan K.A., Stahli B.E. et al. Age-related variations in takotsubo syndrome. J Am Coll Cardiol. 2020; 75(16): 1869–77. https://dx.doi.org/10.1016/j.jacc.2020.02.057.


About the Autors

Dmitry S. Evdokimov, postgraduate student of the Department of faculty therapy, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195067, Saint Petersburg, 47 Piskarevsky Avenue. E-mail: kasabian244@gmail.com. ORCID: https://orcid.org/0000-0002-3107-1691
Valeria S. Feoktistova, PhD in Medical Sciences, associate professor of the Department of faculty therapy, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195067, Saint Petersburg, 47 Piskarevsky Avenue. E-mail: lerissima@yandex.ru. ORCID: https://orcid.org/0000-0003-4161-3535
Alena P. Semenova, postgraduate student of the Department of faculty therapy, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195067, Saint Petersburg, 47 Piskarevsky Avenue. E-mail: semionova.al@mail.ru. ORCID: https://orcid.org/0000-0002-6386-1612
Svetlana A. Boldueva, MD, professor, head of the Department of faculty therapy, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195067, Saint Petersburg, 47 Piskarevsky Avenue. E-mail: svetlanaboldueva@mail.ru. ORCID: https://orcid.org/0000-0002-1898-084X
Svyatoslav L. Plavinsky , MD, professor of the Department of pedagogy, philosophy and law, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 195067, Saint Petersburg, 47 Piskarevsky Avenue. E-mail: s.plavinskij@gmail.com. ORCID: https://orcid.org/0000-0001-9159-6177


Similar Articles

Back to Content

Бионика Медиа