Roberta Giudice

Differences in Clinical Features and In‐Hospital Outcomes of Older Adults with Tako‐Tsubo Cardiomyopathy

To describe the clinical characteristics and in‐hospital outcomes of older adults with tako‐tsubo cardiomyopathy (TTC).

Echocardiographic assessment of regional left ventricular wall motion abnormalities in patients with tako-tsubo cardiomyopathy: comparison with anterior myocardial infarction

AIMS The aim of this study was to assess the echocardiographic distribution of regional wall motion abnormalities (RWMA) in patients with tako-tsubo cardiomyopathy (TTC) compared with anterior ST-elevation myocardial infarction (ant-STEMI). METHODS AND RESULTS Thirty-seven TTC and 37 ant-STEMI patients underwent standard echocardiographic examination at the time of hospital admission. RWMA and the involvement of the left ventricular territories supplied by each coronary artery according to the American Society of Echocardiography classification were reported. TTC patients showed a lower left ventricular ejection fraction (37.6 ± 5.1 vs. 40.9 ± 3.7%; P = 0.002) and a higher wall motion score index (WMSI; 1.98 ± 0.2 vs. 1.51 ± 0.14; P < 0.001) compared with ant-STEMI patients. No significant differences were observed between groups with regard to detection of RWMA in the territory supplied by the left anterior descending coronary artery (LAD) (37 vs. 37; P = 1). Conversely, in TTC patients, the territories supplied by the LAD/left circumflex coronary artery (LCX) (37 vs. 31; P = 0.011), LAD/right coronary artery (RCA) (34 vs. 13; P < 0.001), RCA (33 vs. 5; P < 0.001), and RCA/LCX (31 vs. 2; P < 0.001) were more frequently involved. A cut-off value of WMSI ≥1.75 (area under the curve 0.956) and for the number of territories with RWMA ≥4 (AUC = 0.928) predicted TTC with a sensitivity of 83 and 84% and a specificity of 100 and 97%, respectively. CONCLUSION Echocardiography revealed a distinctive pattern of contractility in TTC patients, characterized by symmetrical RWMA extending equally into the territory of distribution of all coronary arteries.

Primary prevention with statins and incident diabetes in hypertensive patients at high cardiovascular risk

BACKGROUND AND AIMS The ESC/ESH guidelines for arterial hypertension recommend using statins for patients with high cardiovascular (CV) risk for both secondary and primary prevention. A recent meta-analysis, combining previous studies on statins, concluded that they are associated with a 9% increased risk of incident type 2 diabetes mellitus (DM). There is no information on whether statins increase incidence of DM in primary prevention. METHOD AND RESULTS We evaluated risk of incident DM in relation to statin prescription in 4750 hypertensive, non-diabetic outpatients (age 58.57 ± 9.0 yrs, 42.3% women), from the CampaniaSalute Network, without chronic kidney disease more than grade 3, free of prevalent CV disease and with at least 12 months of follow-up. DM was defined according to ADA criteria. At the end of follow-up period (55.78 ± 42.5 months), 676 patients (14%) were on statins. These patients were older (62.54 ± 7.3 vs 57.91 ± 9.1 yrs; p < 0.0001), more often female (49% vs 41.2%; p = 0.0001), with higher initial total cholesterol (217.93 ± 44.3 vs 205.29 ± 36.6 mg/dl), non-HDL cholesterol (167.16 ± 44.5 vs 155.18 ± 36.7 mg/dl) and triglycerides (150.69 ± 85.2 vs 130.98 ± 72.0 mg/dl; all p < 0.0001) than patients no taking statins, without other differences in clinical and laboratory characteristics. At the end of follow-up, prevalence of DM was 18.1% among patients on statins and 7.2% among those without lipid-lowering therapy (p < 0.0001). However, incident DM was 10.2% in patients on statins and 8.7% in those free of statin therapy (NS). CONCLUSION In real-life outpatient environment, statin prescription for primary prevention is not associated with increased risk of incident DM.

Is Tako-tsubo syndrome in the postpartum period a clinical entity different from peripartum cardiomyopathy?

Aims To conduct a systematic review of case reports about Tako-tsubo syndrome (TTS) after delivery in order to assess whether TTS in the postpartum period is a peculiar entity or only a variant form of peripartum cardiomyopathy. Methods We performed a systematic literature search on the occurrence of TTS after Cesarean section or spontaneous delivery using the scientific literature databases Medline, EMBASE and the Cochrane library. We selected 14 case reports in English. Primary/elective cesarean section or spontaneous delivery; absence of preexisting cardiovascular disease or fetal malformations; identification of diagnostic criteria for TTS; onset of TTS symptoms after delivery were the inclusion criteria. Results Fifteen cases were selected. Cesarean section 24 h before the onset of TTS was reported in 13. All patients presented dyspnea or chest pain. The majority had mild troponin elevation, non-ST-segment elevation. Apical ballooning was observed in 60% of cases, midventricular ballooning in 33%, basal ballooning in 7%. Although 13 patients experienced acute cardiac complications (pulmonary edema, cardiogenic shock, cardiac arrest), in all left ventricular systolic function normalized within 13.43 ± 10.96 days. Conclusion Women in the postpartum period, notably after Cesarean delivery, may represent another new vulnerable group at increased risk for TTS. TTS in the postpartum period should be considered a clinical entity different from peripartum cardiomyopathy with specific clinical, therapeutic and prognostic implications.

Polymorphisms of the antiapoptotic protein bag3 may play a role in the pathogenesis of tako-tsubo cardiomyopathy

following classes this dependence progressively increased up to the extremely high level in hrv7 class. Thiswaywe have obtained a set of HRV indiceswhich are associated in different extent with HR. Such parameters constitute a perfect material for investigations of the HR contribution to the HRV prognostic power [5]. Moreover, this may be applied not only to the spectral HRV analysis but also to any other analysis of heart rate dynamics which parameters are associated with HR — in such instances the RR-interval tachograms should rather be modified (i.e. divided or multiplied by avRRs) before a given heart rate dynamics is analyzed. Importantly, if one calculates average HRV indices from the indices corresponding to short RR interval segments (e.g. from Holter recordings), one should first obtain the global average HRV indices of all RR interval segments and then divide or multiply them by a global avRR — the division or multiplication for each segment separately may create the situation where a single RR interval segment with unusually slow or fast HR determines the results for a given patient (it is especially likely if one employs high powers of avRR). To conclude, the described approach opens new perspectives for the analysis of HR dynamics, i.e. it makes possible to separate clinical (e.g. prognostic) information coming from average heart rate and from its dynamics.

Acute heart failure after Caesaerean section: peri-partum or tako-tsubo cardiomiopathy?

A young woman undergoes Caesarean section at the 39th week of pregnancy: shortly after she develops acute cardiorespiratory failure. The electrocardiography shows sinus tachycardia and right bundle branch block. The ventriculography confirms the decrease of the pump function and the mid-ventricular ballooning of the left ventricle; the differential diagnosis is between peri-partum cardiomyopathy and stress induced tako-tsubo cardiomyopathy: the sudden onset, the results of the ventriculography and the complete recovery after 11 days of treatment for acute heart failure led the diagnosis towards tako-tsubo cardiomyopathy.