Takotsubo cardiomyopathy in athletes
https://doi.org/10.47529/2223-2524.2024.2.2
Abstract
Takotsubo cardiomyopathy (TTC) has become more common in clinical practice, and with a wide variety of pathologies, which is apparently associated with an improvement in the diagnosis of this disease. At the same time, this diagnosis is still not always established, primarily due to the lack of doctors’ awareness about this disease. TTC has many synonyms: broken heart syndrome, stress-induced cardiomyopathy, apical ballooning syndrome. TTC is a form of acute and, as a rule, reversible heart failure, provoked in most patients by various stress factors, occurring with transient dysfunction primarily of the left ventricle, clinically and echocardiographically resembling acute coronary syndrome. Recently, TTC has become more common in athletes, during stress testing (bicycle ergometry, treadmill test). Taking into account the large amount of information about TTC and the many unresolved issues, it’s necessary to analyze the literature and share our own experience in TTC diagnosis. The article highlights aspects of the etiology, pathogenesis, epidemiology, diagnostics and treatment of stress-induced TTC, which occurs in response to physical or mental stress and characterized by transient left ventricular dysfunction. The clinical example is the authors’ own observation.
About the Authors
M. V. PetrovaRussian Federation
Marina V. Petrova, Head of the Department, Department of Anesthesiology and Intensive Care with a Course of Medical Rehabilitation of Medical Institute
6 Miklukho-Maklaya str., Moscow, 117198
A. A. Spassky
Russian Federation
Andrey A. Spassky, Professor, Department of Anesthesiology and Intensive Care with a Course of Medical Rehabilitation of Medical Institute of Peoples’ Friendship University of Russia; Deputy Director General for Sports Medicine, International Center for Health Protection
6 Miklukho-Maklaya str., Moscow, 117198;
2 Oktyabrskaya str., Moscow
B. A. Polyaev
Russian Federation
Boris A. Polyaev, Head, Department of Rehabilitation, Sports Medicine and Physical Culture; Chief Specialist of the Ministry of Health of the Russian Federation in Sports Medicine
1 Ostrovityanova str., Moscow, 117513
A. A. Mihaylov
Russian Federation
Alexey A. Mihaylov, Professor, Department of Anesthesiology and Intensive Care with a Course of Medical Rehabilitation of Medical Institute
117198, 6 Miklukho-Maklaya str., Moscow
References
1. Steklov V.I., Morozova N.V., Ivanov S.A., Gmir T.N. Hypertrophic cardiomyopathy: diagnosis, risk stratification and strategies to prevent sudden cardiac death. Voenno-meditsinskii zhurnal = War and Medical Journal. 2024;345(1):39–50. (In Russ.).
2. Maron B.J., Towbin J.A., Thiene G., Antzelevitch C., Corrado D., Arnett D., et al. Contemporary defi nitions and classification of the cardiomyopathies: an American Heart Association Scientifi c Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–1816. https://doi.org/10.1161/circulationaha.106.174287
3. Sealove B.A., Tiyyagura S., Fuster V.J. Тakotsubo cardiomyopathy. J. Gen. Intern. Med. 2008;23(11):1904–1908. https://doi.org/10.1007/s11606-008-0744-4
4. Sato H., Tateishi H., Uchida T., et al. Takotsubo-type cardiomyopathy due to multivessel spasm. In: Kodama K., Haze K. Hom M, eds. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyouronsya Co.; 1990, p. 56–64. (In Japanese).
5. Tsushikashi K., Ueshima K., Uchida T. Transient left ventricular apical ballooning syndrome without coronary artery stenosis; a novel heart syndrome mimicking acute myocardial infarction. J. Amer. Coll. Cardiology. 2001;38(1):11–18. https://doi.org/10.1016/s0735-1097(01)01316-x
6. Desmet W.J., Adriaenssens B.F., Dens J.A. Apical ballooning of the left ventricle: first series in white patients. Heart. 2003;89(9):1027–1031. https://doi.org/10.1136/heart.89.9.1027
7. Gianni M., Dentali F., Grandi A.M., Sumner G., Hiralal R., Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur. Heart J. 2006;27(13):1523–1529. https://doi.org/10.1093/eurheartj/ehl032
8. Cimarelli S., Sauer F., Morel O., Ohlmann P., Constantinesco A., Imperiale A. Transient left ventricular dysfunction syndrome: Pathophysiological bases through nuclear medicine imaging. Int. J. Cardiol. 2010;144(2):212–218. https://doi.org/10.1016/j.ijcard.2009.04.025
9. Khallafi H., Chacko V., Varveralis N., Elmi F. “Broken heart syndrome”: catecholamine surge or aborted myocardial infarction? J. Invasive Cardiol. 2008;20(1):E9–13.
10. Pfister R., Erdmann E., Hoppe U.C. The Takotsubo syndrome-a psychosomatic cardiac complication? MMW Fortschr. Med. 2007;149(1–2):41–43.
11. Yilmaz Y. Apical ballooning syndrome: A metabolic form of cardiomyopathy? Med. Sci. Monit. 2008;14(6):HY9–12.
12. Finsterer J., Stollberger C., Sehnal E. et al. Apical ballooning (Takotsubo syndrome) in mitochondrial disorder during mechanical ventilation. J. Cardiovasc. Med (Hagerstown). 2007;8(10):859–863. https://doi.org/10.2459/JCM.0b013e3280103d1b
13. McGavock J.M., Lingvay I., Zib I.,Tillery T., Salas N., Unger R., et al. Cardiac steatosis in diabetes mellitus: a 1H-magnetic resonance spectroscopy study. Circulation. 2007;116(10):1170–1175. https://doi.org/10.1161/CIRCULATIONAHA.106.645614
14. Pilgrim T.M., Wyss T.R. Takotsubo cardiomyopathy or transient left ventricular ballooning syndrome. A systematic review. Int. J. Cardiol. 2008;124(3):283–292. https://doi.org/10.1016/j.ijcard.2007.07.002
15. Ito K., Sugihara H., Katoh S., Azuma A., Nakagawa M. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT-comparison with acute coronary syndrome. Ann. Nucl. Med. 2003;17(2):115–122. https://doi.org/10.1007/BF02988449
16. Bybee K.A., Prasad A., Barsness G.W., Lerman A., Jaffe A.S., Murphy J.G., Wright R.S., Rihal C.S. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am. J. Cardiol. 2004;94(3):343–346. https://doi.org/10.1016/j.amjcard.2004.04.030
17. Gianni M., Dentali F., Grandi A.M., Sumner G., Hiralal R., Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur. Heart J. 2006;27(13):1523–1529. https://doi.org/10.1093/eurheartj/ehl032
18. Eshtehardi P., Koestner S.C., Adorjan P., Windecker S., Meier B., Hess O.M., Wahl A., Cook S. Transient apical ballooning syndrome — clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int. J. Cardiol. 2009;135(3):370–375. https://doi.org/10.1016/j.ijcard.2008.03.088
19. von Korn H., Yu J., Lotze U. Ohlow M.-A., Huegl B., Schulte W., et al. Tako-Tsubo-like cardiomyopathy: specific ECG findings, characterization and clinical findings in a European single center. Cardiology. 2009;112(1):42–48. https://doi.org/10.1159/000137698
20. Mathew B., Villarreal D. Two unusual cases of Takotsubo cardiomyopathy. presenting with sudden cardiac death. Am. J. Med. Sci. 2009;337(6):473–475. https://doi.org/10.1097/MAJ.0b013e3181956f49
21. Bybee K.A., Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118(4):397–409. https://doi.org/10.1161/CIRCULATIONAHA.106.677625
22. Citro R., Previtali M., Bossone E. Tako-tsubo cardiomyopathy and drowning syndrome: is there a link? Chest. 2008;134(2):469. https://doi.org/10.1378/chest.08-0541
23. Radhakrishnan A., Granato J.E. An association between Takotsubo cardiomyopathy and thyroid storm. Postgrad. Med. 2009;121(3):126–130. https://doi.org/10.3810/pgm.2009.05.2012
24. Gelow J., Kruer M., Yadav V., Kaul S. Apical ballooning resulting from limbic encephalitis. Am. J. Med. 2009;122(6):583–586. https://doi.org/10.3810/pgm.2009.05.2012
25. Wakabayashi K., Dohi T., Daida H. Takotsubo cardiomyopathy associated with epilepsy complicated with giant thrombus. Int. J. Cardiol. 20011;148(2):e28–30.https://doi.org/10.1016/j.ijcard.2009.01.072
26. Uechi Y., Higa K. Recurrent takotsubo cardiomyopathy within a short span of time in a patient with hereditary motor and sensory neuropathy. Intern. Med. 2008;47(18):1609–1613. https://doi.org/10.2169/internalmedicine.47.1186
27. Punnam S.R., Gourineni N., Gupta V. Takotsubo cardiomyopathy in a patient with Addison disease. Int. J. Cardiol. 2010;144(2):e34–36. https://doi.org/10.1016/j.ijcard.2008.12.191
28. Gangadhar T.C. Von der Lohe E., Sawada S.G., Helft P.R. Takotsubo cardiomyopathy in a patient with esophageal cancer: a case report. J. Med. Case Reports. 2008;2:379. https://doi.org/10.1186/1752-1947-2-379
29. Mahida S., Dalageorgou C., Behr E.R. Long-QT syndrome and torsades de pointes in a patient with Takotsubo cardiomyopathy: an unusual case. Europace. 2009;11(3):376–378. https://doi.org/10.1093/europace/eun336
30. Skolnick A.H., Michelin K., Nayar A., Fisher D., Kronzon I. Transient apical ballooning syndrome precipitated by dobutamine stress testing. Ann. Intern. Med. 2009;150(7):501–502. https://doi.org/10.7326/0003-4819-150-7-200904070-00015
31. Jayawardena S., Sooriabalan D., Burzyantseva O., Sinnapunayagm S. Takotsubo cardiomyopathy in a 68-year-old Russian female. Cases J. 2008;1(1):64. https://doi.org/10.1186/1757-1626-1-64
32. Kawai S., Kitabatake A., Tomoike H. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ. J. 2007;71(6):990–992. https://doi.org/10.1253/circj.71.990
33. Dib C., Asirvatham S., Elesber A., Rihal C., Friedman P., Prasad A. Clinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy. Am. Heart J. 2009;157(5):933–938. https://doi.org/10.1016/j.ahj.2008.12.023
34. Jim M.H., Chan A.O., Tsui P.T. et al. A new ECG criterion to identify takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads. Heart Vessels. 2009;24(2):124–130. https://doi.org/10.1007/s00380-008-1099-9
35. Kimura S., Mitsuma W., Ito M., Suzuki H., Hosaka Y., Hirayama S., et al. Inverted Takotsubo contractile pattern caused by pheochromocytoma with tall upright T-waves, but not typical deep T-wave inversion. Int. J. Cardiol. 2008;139(2):e15–17. https://doi.org/10.1016/j.ijcard.2008.06.073
36. Sealove B.A., Tiyyagura S., Fuster V. Takotsubo cardiomyopathy. J. Gen. Intern. Med. 2008;23(11):1904–1908. https://doi.org/10.1007/s11606-008-0744-4
37. Ramaraj R., Sorrell V.L., Movahed M.R. Levels of troponin release can aid in the early exclusion of stressinduced (takotsubo) cardiomyopathy. Exp. Clin. Cardiol. 2009;14(1):6–8.
38. Kurisu S., Inoue I., Kawagoe T., Ishihara M., Shimatani Y., Nakama Y., et al. Prevalence of incidental coronary artery disease in tako-tsubo cardiomyopathy. Coron. Artery Dis. 2009;20(3):214–218. https://doi.org/10.1097/MCA.0b013e3283299260
39. Ostroumov E.N., Nudnov N.V., Artemova E.V., Khorikova E.N. Diagnosis of ampoule cardiomyopathy using myocardial perfusion tomoscintigraphy. Rossiiskii meditsinskii zhurnal = Medical Journal of the Russian Federation. 2006;(3):5–8. (In Russ.).
40. Mitchell J.H., Hadden T.B., Wilson J.M., Achari A., Muthupillai R., Flamm S.D. Clinical features of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Tackotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome). Am. J. Cardiology. 2007;100(2):296–301. https://doi.org/10.1016/j.amjcard.2007.02.091
41. Gorenek B., Kudaiberdieva G., Taraktas M., Cavusoglu Y., Timuralp B., Goktekin O., Ata N., Unalir A. Correlation between left ventricular ejection fraction and cardiac troponin T concentration is more pronounced in patients with nonischemic cardiomyopathy. J. Electrocardiology. 2007;40(4):S75. https://doi.org/10.1016/j.jelectrocard.2007.03.039
42. Sharkey S.W., Lesser J.R., Menon M., Parpart M., Maron M.S., Maron B.J. Spectrum and significance of electrocardiographic patterns, troponin levels, and thrombolysis in myocardial infarction frame count in patients with stress (tako-tsubo) cardiomyopathy and comparison to those in patients with ST-elevation anterior wall myocardial infarction. Am. J. Cardiol. 2008;101(12):1723–1728. https://doi.org/10.1016/j.amjcard.2008.02.062
43. Madhavan M., Borlaug B.A., Lerman A., Rihal C.S., Prasad A. Stress Hormone and Circulating Biomarker Profi le of Apical Ballooning Syndrome (Takotsubo Cardiomyopathy): Insights into the Clinical Significance of BNP and Troponin Levels. Heart. 2009;95(17):1436–1441. https://doi.org/10.1136/hrt.2009.170399
44. Yoshimura S., Toyoda K., Ohara T., Nagasawa H., Ohtani N., Kuwashiro T., Naritomi H., Minematsu K. Takotsubo cardiomyopathy in acute ischemic stroke. Ann. Neurol. 2008;64(5):547–554. https://doi.org/10.1002/ana.21459
45. Doust J.A., Glasziou P.P., Pietrzak E., Dobson A.J. A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Arch. Intern. Med. 2004;164(18):1978–1984. https://doi.org/10.1001/archinte.164.18.1978
46. Nef H.M., Molman H., Kostin S., Troidl C., Voss S., Weber M., et al. Takotsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after structural recovery. Eur. Heart J. 2007;28(20):2456–2464.https://doi.org/10.1093/eurheartj/ehl570
47. Okada T., Miyata S., Hashimoto K., Maie K., Mochizuki S. Takotsubo cardiomyopathy associated with torsades de pointes and long QT interval: a case report. J. Cardiol. 2007;50(1):83–88.
48. Haghi D., Papavassiliu T., Heggemann F., Kaden J.J., Borggrefe M., Suselbeck T. Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography. QJM. 2008;101(5):381–386. https://doi.org/10.1093/qjmed/hcn017
49. Limankina I.N. Tako Tsubo Cardiomyopathy. Vestnik of Atitmologii= Journal of Arrhythmology. 2009;(56):48–58. (In Russ.).
Supplementary files
Review
For citations:
Petrova M.V., Spassky A.A., Polyaev B.A., Mihaylov A.A. Takotsubo cardiomyopathy in athletes. Sports medicine: research and practice. 2024;14(2):68-78. (In Russ.) https://doi.org/10.47529/2223-2524.2024.2.2