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. 2021 Jan 1:138:118-120.
doi: 10.1016/j.amjcard.2020.10.005. Epub 2020 Oct 9.

Takotsubo Syndrome in Coronavirus Disease 2019

Christian Templin  1 , Robert Manka  2 , Victoria Lucia Cammann  3 , Konrad Andreas Szawan  3 , Alexander Gotschy  2 , Mihaly Karolyi  4 , Stephan Winnik  3 , Holger Moch  5 , Philippe Meyer  6 , Antonella Moreo  7 , Eduardo Bossone  8 , Fabrizio D'Ascenzo  9 , Gioel Gabrio Secco  10 , Massimo Mancone  11 , Fabio Infusino  11 , Luca Gaido  12 , Massimo Giammaria  12 , Ilan S Wittstein  13 , Zsuzsanna Varga  5 , Jelena R Ghadri  3
Affiliations

Takotsubo Syndrome in Coronavirus Disease 2019

Christian Templin et al. Am J Cardiol. .
No abstract available

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Figures

Figure 1
Figure 1
Electrocardiography (ECG; top row), left ventriculography (second row), and cardiac magnetic resonance images (CMR; fourth row) from patients with TTS, COVID-19, and COVID-19+TTS. Coronary angiography (third row) showed unobstructed coronary arteries in all 3 patients. The CMR images display the 2-chamber cine frame; the basal, mid-ventricular, and apical T2 maps, and the T2 bulls eye plot. In-hospital outcomes (including death or ventilation) are also summarized (bottom left). Routine hematoxylin and eosin (H&E) stained section of the posterior myocardial wall from a COVID-19+TTS patient (autopsy heart specimen; bottom right). First column: TTS patients show deep negative T-waves and prolonged QTc time on ECG. Left ventriculography shows classical apical ballooning with compensatory hypercontractility of the basal segments. CMR with edema sensitive T2-mapping showed normal T2 values in the basal segments and edema of the mid-ventricular and apical segments (T2 z-score mid-ventricular and apical: 4 and 8). Second column: COVID-19 patient with ST-segment elevation in I, aVL, V5, and V6, with normal QTc time on ECG. Left ventriculography shows mildly-reduced left ventricular ejection fraction with infero- and antero-lateral basal hypokinesia. CMR demonstrates diffusely elevated T2 values that are accentuated in the hypokinetic segments (infero-lateral basal, T2 z-score: 5). Third column: COVID-19 TTS patients show significant ST-elevations in the septal and anterior chest leads on ECG after 3 weeks of intensive care treatment (including mechanical ventilation for acute respiratory distress syndrome). Left ventriculography shows rapid deterioration of left ventricular function with TTS wall motion pattern. Representative CMR shows excessively high T2 values over the entire myocardium, indicating global edema with peak values in the apical segments (T2 z-score: 9). The myocardial fibers show loss of cross-striations and nuclei are not visible in most areas. Most fibers display several irregularly shaped wavy contractions extending across the myocardial fibers (arrows). Some congested small capillaries can be observed in the interstitial space with increased mononuclear cells.
See this image and copyright information in PMC

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