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Review
. 2021 May 26;3(10):1249-1256.
doi: 10.1016/j.cjco.2021.05.011. eCollection 2021 Oct.

Takotsubo Syndrome During the COVID-19 Pandemic: State-of-the-Art Review

Gassan Moady  1   2 , Shaul Atar  1   2
Affiliations
Review

Takotsubo Syndrome During the COVID-19 Pandemic: State-of-the-Art Review

Gassan Moady et al. CJC Open. .

Abstract
in English, French

The current coronavirus disease 2019 (COVID-19) presents an ongoing medical challenge, as it involves multiple organs, including the cardiovascular system. Takotsubo syndrome (TTS) has been described in the context of COVID-19 in 2 different scenarios: as a direct complication of the infection, and as an indirect outcome secondary to the psychological burden of quarantine and social isolation (ie, stress-induced cardiomyopathy). Confirming the diagnosis of TTS in COVID-19 may be challenging due to the limited use of coronary angiography consistent with the recommended guidelines aimed at minimizing contact with infected individuals. The use of natriuretic peptide as a diagnostic and prognostic marker in this context may not be reliable as this peptide is already elevated in severe cases of COVID-19 regardless of TTS diagnosis. A relatively high incidence of complications has been reported in these cases, probably related to the severity of the underlying infectious disease. Although quarantine-induced stress cardiomyopathy is an unsurprising outcome of the powerful stress resulting from the current pandemic, conflicting results have been reported, and further studies are encouraged to determine the true incidence.

La maladie à coronavirus 2019 (COVID-19) qui sévit actuellement représente un défi médical continu, car elle touche plusieurs organes, dont l'appareil cardiovasculaire. Le syndrome de Takotsubo a été décrit dans le contexte de la COVID-19 en fonction de deux scénarios différents : en tant que complication directe de l'infection et comme conséquence indirecte secondaire du fardeau psychologique imposé par la quarantaine et l'isolement social (c'est-à-dire une cardiomyopathie induite par le stress). La confirmation du diagnostic de syndrome de Takotsubo dans les cas de COVID-19 peut s'avérer difficile en raison du recours limité à la coronarographie, conformément aux recommandations visant à réduire au minimum les contacts avec les personnes infectées. L'utilisation du peptide natriurétique comme marqueur diagnostique et pronostique dans ce contexte peut ne pas être fiable, car le taux de ce peptide est déjà élevé dans les cas sévères de COVID-19, indépendamment du diagnostic de syndrome de Takotsubo. Une incidence relativement élevée de complications a été signalée dans ces cas, probablement liée à la sévérité de la maladie infectieuse sous-jacente. Bien que la cardiomyopathie de stress provoquée par la quarantaine soit un résultat peu étonnant du stress puissant associé à la pandémie actuelle, des résultats contradictoires ont été rapportés; il serait donc bon de mener des études supplémentaires pour en déterminer la véritable incidence.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Image, graphical abstract
Graphical abstract
Figure 1
Figure 1
Suggested algorithm for managing patients with suspected Takotsubo syndrome (TTS) who also have COVID-19. CAD, coronary artery disease; CT, computed tomography; ECG, electrocardiogram; InterTAK, International Takotsubo Registry; LV, left ventricular. WMA, wall motion abnormality.
See this image and copyright information in PMC

References

    1. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–548. - PubMed
    1. Tmplin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929–938. - PubMed
    1. 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. - PubMed
    1. 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;39:2032–2046. - PMC - PubMed
    1. Medina de Chazal H, Del Buono MG, Keyser-Marcus L, et al. Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72:1955–1971. - PMC - PubMed

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