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Myocarditis I: Introduction01:21

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Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Cardiomyopathy I: Introduction and Classification01:25

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Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
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Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy.

Caroline Scally1, Amelia Rudd2, Alice Mezincescu2

  • 1Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.). carolinescally@abdn.ac.uk.

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Summary

Takotsubo cardiomyopathy, often linked to stress, can lead to long-term heart failure symptoms and impaired cardiac function, even after initial recovery. This study reveals persistent dysfunction in patients long after the initial event.

Keywords:
broken heart syndromecardiac energeticscardiopulmonary exercise testingstress-induced cardiomyopathytakotsubo

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Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Heart Failure Research

Background:

  • Takotsubo cardiomyopathy (TTC), an acute heart failure syndrome, is triggered by emotional stress.
  • While initial recovery of left ventricular ejection fraction is common, long-term consequences remain unclear.

Purpose of the Study:

  • To investigate the long-term clinical and functional outcomes of takotsubo cardiomyopathy.
  • To assess persistent cardiac dysfunction and heart failure phenotype in prior TTC patients.

Main Methods:

  • An observational case-control study involving 37 TTC patients (>12 months post-event) and 37 matched controls.
  • Utilized questionnaires (Minnesota Living with Heart Failure), cardiopulmonary exercise testing, echocardiography, and cardiac MRI with 31P-spectroscopy.

Main Results:

  • 88% of TTC patients reported persistent heart failure symptoms and exercise limitations.
  • Impaired cardiac deformation (reduced strain), elevated native T1 mapping, and reduced cardiac energetics (phosphocreatine/ATP ratio) were observed in TTC patients.
  • Despite normal ejection fraction and biomarkers, significant subclinical cardiac dysfunction was evident.

Conclusions:

  • Takotsubo cardiomyopathy results in long-lasting clinical consequences, contrary to prior perceptions.
  • Patients develop persistent symptomatic and functional impairment with subclinical cardiac dysfunction.
  • A long-term heart failure phenotype is established after takotsubo cardiomyopathy.