A review of the presentation and outcome of Takotsubo cardiomyopathy in COVID-19

Submitted: November 30, 2020
Accepted: January 23, 2021
Published: March 23, 2021
Abstract Views: 6846
PDF: 2042
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Although the most frequent presentation of the novel Coronavirus disease-2019 (COVID-19) is a respiratory syndrome, cardiac involvement is being increasingly recognized. One such entity is Takotsubo cardiomyopathy. We sought to review the various cases of Takotsubo cardiomyopathy reported during the COVID-19 pandemic and consolidate the information available on its clinical features, evaluation and treatment. We performed a PubMed search using the MeSH terms “Takotsubo Cardiomyopathy” or “Stress Cardiomyopathy” and “COVID-19”, and identified 16 case reports, two case series, and one retrospective cohort study. There was a total of 24 reported patients with COVID-19 infection, who developed takotsubo cardiomyopathy, and two patients without COVID-19 who developed takotsubo cardiomyopathy due to the emotional stress associated with the global pandemic. The mean age of the patients was 67.19 years (SD 15.83) and 16(59.3%) were women. Chest pain was reported in only ten patients (38.46 %) and ST-elevation was seen in 11 patients (42.3%). While most patients had typical takotsubo cardiomyopathy, four patients had inverted(reverse) takotsubo cardiomyopathy, two had bi-ventricular involvement, one had median Takotsubo and another had global Takotsubo with apical sparing variant. Most patients had a positive outcome with complete or near-complete reversal of cardiac dysfunction at the time of discharge. Five deaths (19.23%) were reported. Takotsubo cardiomyopathy is a rare, but increasingly reported reversible cardiomyopathy that can be seen in patients with COVID-19 infection and the diagnosis must be actively sought for in these patients.

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Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of Novel coronavirus–infected pneumonia. N Engl J Med 2020; 382:1199–207. DOI: https://doi.org/10.1056/NEJMoa2001316
Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382:1708-1720 DOI: https://doi.org/10.1056/NEJMoa2002032
Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case surveillance — United States, January 22–May 30, 2020. Morb Mortal Wkly Rep. 2020; 69:759–65. DOI: https://doi.org/10.15585/mmwr.mm6924e2
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy. Circulation. 2008; 118:2754–62. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.767012
Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am Heart J. 2008; 155:408–17. DOI: https://doi.org/10.1016/j.ahj.2007.11.008
Sato M, Fujita S, Saito A, et al. Increased incidence of transient left ventricular apical ballooning (so-called `Takotsubo’ cardiomyopathy) after the mid-niigata prefecture earthquake. Circ J. 2006; 70:947–53. DOI: https://doi.org/10.1253/circj.70.947
Chadha S. “COVID-19 pandemic” anxiety-induced Takotsubo cardiomyopathy. QJM Mon J Assoc Physicians. 2020; 113:488–90. DOI: https://doi.org/10.1093/qjmed/hcaa135
Rivers J, Ihle JF. COVID-19 social isolation-induced Takotsubo cardiomyopathy. Med J Aust. 2020; 213:336-336.e1. DOI: https://doi.org/10.5694/mja2.50770
Nguyen D, Nguyen T, De Bels D, Castro Rodriguez J. A case of Takotsubo cardiomyopathy with COVID-19. Eur Heart J Cardiovasc Imaging. 2020 Sep 1;21(9):1052. DOI: https://doi.org/10.1093/ehjci/jeaa152
Bhattacharyya PJ, Attri PK, Farooqui W. Takotsubo cardiomyopathy in early term pregnancy: A rare cardiac complication of SARS-CoV-2 infection. BMJ Case Rep. 2020; 13: e239104. DOI: https://doi.org/10.1136/bcr-2020-239104
Jabri A, Kalra A, Kumar A, et al. Incidence of stress cardiomyopathy during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020; 3:e2014780. DOI: https://doi.org/10.1001/jamanetworkopen.2020.14780
Tsao CW, Strom JB, Chang JD, Manning WJ. COVID-19-associated stress (Takotsubo) cardiomyopathy. Circ Cardiovasc Imaging. 2020; 13:e011222. DOI: https://doi.org/10.1161/CIRCIMAGING.120.011222
Dave S, Thibodeau JT, Styrvoky K, Bhatt SH. Takotsubo cardiomyopathy in a coronavirus disease-2019–positive patient: A case report. AA Pract. 2020; 14:e01304. DOI: https://doi.org/10.1213/XAA.0000000000001304
Solano-López J, Sánchez-Recalde A, Zamorano JL. SARS-CoV-2, a novel virus with an unusual cardiac feature: Inverted Takotsubo syndrome. Eur Heart J. 2020; 41:3106. DOI: https://doi.org/10.1093/eurheartj/ehaa390
Faqihi F, Alharthy A, Alshaya R, et al. Reverse Takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: A case-report. BMC Cardiovasc Disord. 2020 26; 20:389.
Hegde S, Khan R, Zordok M, Maysky M. Characteristics and outcome of patients with COVID-19 complicated by Takotsubo cardiomyopathy: Case series with literature review. Open Heart. 2020; 7:e001360. DOI: https://doi.org/10.1136/openhrt-2020-001360
Minhas AS, Scheel P, Garibaldi B, et al. Takotsubo syndrome in the setting of COVID-19. JACC Case Rep. 2020; 2:1321–5. DOI: https://doi.org/10.1016/j.jaccas.2020.04.023
Sala S, Peretto G, Gramegna M, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020; 41:1861–2. DOI: https://doi.org/10.1093/eurheartj/ehaa286
Pasqualetto MC, Secco E, Nizzetto M, et al. Stress cardiomyopathy in COVID-19 disease. Eur J Case Rep Intern Med. 2020; 7: 001718.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020; 323:1061–9. DOI: https://doi.org/10.1001/jama.2020.1585
Mishra AK, Lal A, Sahu KK, et al. Quantifying and reporting cardiac findings in imaging of COVID-19 patients. Monaldi Arch Chest Dis. 2020; 90. DOI: https://doi.org/10.4081/monaldi.2020.1394
Veillet-Chowdhury M, Hassan SF, Stergiopoulos K. Takotsubo cardiomyopathy: A review. Acute Card Care. 2014; 16:15–22. DOI: https://doi.org/10.3109/17482941.2013.869346
Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020; 181:271-280.e8. DOI: https://doi.org/10.1016/j.cell.2020.02.052
Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020; 17:1463–71. DOI: https://doi.org/10.1016/j.hrthm.2020.05.001
Papanikolaou J, Tsolaki V, Makris D, Zakynthinos E. Early levosimendan administration may improve outcome in patients with subarachnoid hemorrhage complicated by acute heart failure. Int J Cardiol. 2014; 176:1435–7. DOI: https://doi.org/10.1016/j.ijcard.2014.08.039
Mrozek S, Srairi M, Marhar F, et al. Successful treatment of inverted Takotsubo cardiomyopathy after severe traumatic brain injury with milrinone after dobutamine failure. Heart Lung J Crit Care. 2016; 45:406–8. DOI: https://doi.org/10.1016/j.hrtlng.2016.06.007
Santoro F, Ieva R, Ferraretti A, et al. Hemodynamic effects, safety, and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: Results from a multicenter registry. Cardiovasc Ther. 2016; 34:161–6. DOI: https://doi.org/10.1111/1755-5922.12182
Isogai T, Matsui H, Tanaka H, et al. Early β-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy. Heart Br Card Soc. 2016; 102:1029–35. DOI: https://doi.org/10.1136/heartjnl-2015-308712
Mishra AK, Lal A, Sahu KK, Sargent J. Cardiovascular factors predicting poor outcome in COVID-19 patients. Cardiovasc Pathol. 2020; 49:107246. DOI: https://doi.org/10.1016/j.carpath.2020.107246
Mishra AK, Sahu KK, George AA, Lal A. A review of cardiac manifestations and predictors of outcome in patients with COVID – 19. Heart Lung. 2020; 49:848–52. DOI: https://doi.org/10.1016/j.hrtlng.2020.04.019
Roca E, Lombardi C, Campana M, et al. Takotsubo syndrome associated with COVID-19. Eur J Case Rep Intern Med. 2020; 7(5): 001665. DOI: https://doi.org/10.12890/2020_001665
Meyer P, Degrauwe S, Van Delden C, et al. Typical Takotsubo syndrome triggered by SARS-CoV-2 infection. Eur Heart J. 2020;41:1860. DOI: https://doi.org/10.1093/eurheartj/ehaa306
Taza F, Zulty M, Kanwal A, Grove D. Takotsubo cardiomyopathy triggered by SARS-CoV-2 infection in a critically ill patient. BMJ Case Rep. 2020;13:e236561 . DOI: https://doi.org/10.1136/bcr-2020-236561
Moderato L, Monello A, Lazzeroni D, et al. [Takotsubo syndrome during SARS-CoV-2 pneumonia: a possible cardiovascular complication]. G Ital Cardiol (2006). 2020; 21:417–20.
Dabbagh MF, Aurora L, D’Souza P et al. Cardiac tamponade secondary to COVID-19. JACC Case Rep. 2020; 2:1326–30. DOI: https://doi.org/10.1016/j.jaccas.2020.04.009
Faqihi F, Alharthy A, Alshaya R, et al. Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report. BMC Cardiovasc Disord. 2020; 20:389. DOI: https://doi.org/10.1186/s12872-020-01665-0
Oyarzabal L, Gómez-Hospital JA, Comin-Colet J. Tako-tsubo syndrome associated with COVID-19. Rev Espanola Cardiol Engl Ed. 2020; 73:846. DOI: https://doi.org/10.1016/j.recesp.2020.06.022

How to Cite

John, Kevin, Amos Lal, and Ajay Mishra. 2021. “A Review of the Presentation and Outcome of Takotsubo Cardiomyopathy in COVID-19”. Monaldi Archives for Chest Disease 91 (3). https://doi.org/10.4081/monaldi.2021.1710.