Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases
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COVID-19
Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases Sandeep Singh 1 & Rupak Desai 2 & Zainab Gandhi 3 & Hee Kong Fong 4 & Shriya Doreswamy 5 & Virmitra Desai 6 & Anand Chockalingam 7 & Puja K. Mehta 8 & Rajesh Sachdeva 2,9,10 & Gautam Kumar 2,8 Accepted: 24 September 2020 # The Author(s) 2020
Abstract Takotsubo syndrome (TTS) is caused by catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed/Medline, SCOPUS, Web of Science, and Google Scholar databases to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, clinical attributes, and outcomes. There are 12 cases reported of TTS associated with COVID-19 infection with mean age of 70.8 ± 15.2 years (range 43–87 years) with elderly (66.6% > 60 years) female (66.6%) majority. The time interval from the first symptom to TTS was 8.3 ± 3.6 days (range 3–14 days). Out of 12 cases, 7 reported apical ballooning, 4 reported basal segment hypo/akinesia, and 1 reported median TTS. Out of 12 cases, during hospitalization, data on left ventricular ejection fraction (LVEF) was reported in only 9 of the cases. The mean LVEF was 40.6 ± 9.9% (male, 46.7 ± 5.7%, and female, 37.7 ± 10.6%). Troponin was measured in all 12 cases and was elevated in 11 (91.6%) without stenosis on coronary angiography except one. Out of 11 cases, 6 developed cardiac complications with 1 case each of cardiac tamponade, heart failure, myocarditis, hypertensive crisis, and cardiogenic shock in 2. Five patients required intubation, 1 patient required continuous positive airway pressure, and 1 patient required venovenous extracorporeal membrane oxygenation. The outcome was reported in terms of recovery in 11 (91.6%) out of 12 cases, and a successful recovery was noted in 10 (90.9%) cases. COVID-19-related TTS has a higher prevalence in older women. Despite a lower prevalence of cardiac comorbidities in COVID-19 patients, direct myocardial injury, inflammation, and stress may contribute to TTS with a high complication rate. Keywords COVID-19 . SARS-CoV-2 . Takotsubo syndrome . Takotsubo cardiomyopathy . Apical ballooning syndrome . Broken heart syndrome
Sandeep Singh and Rupak Desai contributed equally to this work. This article is part of the Topical Collection on Covid-19 * Gautam Kumar [email protected] 1
2
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, AMC, Amsterdam, Netherlands Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA
5
Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
6
University of North Texas Health Science Center, Fort Worth, TX, USA
7
Division of Cardiology, University of Missouri Health Care, Columbia, MO, USA
8
Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
3
Department of Internal Medicine, Geisinger Community Medical Center, Scranton, PA, USA
9
Division of Cardiology,
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