Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases.

• Authors: Sandeep Singh, Amsterdam University; Rupak Desai, Atlanta VA Medical Center; Zainab Gandhi, Geisinger Community Medical Center; Hee Kong Fong, University of California Davis; Shriya Doreswamy, Vydehi Institute of Medical Sciences and Research Centre; Virmitra Desai, University of North Texas; Anand Chockalingam, University of Missouri; Puja Mehta, Emory University; Rajesh Sachdeva, Emory University; Gautam Kumar, Emory University
• Journal Title: SN Compr Clin Med
• Volume: Volume 2, Number 11
• Publisher: Nature | 2020, Pages 2102-2108
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s42399-020-00557-w
• Subjects: Health Sciences, Public Health; Biology, Virology
• Keywords: Apical ballooning syndrome; Broken heart syndrome; COVID-19; SARS-CoV-2; Takotsubo cardiomyopathy; Takotsubo syndrome

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.