Recent studies have suggested a pathogenetic link between impaired mitochondria and Takotsubo syndrome (TTS), which is closely connected with catecholamine overstimulation, poor outcomes, and changes in lipid metabolism. We investigated the changes in lipid metabolism at the level of fatty acid β-oxidation and changes in the intracellular lipidomic spectrum. The immortalized cell line of HL-1 cardiomyocytes was used in this study as an established in vitro model of TTS. The cells were exposed to the non-selective β-agonist isoprenaline (ISO) for acute (2 h) and prolonged (24 h) periods. We investigated the impact on mitochondrial adenosine 5'-triphosphate (ATP) production and β-oxidation using real-time cell metabolic analysis, total lipid content, and changes in the lipidomic spectrum using high-performance liquid chromatography (HPLC) and mass spectrometry. Furthermore, modifications of selected lipid transporters were determined using real-time - polymerase chain reaction (RT-PCR) and/or Western blot techniques. By choosing this wide range of targets, we provide a detailed overview of molecular changes in lipid metabolism during catecholamine overstimulation. The present study demonstrates that acute exposure to ISO decreased ATP production by up to 42.2%, and prolonged exposure to ISO decreased β-oxidation by 86.4%. Prolonged exposure to ISO also increased lipid accumulation by 4%. Lipid spectrum analysis of prolonged exposure to ISO showed a reduced concentration of cardioprotective and an increased concentration of lipotoxic lipid molecules during long-term exposure. Decreased lipid utilization can lead to higher intracellular lipid accumulation and the formation of lipotoxic molecules. Changes in the lipid spectrum can induce pathophysiological signaling pathways leading to cardiomyocyte remodeling or apoptosis. Thus, changes in lipid metabolism induced by excessive doses of catecholamines may cause TTS and contribute to a progression of heart failure, which is at increased risk after a TTS episode.

• Klíčová slova
• cardiomyocyte, fatty acid, isoprenaline, lipid, metabolism, mitochondria, takotsubo,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Takotsubo syndrome (TTS), also known as stress cardiomyopathy or "broken heart" syndrome, is a mysterious condition that often mimics an acute myocardial infarction. Both are characterized by left ventricular systolic dysfunction. However, this dysfunction is reversible in the majority of TTS patients. PURPOSE: Recent studies surprisingly demonstrated that TTS, initially perceived as a benign condition, has a long-term prognosis akin to myocardial infarction. Therefore, the health consequences and societal impact of TTS are not trivial. The pathophysiological mechanisms of TTS are not yet completely understood. In the last decade, attention has been increasingly focused on the putative role of the central nervous system in the pathogenesis of TTS. CONCLUSION: In this review, we aim to summarize the state of the art in the field of the brain-heart axis, regional structural and functional brain abnormalities, and connectivity aberrancies in TTS.

• Klíčová slova
• Amygdala, Brain connectivity, Brain–heart axis, Insular cortex, Takotsubo syndrome,
• MeSH
• autonomní nervový systém MeSH
• lidé MeSH
• mozek MeSH
• prognóza MeSH
• takotsubo kardiomyopatie * etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

AIMS: Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. METHODS AND RESULTS: Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002). CONCLUSIONS: The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.

• Klíčová slova
• Acute respiratory insufficiency, Broken heart syndrome, Chronic obstructive pulmonary disease, InterTAK Registry, Outcome, Takotsubo syndrome,
• MeSH
• analýza přežití MeSH
• kardiogenní šok MeSH
• lidé MeSH
• prognóza MeSH
• registrace MeSH
• takotsubo kardiomyopatie * komplikace   diagnóza   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIMS: We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS: We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS: Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

• Klíčová slova
• Acute heart failure, Broken heart syndrome, Cardiac arrest, Outcome, Takotsubo syndrome,
• MeSH
• analýza přežití MeSH
• lidé středního věku MeSH
• lidé MeSH
• prognóza MeSH
• registrace MeSH
• retrospektivní studie MeSH
• srdeční zástava diagnóza   epidemiologie   etiologie   mortalita   MeSH
• takotsubo kardiomyopatie komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

BACKGROUND: Acute ST-elevation myocardial infarction in patients with normal coronary arteries has previously been described, but coronary angiography in these patients was performed after the acute phase of the infarction. It is possible that these patients did not have normal angiograms during the acute phase (transient coronary thrombosis or spasm were usually suspected to be the cause). Information on the prevalence of truly normal coronary angiograms during the acute phase of a suspected ST-elevation myocardial infarction is lacking. PATIENTS AND METHODS: The Primary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis-1 (PRAGUE-1) and PRAGUE-2 studies enrolled 1150 patients with ST-elevation acute myocardial infarction, in whom 625 coronary angiograms were performed within 2 h of the initial electrocardiogram. A simultaneous registry included an additional 379 coronary angiograms performed during the ST-elevation phase of a suspected myocardial infarction. Thus, a total of 1004 angiograms were retrospectively analyzed. A normal coronary angiogram was defined as one with the absence of any visible angiographic signs of atherosclerosis, thrombosis or spontaneous spasm. RESULTS: Normal coronary angiograms were obtained for 26 patients (2.6%). Among these, the diagnosis at discharge was a small myocardial infarction in seven patients (0.7%), acute (peri)myocarditis in five patients, dilated cardiomyopathy in four patients, hypertension with left ventricular hypertrophy in three patients, pulmonary embolism in two patients and misinterpretation of the electrocardiogram (ie, no cardiac disease) in five patients. Seven patients with small infarctions underwent angiography within 30 min to 90 min of complete relief of the signs of acute ischemia, and thus, angiograms during pain were not taken. None of the 898 patients catheterized during ongoing symptoms of ischemia had a normal coronary angiogram. Spontaneous coronary spasm as the only cause (without underlying coronary atherosclerosis) for the evolving infarction was not seen among these 898 patients. Thus, the causes of the seven small infarcts in patients with normal angiograms remain uncertain. CONCLUSIONS: The observed prevalence of normal coronary angiography in patients presenting with acute chest pain and ST elevations was 2.6%. Most of these cases were misdiagnoses, not infarctions. A normal angiogram during a biochemically confirmed infarction is extremely rare (0.7%) and was not seen during the ongoing symptoms of ischemia.

HISTORIQUE: On a déjà décrit des infarctus du myocarde avec surélévation du segment ST chez des patients aux artères coronaires saines, mais la coronarographie avait été effectuée après la phase aiguë de l’infarctus. Estil possible que la coronarographie n’ait pas été normale pendant la phase aiguë (on présumait généralement une thrombose coronaire transitoire ou des spasmes). On ne possède pas d’information sur la prévalence d’une coronarographie vraiment normale pendant la phase aiguë d’une présomption d'infarctus du myocarde avec surélévation du segment ST. PATIENTS ET MÉTHODOLOGIE: Dans le cadre des études PRAGUE-1 et PRAGUE-2 sur l’angioplastie primaire de patients transférés d’un hôpital général à une unité spécialisée de coronaropathie percutanée transluminale, on a enrôlé 1 150 patients ayant un infarctus aigu du myocarde avec surélévation du segment ST, chez qui 625 coronarographies ont été effectuées dans les deux heures suivant le premier électrocardiogramme. Un registre simultané contenait 379 autres coronarographies exécutées pendant la phase de surélévation du segment ST d’une présomption d’infarctus du myocarde. Ainsi, au total, 1 004 coronarographies ont fait l’objet d’une analyse rétrospective. Une coronarographie normale était définie comme un examen ne comportant aucun signe angiographique visible d’artériosclérose, de thrombose ou de spasme spontané. RÉSULTATS: On a obtenu des coronarographies normales auprès de 26 patients (2,6 %). De ce nombre, à leur congé, sept patients avaient un diagnostic de petit infarctus du myocarde (0,7 %) au congé, cinq patients, une (péri)myocardite, quatre patients, une myocardiopathie dilatée, trois patients, une hypertension accompagnée d’une hypertrophie ventriculaire gauche, deux patients, une embolie pulmonaire et cinq patients, une mauvaise interprétation de l’électrocardiogramme (c'est-à-dire, pas de maladie cardiaque). Les sept patients ayant un petit infarctus ont subi une angiographie de 30 à 90 minutes après le soulagement complet des signes d’ischémie aiguë, et non pendant la douleur. Aucun des 898 patients ayant subi un cathétérisme pendant des symptômes d’ischémie ne présentait de coronarographie normale. Chez ces 898 patients, on n’a observé aucun cas de spasme coronaire spontané (sans artériosclérose coronarienne sous-jacente) expliquant l’infarctus en évolution. Ainsi, les causes des petits infarctus chez les sept patients ayant une angiographie normale ne sont pas claires. CONCLUSIONS: On a observé une prévalence de 2,6 % de coronarographies normales chez les patients ayant des douleurs thoraciques aiguës et une surélévation du segment ST. La plupart de ces cas étaient des mauvais diagnostics et non des infarctus. Il est extrêmement rare de constater une coronarographie normale pendant un infarctus confirmé biologiquement (0,7 %), et on n’en a pas observé pendant les symptômes continus d’ischémie.

• MeSH
• balónková koronární angioplastika MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• echokardiografie MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční MeSH
• infarkt myokardu diagnóza   diagnostické zobrazování   patofyziologie   terapie   MeSH
• koronární angiografie * MeSH
• kreatinkinasa, forma MB krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prevalence MeSH
• převodní systém srdeční diagnostické zobrazování   patologie   patofyziologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tepový objem MeSH
• troponin krev   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• biologické markery MeSH
• kreatinkinasa, forma MB MeSH
• troponin MeSH