Takotsubo syndrome: a call to action.

Catheterization and Cardiovascular Interventions 82:914 (2013) Editorial Comment Takotsubo Syndrome: a Call to Action Jonathan Tobis,* MD , FSCAI Prof. of Medicine/Cardiology UCLA In this issue of CCI, Angulo-Llanos and coworkers describe an unusual presentation of Takotsubo Cardio- myopathy in a 71-year old woman who developed an apparent embolus to the mid right coronary artery (RCA) 12 h after presentation. They speculate that a thrombus embolized from the apical akinetic left ven- tricle to the RCA. There is some uncertainty because the patient also developed atrial fibrillation for 10 h before the infarction occurred. I chose to write an edi- torial about this case because I wanted to highlight the condition of Takotsubo cardiomyopathy and discuss how the interventional cardiology community might work together to shed some light on the etiology and pathophysiology of this poorly understood problem. We have all seen sporadic cases of Takotsubo Syn- drome, but very few people have acquired a large se- ries to make any definitive statements. It is time that interventional cardiologists begin to spend more time to try and figure out why this happens and how best to treat it. Paolo Angelini at the Texas Heart Institute has an interesting hypothesis that Takotsubo Syndrome is caused by intense vasospasm of all of the major epicar- dial coronary vessels. He has a series of 35 patients with angiograms before and after infusion of acetylcho- line to demonstrate spasm in the coronaries. If all three vessels are involved, one sees the typical pattern of ap- ical ballooning. Other patterns of LV dysfunction are associated with other distributions of coronary spasm. The endothelial dysfunction is transient and is only present for about 2 weeks. We do not know if this pat- tern is present in all or most cases of Takotsubo Syn- drome, and it is not known what the trigger of this intense spasm may be. Emotional stress is present in many of the patients, but not all. It is often stated that catecholamine levels are high in these patients, but there is documentation of this statement in only one case report. In fact, the inotropic support used in this patient, may have exacerbated her coronary spasm and could have precipitated the development of in situ thrombus in the RCA, so it may not have been due to an embolus from the LV or the Left atrium. Jeffrey C 2013 Wiley Periodicals, Inc. V Schussler from Baylor University, one of this year’s society of cardiac angiography and interventions (SCAI) emerging leaders and mentors (ELM) program recipients, is actively involved in generating a registry of these patients and the variety of his observations are quite unusual. In association with Dr. Angelini and Dr. Schussler, we are trying to develop a web based system that will act as a repository and registry for Takotsubo Syn- drome cases from all over the world. We are asking for clinicians to participate in this nonfunded registry so that we may learn more about Takotsubo Syndrome and eventually develop more sound recommendations for how best to treat it. For those of you who are inter- ested in helping out with this project, please contact Dr. Angelini, Dr. Schussler, or myself at the email addresses below. We can send you a copy of the proto- col and consent form for you to use as a template for your investigational review board (IRB). For those of you who may not be able to participate with the acetyl- choline infusions, you can still participate in the regis- try with Dr. Schussler by contacting him at the email address below. ACKNOWLEDGMENT The author acknowledges Paolo Angelini, MD (Texas Heart Institute, Cardiology; pangelini@ leachmancardiology.com) and Jeffrey Schussler, MD (Baylor University, Cardiology; Jeffrey.Schussler@ baylorhealth.edu). Conflict of interest: Nothing to report. *Correspondence to: Jonathan Tobis; BL-394 CHS UCLA, Box 951717, Los Angeles, California 90095. E-mail: jtobis@mednet.ucla.edu Received 13 September 2013; Revision accepted 14 September DOI: 10.1002/ccd.25214 Published online 5 November 2013 in Wiley Online Library (wileyonlinelibrary.com)