Article

5 Iconography
@@#100319@@
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text
Advertising


Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates



@@#116300@@

Archives of cardiovascular diseases
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 24 janvier 2020
Doi : 10.1016/j.acvd.2019.11.005
Received : 1 August 2019 ;  accepted : 13 November 2019
Incidence, clinical features and outcome of Takotsubo syndrome in the intensive care unit
Incidence, caractéristiques cliniques et pronostic du syndrome de Takotsubo en réanimation
 

Denis Doyen a, b, , Sébastien Moschietto c, Fabien Squara b, Pamela Moceri b, Hervé Hyvernat a, Emile Ferrari b, Jean Dellamonica a, Gilles Bernardin a
a Medical Intensive Care Unit, Archet 1 University Hospital, 06200 Nice, France 
b Department of Cardiology, Pasteur University Hospital, 06000 Nice, France 
c General Intensive Care Unit, Avignon Hospital, 84000 Avignon, France 

Corresponding author. Medical Intensive Care Unit, Archet 1 University Hospital, 151, route Saint-Antoine-de-Ginestière, 06200 Nice, France.Medical Intensive Care Unit, Archet 1 University Hospital151, route Saint-Antoine-de-GinestièreNice06200France
Graphical abstract




The full text of this article is available in PDF format.
Summary
Background

Most diseases encountered in the intensive care unit are associated with major stress that can potentially trigger Takotsubo syndrome. Many severe cardiovascular complications are associated with Takotsubo syndrome, yet little is known about Takotsubo syndrome in the intensive care unit.

Aims

We sought to determine the incidence of Takotsubo syndrome, and to describe its clinical features and outcome in an intensive care unit.

Methods

This prospective single-centre study included all patients admitted consecutively over a 12-month period who had transthoracic echocardiography, electrocardiography and a troponin I assay performed on admission, at 24 and 48hours after admission, and at discharge and in the case of clinical worsening.

Results

The incidence of Takotsubo syndrome was 4.6% (13/280 patients) and female sex predominated (69.2%). The median age of the subgroup with Takotsubo syndrome was 64 (56–72) years. Pulmonary disease and sepsis were the most frequent triggers (46.2% and 38.5%, respectively). Median left ventricular ejection fraction was 29.0% (20.0–37.0). Patients with Takotsubo syndrome presented with shock and arrhythmias and needed ventilation more frequently than patients without Takotsubo syndrome (69.2% vs. 36.3%, P =0.035; 46.2% vs. 13.5%, P =0.006; and 92.3% vs. 60.7%, P =0.021), but mortality rates were similar. The median delay to cardiac index recovery, when impaired, was 2.0 (1.0–2.75) days, and that of left ventricular ejection fraction was 12.5 (7–14.75) days.

Conclusion

Takotsubo syndrome in the intensive care unit is not uncommon and is associated with substantial haemodynamic and respiratory instability. New-onset arrhythmias and respiratory and haemodynamic worsening could arouse suspicion of and prompt screening for Takotsubo syndrome in the intensive care unit.

The full text of this article is available in PDF format.
Résumé
Contexte

La plupart des pathologies rencontrées en réanimation est associée à un stress majeur pouvant potentiellement déclencher un syndrome de Takotsubo (STT) responsable de nombreuses complications cardio-vasculaires. Peu de données existent concernant les STT en réanimation.

Buts

Déterminer l’incidence du STT, ses caractéristiques cliniques et son pronostic en réanimation.

Méthodes

Il s’agit une étude prospective monocentrique. Pour tous les patients admis consécutivement pendant 12 mois ont été pratiqués une échocardiographie transthoracique, un électrocardiogramme et un dosage de troponine I à l’admission, 24 et 48heures après l’admission, à la sortie du patient et en cas de dégradation clinique.

Résultats

L’incidence de STT a été de 4,6 % (13 patients sur 280). Le sexe féminin était prédominant (69,2 %). L’âge médian était de 64 (56,0–71,5) ans. Les pathologies pulmonaires et les sepsis représentaient les facteurs déclenchant les plus fréquents (46,2 % et 38,5 %, respectivement). La fraction d’éjection ventriculaire gauche (FEVG) médiane était de 29,0 % (20,0–37,0 %). Les STT ont présenté plus d’état de choc, d’arythmies et de recours à la ventilation que les autres patients (69,2 % vs 36,3 %, 46,2 % vs 13,5 % et 92,3 % vs 60,7 %; p =0,035, p =0,006 et p =0,021, respectivement) mais avec une mortalité similaire. Le délai de récupération du débit cardiaque était de 2,0 (1–2,75) jours, et celui de la FEVG 12,5 (7–14,75) jours.

Conclusions

Le STT en réanimation n’est pas rare et est associé à une instabilité hémodynamique et respiratoire importante. La survenue d’arythmies, d’une dégradation respiratoire ou hémodynamique peut faire suspecter la survenue d’un STT.

The full text of this article is available in PDF format.

Keywords : Takotsubo syndrome, Incidence, Intensive care unit, Shock, Arrhythmia

Mots clés : Syndrome de Takotsubo, Incidence, Réanimation, Choc, Arythmie

Abbreviations : ACS, BNP, ESC, ICU, LVEF, MRI, TTE, TTS




© 2020  Elsevier Masson SAS. All Rights Reserved.
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Close
Article Outline