Probable protective role of diabetes mellitus in takotsubo cardiomyopathy: a review

Abstract

Takotsubo cardiomyopathy (TC) is a syndrome that predominantly affects postmenopausal women and is characterized by transient regional systolic dysfunction of the left ventricle which occurs in the absence of angiographic evidence of significant obstructive coronary artery disease. It is often but not always triggered by emotional or physical stressful stimuli. In most cases, the regional ventricular dysfunction extends beyond a single epicardial coronary artery territory. It typically involves the apex, with rare atypical presentations involving the base and right ventricle. Although the pathophysiological underpinnings of TC have not been completely elucidated, possible mechanisms include catecholamine overactivity, diffuse multivessel coronary spasm, microvascular dysfunction and estrogen deficiency. The prevalence of diabetes mellitus has been noted to be low in multiple studies of patients with TC. In this review, the authors discuss the association between diabetes mellitus and TC, with a special emphasis on the possible protective effect of diabetes mellitus in development of TC.

Keywords

Diabetes mellitus / stress cardiomyopathy / takotsubo cardiomyopathy

References

[1] Parodi G,Carrabba N,Memisha G,Antoniucci D.Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome..Am J Cardiol2007;99:182-5

[2] Akashi YJ,Barbaro G.Takotsubo cardiomyopathy: a new form of acute, reversible heart failure..Circulation2008;118:2754-62 PMCID:PMC4893309

[3] Sato H,Uchida T.Takotsubo-type cardiomyopathy due to multivessel spasm..In: Kodama K, Haze K, Hon M, editors. Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure.1990;Tokyo, JapanKagakuhyouronsha56-64

[4] Gowdar S.Microvascular dysfunction in takotsubo cardiomyopathy..ICF J2016;5:40-9

[5] Madias JE.Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible 'protective' effect with pathophysiologic connotations..Eur Heart J Acute Cardiovasc Care2016;5:164-70

[6] Khalid N.Takotsubo cardiomyopathy and microcirculatory dysfunction..Nat Rev Cardiol2015;12:497

[7] Khalid N,Umer A.Coronary flow reserve assessment via invasive and noninvasive means in Takotsubo cardiomyopathy..Int J Cardiol2016;202:573

[8] Pelliccia F,Greco C,Brenner R,Cacciotti L,Citro R,Guerra F,Lairez O,Lee PH,Marazzi G,Morel O,Nunez Gil IJ,Pineda AM,Santana O,Song BG,Teh AW,Valbusa A,Yoshida T,Kaski JC.Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients..Am J Med2015;128:654.e11-9

[9] Nú-ez-Gil IJ,Andrés M,Martin A,Córdoba-Soriano JG,González Sucarrats S,Fabregat-Andrés O,Escudier-Villa JM,Pérez-Castellanos A,Cambeiro C,Vidal-Perez R,García de la Villa B,Biagioni C,Feltes G.Secondary forms of Takotsubo cardiomyopathy: a whole different prognosis..Eur Heart J Acute Cardiovasc Care2016;5:308-16

[10] Madias JE.Diabetes mellitus and Takotsubo syndrome in two Spanish cohorts..Eur Heart J Acute Cardiovasc Care2016;5:297

[11] Khalid N,Coram R,Fahsah I.Thrombolysis in myocardial infarction frame count in takotsubo cardiomyopathy..Int J Cardiol2015;191:107-8

[12] Brinjikji W,Salka S.In-hospital mortality among patients with takotsubo cardiomyopathy: a study of the National Inpatient Sample 2008 to 2009..Am Heart J2012;164:215-21

[13] Patel SM,Prasad K.Distinctive clinical characteristics according to age and gender in apical ballooning syndrome (takotsubo/stress cardiomyopathy): an analysis focusing on men and young women..J Card Fail2013;19:306-10

[14] Dias A,Rubio M,Bhalla V,Hebert K.Takotsubo syndrome: does it matter if you have diabetes mellitus?.Int J Cardiol2016;224:398-9

[15] Auzel O,Pillière R,Dubourg O.Incidence, characteristics, risk factors, and outcomes of takotsubo cardiomyopathy with and without ventricular arrhythmia..Am J Cardiol2016;117:1242-7

[16] Khera R,Zahr F,Girotra S.Trends in hospitalization for takotsubo cardiomyopathy in the United States..Am Heart J2016;172:53-63 PMCID:PMC4748175

[17] Eitel I,Bernhardt P,Muellerleile K,Francone M,Gutberlet M,Schuler G,Thiele H.Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy..JAMA2011;306:277-86

[18] Nú-ez-Gil IJ,Bernardo E,Ruiz-Mateos B,Vivas D,Luaces M,Zamorano J,Fernández-Ortiz A.Tako-tsubo syndrome and heart failure: long-term follow-up..Rev Esp Cardiol (Engl Ed)2012;65:996-1002

[19] Nú-ez Gil IJ,Almendro Delia M,Martín A,Córdoba Soriano JG,González Sucarrats S.Characterization of Tako-tsubo cardiomyopathy in Spain: results from the RETAKO National Registry..Rev Esp Cardiol (Engl Ed)2015;68:505-12

[20] Templin C,Diekmann J,Bataiosu DR,Cammann VL,Geyer V,Seifert B,Schwyzer M,Jenewein J,Katus HA,Schunkert H,Thiele H,Tschöpe C,Laney CA,Michels G,Ukena C,Erbel R,Kuck KH,Hasenfuss G,Koenig W,Said SM,Cuculi F,Fischer TA,Airaksinen KE,Rynkiewicz A,Opolski G,MacCarthy P,Osswald S,Crea F,Franz WM,Felix SB,Lairez O,Bax JJ,Ruschitzka F,Lüscher TF.Clinical features and outcomes of takotsubo (stress) cardiomyopathy..N Engl J Med2015;373:929-38

[21] Madias JE.Baroreceptor dysfunction, diabetes mellitus, and takotsubo syndrome: an intricate triangle needing exploration..Int J Cardiol2015;184:517-8

[22] Citro R,Previtali M,Canterin FA,Giudice R,Vriz O,Baldi C,Bossone E.Differences in clinical features and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy..J Am Geriatr Soc2012;60:93-8

[23] Falola M,McGwin GJr.Takotsubo cardiomyopathy versus ST-elevation myocardial infarction in a large case-control study: proposing a new mechanism..Int J Cardiol2013;167:1079-81

[24] Tornvall P,Ehrenborg E.A case-control study of risk markers and mortality in takotsubo stress cardiomyopathy..J Am Coll Cardiol2016;67:1931-6

[25] Zalewska-Adamiec M,Tomaszuk-Kazberuk A,Drozdowski P,Krynicki R,Dobrzycki S.Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study..Neth Heart J2016;24:511-19 PMCID:PMC5005189

[26] Boland TA,Bleck TP.Stress-induced cardiomyopathy..Crit Care Med2015;43:686-93

[27] Khalid N,Umer A.Role of microcirculatory disturbances and diabetic autonomic neuropathy in takotsubo cardiomyopathy..Crit Care Med2015;43:e527

[28] Khalid N,Ahmad SA,Spodick DH.Autonomic dysfunction and takotsubo cardiomyopathy..Am J Med2015;128:e45-6

[29] Chhabra L.Brain-heart disconnection: a protective effect of diabetes mellitus in takotsubo cardiomyopathy..Am J Cardiol2016;117:1858

[30] Chhabra L.Takotsubo cardiomyopathy and microvascular dysfunction..Int J Cardiol2015;196:107

[31] Chhabra L.Low incidence of diabetes mellitus in coronary microvascular dysfunction: an intriguing association..JACC Cardiovasc Interv2016;9:395-6

[32] Ohigashi-Suzuki S,Tatsuno I.Takotsubo cardiomyopathy associated with sepsis in type 2 diabetes mellitus..Am J Emerg Med2007;25:230-2

[33] Sara JD,Matsuzawa Y,Lerman LO.Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease..JACC Cardiovasc Interv2015;8:1445-53

[34] Kawata T,Miyazaki S,Maruyama M,Ito C,Watada H.Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus..Cardiovasc Diabetol2015;14:98 PMCID:PMC4525728

[35] Sucato V,Quagliana A,Andolina G,Novo S.Comparison of coronary artery flow impairment in diabetic and hypertensive patients with stable microvascular angina..Eur Rev Med Pharmacol Sci2014;18:3687-9