Volume 13 Issue 5
Sep.  2022
Turn off MathJax
Article Contents
Article Navigation >  ORGAN TRANSPLANTATION  > 2022  >  13(5): 640-646
Kang Yisheng, Li Danyang, Yu Lixin, et al. Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review[J]. ORGAN TRANSPLANTATION, 2022, 13(5): 640-646. doi: 10.3969/j.issn.1674-7445.2022.05.014
Citation: Kang Yisheng, Li Danyang, Yu Lixin, et al. Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review[J]. ORGAN TRANSPLANTATION, 2022, 13(5): 640-646. doi: 10.3969/j.issn.1674-7445.2022.05.014
shu

Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review

doi: 10.3969/j.issn.1674-7445.2022.05.014

  • Transplant Intensive Care Unit, Tianjin First Central Hospital, Tianjin 300192, China

More Information
  • Corresponding author: Liu Yihe, Email: 13902011113@163.com
  • Received Date: 2022-04-04
    Available Online: 2022-09-14
  • Publish Date: 2022-09-15
    Abstract
  •   Objective  To summarize the experience of diagnosis and treatment of Takotsubo syndrome (TTS) after liver transplantation.  Methods  Clinical data of one TTS patient after liver transplantation was retrospectively analyzed. Clinical features, diagnosis and treatment strategies were summarized, and literature review was conducted.  Results  A 43-year-old female patient successfully underwent split liver transplantation due to primary biliary cirrhosis for 8 years. At postoperative 3 d, the patient developed anxiety, irritation, dyspnea, disorientation, hypotension, N-terminal pro-brain natriuretic peptide (NT-proBNP) of > 35 000 pg/mL, creatine kinase isoenzyme (CK-MB) of 5.9 U/L and troponin I (TnI) of 1.78 μg/L. Electrocardiogram indicated the signs of sinus rhythm. Echocardiography indicated diffuse weakening of the left ventricular wall motion and spherical dilatation of the apex, accompanied with moderate and severe regurgitation of the mitral valve and tricuspid valve. The left ventricular ejection fraction (LVEF) declined to 23%, whereas no abnormal segmental motion of ventricular wall or corresponding electrocardiogram changes were observed. The possibility of acute coronary syndrome was excluded. The InterTAK diagnostic score was 73. The diagnosis of TTS after liver transplantation was considered. Metoprolol, coenzyme Q10, recombinant human brain natriuretic peptide, deacetyl lanatoside and lorazepam were given. Echocardiography at postoperative 10 d showed that the left ventricular function was significantly improved and the LVEF recovered to 50%. The patient was discharged 40 d after liver transplantation. The liver function was recovered well. During postoperative follow-up, she was given with metoprolol till the submission date, and no recurrence was reported.  Conclusions  TTS after liver transplantation is rare in clinical practice. It is difficult to make the diagnosis. The condition of TTS is severe and clinical prognosis is poor. Prompt diagnosis and interventions should be implemented.

     

    • FullText(HTML)
  • loading
    • References(32)
  • [1]
    SINGH T, KHAN H, GAMBLE DT, et al. Takotsubo syndrome: pathophysiology, emerging concepts, and clinical implications[J]. Circulation, 2022, 145(13): 1002-1019. DOI: 10.1161/CIRCULATIONAHA.121.055854.
    [2]
    LEE HR, HURST RT, VARGAS HE. Transient left ventricular apical ballooning syndrome (Takotsubo cardiomyopathy) following orthotopic liver transplantation[J]. Liver Transpl, 2007, 13(9): 1343-1345. DOI: 10.1002/lt.21169.
    [3]
    ANISKEVICH S, CHADHA RM, PEIRIS P, et al. Intra-operative predictors of postoperative Takotsubo syndrome in liver transplant recipients-an exploratory case-control study[J]. Clin Transplant, 2017, 31(11): e13092. DOI: 10.1111/ctr.13092.
    [4]
    PHILLIPS MS, PRUETT TL, BERG CL, et al. Takotsubo cardiomyopathy in a liver transplant recipient: a diagnosis of exclusion?[J]. J Cardiothorac Vasc Anesth, 2009, 23(2): 268-269. DOI: 10.1053/j.jvca.2008.08.013.
    [5]
    SANER FH, PLICHT B, TRECKMANN J, et al. Tako-Tsubo syndrome as a rare cause of cardiac failure in liver transplantation[J]. Liver Int, 2010, 30(1): 159-160. DOI: 10.1111/j.1478-3231.2009.02062.x.
    [6]
    ANDERS MM, COMIGNANI PD, COUCE R, et al. Takotsubo cardiomyopathy: a cardiac syndrome mimicking acute myocardial infarction in a liver transplant recipient[J]. Cardiol Res, 2011, 2(2): 82-85. DOI: 10.4021/cr35e.
    [7]
    TACHOTTI PIRES LJ, CARDOSO CURIATI MN, VISSOCI REICHE F, et al. Stress-induced cardiomyopathy (Takotsubo cardiomyopathy) after liver transplantation-report of two cases[J]. Transplant Proc, 2012, 44(8): 2497-2500. DOI: 10.1016/j.transproceed.2012.07.037.
    [8]
    BEDANOVA H, ORBAN M, NEMEC P. Postoperative left ventricular apical ballooning: transient Takotsubo cardiomyopathy following orthotopic liver transplantation[J]. Am J Case Rep, 2013, 14: 494-497. DOI: 10.12659/AJCR.889102.
    [9]
    VACHIAT A, MCCUTCHEON K, MAHOMED A, et al. Takotsubo cardiomyopathy post liver transplantation[J]. Cardiovasc J Afr, 2016, 27(5): e1-e3. DOI: 10.5830/CVJA-2016-032.
    [10]
    BIONDI RS, BARZILAI VS, WATANABE ALC, et al. Use of extracorporeal membrane oxygenation for treating acute cardiomyopathy after liver transplantation: a case report[J]. Rev Bras Ter Intensiva, 2018, 30(2): 233-236. DOI: 10.5935/0103-507X.20180029.
    [11]
    REDDY RV, AGARWAL S, CHOUDHARY V, et al. Reverse stress cardiomyopathy post-liver transplant needing mechanical circulatory support[J]. Indian J Anaesth, 2018, 62(12): 988-990. DOI: 10.4103/ija.IJA_402_18.
    [12]
    GALVÁN NT, KUMM K, KUEHT M, et al. Mending a broken heart: treatment of stress-induced heart failure after solid organ transplantation[J]. J Transplant, 2018: 9739236. DOI: 10.1155/2018/9739236.
    [13]
    MAESTAS C, LAZKANI M, SULTAN M, et al. Severe Takotsubo cardiomyopathy following orthotopic liver transplantation: a case series[J]. Clin Res Hepatol Gastroenterol, 2019, 43(4): e48-e53. DOI: 10.1016/j.clinre.2018.11.009.
    [14]
    TANAKA A, ONOE T, ISHIYAMA K, et al. A rare case of transient left ventricular apical ballooning syndrome following living donor liver transplantation: a case report and literature review[J]. Int J Surg Case Rep, 2019, 55: 218-222. DOI: 10.1016/j.ijscr.2019.02.002.
    [15]
    LUU LA, RAWASHDEH B, GOLDARACENA N, et al. Hepatic artery thrombosis and Takotsubo syndrome after liver transplantation - which came first?[J]. Am J Case Rep, 2020, 21: e920263. DOI: 10.12659/AJCR.920263.
    [16]
    BEDANOVA H, ONDRASEK J, FILIPENSKY P, et al. Inverted Takotsubo cardiomyopathy as an early complication after liver transplantation[J]. Am J Case Rep, 2021, 22: e930484. DOI: 10.12659/AJCR.930484.
    [17]
    SHAMAA O, JAFRI SM, SHAMAA MT, et al. Takotsubo cardiomyopathy following liver transplantation: a report of 2 cases[J]. Transplant Proc, 2021, 53(1): 239-243. DOI: 10.1016/j.transproceed.2020.07.021.
    [18]
    YANG J, RAO Z, HONG F, et al. Takotsubo syndrome after liver transplantation: an association with intraoperatively administered epinephrine and fentanyl[J]. Clin Transplant, 2021, 35(11): e14463. DOI: 10.1111/ctr.14463.
    [19]
    AGARWAL S, BEAN MG, HATA JS, et al. Perioperative Takotsubo cardiomyopathy: a systematic review of published cases[J]. Semin Cardiothorac Vasc Anesth, 2017, 21(4): 277-290. DOI: 10.1177/1089253217700511.
    [20]
    TEMPLIN C, GHADRI JR, DIEKMANN J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy[J]. N Engl J Med, 2015, 373(10): 929-938. DOI: 10.1056/NEJMoa1406761.
    [21]
    冉倩, 周霞, 孙亚洲, 等. 中国与欧美Takotsubo综合征患者临床特征的比较[J]. 中华心血管病杂志, 2022, 50(4): 386-394. DOI: 10.3760/cma.j.cn112148-20220304-00152.

    RAN Q, ZHOU X, SUN YZ, et al. Comparison on the clinical characteristics of patients with Takotsubo syndrome from China and from Europe/North America[J]. Chin J Cardiol, 2022, 50(4): 386-394. DOI: 10.3760/cma.j.cn112148-20220304-00152.
    [22]
    ASSAD J, FEMIA G, PENDER P, et al. Takotsubo syndrome: a review of presentation, diagnosis and management[J]. Clin Med Insights Cardiol, 2022, 16: 11795468211065782. DOI: 10.1177/11795468211065782.
    [23]
    NAGAI M, KOBAYASHI Y, KOBATAKE H, et al. Happy heart syndrome: a case of Takotsubo syndrome with left internal carotid artery occlusion[J]. Clin Auton Res, 2020, 30(4): 347-350. DOI: 10.1007/s10286-020-00696-z.
    [24]
    GHADRI JR, WITTSTEIN IS, PRASAD A, et al. International expert consensus document on Takotsubo syndrome (part Ⅰ): clinical characteristics, diagnostic criteria, and pathophysiology[J]. Eur Heart J, 2018, 39(22): 2032-2046. DOI: 10.1093/eurheartj/ehy076.
    [25]
    EL HADI H, DI VINCENZO A, VETTOR R, et al. Relationship between heart disease and liver disease: a two-way street[J]. Cells, 2020, 9(3): 567. DOI: 10.3390/cells9030567.
    [26]
    GIBSON LE, KLINKER MR, WOOD MJ. Variants of Takotsubo syndrome in the perioperative period: a review of potential mechanisms and anaesthetic implications[J]. Anaesth Crit Care Pain Med, 2020, 39(5): 647-654. DOI: 10.1016/j.accpm.2020.01.010.
    [27]
    GUGLIN M, NAZIF K. New onset nonischemic cardiomyopathy post liver transplantation[J]. Heart Fail Rev, 2021, 27(5): 1829-1836. DOI: 10.1007/s10741-021-10196-5.
    [28]
    PRASAD A, LERMAN A, RIHAL CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction[J]. Am Heart J, 2008, 155(3): 408-417. DOI: 10.1016/j.ahj.2007.11.008.
    [29]
    WITTSTEIN IS. Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning?[J]. Cell Mol Neurobiol, 2012, 32(5): 847-857. DOI: 10.1007/s10571-012-9804-8.
    [30]
    KAWAI S, KITABATAKE A, TOMOIKE H, et al. Guidelines for diagnosis of Takotsubo (ampulla) cardiomyopathy[J]. Circ J, 2007, 71(6): 990-992. DOI: 10.1253/circj.71.990.
    [31]
    PARODI G, CITRO R, BELLANDI B, et al. Revised clinical diagnostic criteria for Tako-tsubo syndrome: the Tako-tsubo Italian Network proposal[J]. Int J Cardiol, 2014, 172(1): 282-283. DOI: 10.1016/j.ijcard.2013.12.239.
    [32]
    GHADRI JR, WITTSTEIN IS, PRASAD A, et al. International expert consensus document on Takotsubo syndrome (part Ⅱ): diagnostic workup, outcome, and management[J]. Eur Heart J, 2018, 39(22): 2047-2062. DOI: 10.1093/eurheartj/ehy077.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (361) PDF downloads(101) Cited by()
    Proportional views
    Related

    WeChat Subscription Account

    Wechat Service Account

    Contact Us
    • Tel：020-38736410
    • Email: organtranspl@163.com
    • Address：The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou
    • Editorial Office of Organ Transplantation  粤ICP备2021030844号
    Links

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return