title: A single pathophysiological pathway in Takotsubo cardiomyopathy: Catecholaminergic stress.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) continues to be under-diagnosed, due to its varying presentation, with potentially serious consequences if treatment is delayed.
  
  
  OBJECTIVE
  To demonstrate the consistent involvement of catecholaminergic stress in TTC, regardless of the trigger.
  
  
  METHODS
  Between 01 July 2009 and 31 August 2013, patients managed in our centre for thoracic pain syndrome, with or without troponin release, were followed up prospectively. TTC was diagnosed from the apical ballooning seen on left ventricular imaging (angiography or transthoracic echocardiography) in the absence of a significant coronary artery lesion. Triggers (emotional trauma, surgical stress and β2-mimetic intoxication) were recorded; catecholamine-secreting tumours were screened for with a urinary methoxylate-derivative assay.
  
  
  RESULTS
  TTC was diagnosed in 40 out of 2754 (1.5%) patients with thoracic pain syndrome, with or without troponin release. Triggers were emotional trauma (n=29, 72.5%), surgical stress (n=5, 12.5%), adrenergic intoxication (n=3, 7.5%) and catecholaminergic tumour (n=3, 7.5%). Mean left ventricular ejection fraction at admission was 38.0 ± 15.7%. Eight (20%) patients initially showed cardiogenic shock. In-hospital mortality was 7.5%, with no deaths from cardiogenic causes. Thirty-five (94.6%) of the survivors had recovered a normal left ventricular ejection fraction (> 55%) by discharge.
  
  
  CONCLUSIONS
  Whatever the trigger, the common denominator in TTC is catecholaminergic stress. Classically suggested after emotional trauma, TTC may also be induced by surgical stress or endogenous or iatrogenic β2-mimetic intoxication. The various contexts all have a similarly excellent cardiovascular prognosis if treated early.
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Coupez
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France. Electronic address: reschalier@chuclermontferrand.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
authors.affiliation: Biostatistics Unit (Clinical Research and Innovation Direction), CHU de Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Pierrard
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France.
authors.forename: Géraud
authors.initials: G
authors.lastname: Souteyrand
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Clerfond
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Citron
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France.
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Lusson
authors.affiliation: Department of Cardiology, Université de Versailles-Saint-Quentin, Ambroise-Paré Hospital, Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mansencal
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; UMR 6284 CNRS-ISIT, Auvergne University, Clermont-Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000652:urine; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D002395:Catecholamines / Q000009:adverse effects / Q000652:urine*; D004644:Emotions; D005260:Female; D006352:Heart Ventricles / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000652:urine; D011446:Prospective Studies; D012307:Risk Factors; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000150:complications / Q000652:urine; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000652:urine*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002395:Catecholamines
keywords: Catecholamines; Catécholamine; Pheochromocytoma; Phéochromocytome; Takotsubo cardiomyopathy; Takotsubo cardiomyopathie