北原 秀喜

Takotsubo syndrome (TTS) is a complex cardiovascular condition characterized by transient left and/or right ventricular dysfunction in the absence of a coronary artery culprit lesion. The InterTAK registry, a large international collaborative registry, has significantly advanced our understanding of TTS. This review summarizes key findings from the InterTAK registry, including epidemiology, clinical presentation, comorbidities, outcomes, and treatment. The registry has revealed the diverse clinical spectrum of TTS, including atypical presentations, and identified various risk factors associated with adverse outcomes. The InterTAK registry has been instrumental in shaping the current understanding of TTS and will continue to guide future research and clinical practice.

This study aims to compare 1-year outcomes after transcatheter aortic valve replacement (TAVR) between patients with moderate-severe MR and severe MR preoperatively using the Japan Transcatheter Valve Therapy (J-TVT) registry. Patients undergoing TAVR for aortic stenosis between August 2013 and December 2019 with preoperative mitral regurgitation of moderate-severe (group MR3) or severe (group MR4) were included. Patients with a history of valve surgery and dialysis patients were excluded. A total of 2017 patients were included, and 1-year follow-up data were obtained from the registry (follow-up rate 98.5%). Propensity-score matching between MR3 and MR4 groups was performed. All-cause mortality and the composite outcome of death and/or heart failure events were compared. Crude data showed that 1-year survival was significantly higher in the MR 3 (89.8%) than MR 4 (84.7%) groups, and freedom from 1-year mortality and heart failure events was also higher in the MR 3 (87.1%) than MR 4 (80.5%) groups (p = 0.0001). After propensity-score matching, 452 cases (226 cases each in MR 3 group and MR 4 group) were extracted. Cox regression model showed no statistical difference in the 1-year survival rate between MR 3 group (84.5%) and MR 4 group (85.5%) (p = 0.84), nor in freedom from 1-year death and/or heart failure events between MR 3 group (80.2%) and MR 4 group (81.6%) (p = 0.72). The 1-year survival rate and freedom from death and/or heart failure events were found to be similar between patients undergoing TAVR with MR grade 3 and MR grade 4.

Takotsubo syndrome (TTS) can mimic acute coronary syndrome despite being a distinct disease. While typically benign, TTS can lead to serious complications like cardiogenic shock. Cardiogenic shock occurs in 1-20% of TTS cases. Various mechanisms can cause shock, including pump failure, right ventricular involvement, left ventricular outflow tract obstruction, and acute mitral regurgitation. Because treatment depends on the mechanism, early identification of the mechanism developing cardiogenic shock is essential for optimal treatment and improved outcomes in TTS patients with cardiogenic shock. This review summarizes current knowledge on causes and treatment of cardiogenic shock in patients with TTS.