Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports

Aditi Bhanushali; Muskan Kohli; Ananya Prakash; Svaapnika Rao Sarvepalli; Anchal Pandey; Olufemi Odugbemi; Nafisa Reyaz; Bansi Trambadia; Sadhu Aishwarya Reddy; Shaylika Chauhan; Rupak Desai

doi:10.4330/wjc.v15.i8.406

Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports

World J Cardiol. 2023 Aug 26;15(8):406-414. doi: 10.4330/wjc.v15.i8.406.

Authors

Affiliations

¹ Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States.
² Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States.
³ Department of Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore 560066, Karnataka, India.
⁴ Department of Medicine, G.S.V.M. Medical College, Kanpur 208002, Uttar Pradesh, India.
⁵ Department of Internal Medicine, Lincoln Medical and Mental Health Centre, Bronx, NY 10451, United States.
⁶ Department of Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh 202002, UP, India.
⁷ Master of Public Health, Mount Sinai, New York, NY 10029, United States.
⁸ Department of Medicine, Osmania Medical College, Hyderabad 500095, Telangana, India.
⁹ Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States. drshaylikachauhan@gmail.com.
¹⁰ Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States.

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports.

Aim: To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.

Methods: SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results.

Results: Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived.

Conclusion: Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.

Keywords: Cardiology; Coronary angiography; Spontaneous coronary artery dissection; Systematic review; Takotsubo cardiomyopathy; Takotsubo syndrome.