key: cord-0930170-p51hf04d
authors: Giustino, Gennaro; Croft, Lori B.; Oates, Connor P.; Rahman, Karishma; Lerakis, Stamatios; Reddy, Vivek Y.; Goldman, Martin
title: Takotsubo Cardiomyopathy in Males with Covid-19
date: 2020-06-08
journal: J Am Coll Cardiol
DOI: 10.1016/j.jacc.2020.05.068
sha: 14cacb97c3fc2ebefeacb7c17c3b363539dd3212
doc_id: 930170
cord_uid: p51hf04d

nan

shown to be associated with increased risk of in-hospital morbidity and mortality (2) . The underlying mechanisms of myocardial injury in Covid-19 are unclear and most published series define myocardial injury only on the basis of elevated myocardial necrosis biomarkers (2).

Takotsubo cardiomyopathy (TTC) is a syndrome, predominantly seen in women ( representing over 75% of cases), characterized by acute and transient regional left ventricular (LV) systolic dysfunction usually triggered by emotional distress, but has also been associated with respiratory failure and infections (3) Compared with patients with non-TTC myocardial injury and those without myocardial injury, those with TTC had the highest peak levels of cardiac troponin I and creatine-kinase myocardial band (Table) . Conversely, the peak levels of inflammatory and pro-thrombotic biomarkers including interleukin-6, ferritin and d-dimer were the highest among patients with non-TTC myocardial injury (Table) . All patients with TTC had LV dysfunction, and the median LV ejection fraction was lower among patients with TTC compared with those with other myocardial injury and those without myocardial injury (36.0% vs. 55.0% vs. 60.0%; p=0.001).

Among the five patients with TTC, four patients had regional wall abnormalities typical of TTC including circumferential hypokinesis or akinesis of the apical and mid wall segments, while one patient had circumferential hypokinesis of the basal walls (consistent with reversed TTC). None of the patients underwent cardiac catheterization to rule-out coronary artery disease. Two patients had follow-up TTE after 7 days, documenting resolution of the wall motion abnormalities, and were discharged alive. One patient improved clinically and was discharged from the hospital, one patient died while on mechanical ventilatory support and one patient died while on venovenous extracorporeal membrane oxygenation. Rates of all-cause death, acute respiratory distress syndrome and acute kidney injury were significantly higher among those with TTC or other types of myocardial injury compared with those without myocardial injury (Table) .

This series suggests that TTC should be considered in the differential diagnosis across the spectrum of myocardial injury in patients presenting with in Results reported as n (%) and median (interquartile range). ARDS = Acute Respiratory Distress Syndrome; BNP = Brain Natriuretic Peptide; CK-MB = Creatine Kinease-Myocardial Band; LVEDV = Left ventricular end-diastolic volume; LVESV = Left ventricular end-systolic volume.

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BNP peak, pg/mL 153

Ferritin peak