Rapid Recovery of Left Ventricular Function in Patients With Takotsubo Syndrome Undergoing Systemic Infusion of Adenosine: a Randomized Controlled Trial (TITAN Study)

Takotsubo syndrome is a heart condition that is characterized by the rapid onset of left ventricular dysfunction, usually reversible, and meeting the following diagnostic criteria:

• Transient alterations of regional contractility of the myocardial wall of the right or left ventricle, which are frequently, but not always, preceded by a stressful event (emotional or physical).
• The regional changes in contractility of the myocardial wall, often extend beyond the distribution of a single coronary vessel, and often result in a circumferential ventricular dysfunction of the involved segments.
• Absence of a culprit coronary lesion (eg. Of atherosclerotic plaque rupture, thrombus formation, coronary dissection) or other pathological conditions that may explain the regional changes in contractility of the myocardial wall (eg. Hypertrophic cardiomyopathy, viral myocarditis)
• Reversible electrocardiographic abnormalities of the EKG (ST-T segment elevation or depression, new onset of left bundle branch block, inversion of t wave and / or QTc elongation) during the acute phase (3 months).
• Significant increase in serum natriuretic peptide (BNP or NT-proBNP) during the acute phase
• Troponin significant increase, but relatively small, (disparity between the degree of left ventricular dysfunction and the value of troponin).
• The recovery of left ventricular function during follow-up (3-6 months).

Epidemiology Since the Takotsubo syndrome has been described for the first time in 1991, its incidence, with the passing of years has been increasing, thanks to the possibility with networks for the treatment of acute myocardial infarction, to have a early access to coronary angiography study. Currently this syndrome accounts for 2% of all acute coronary syndromes who are undergoing coronary angiography.

Pathophysiology The pathophysiology of Takotsubo syndrome is complex, and not fully clarified. There are several causes have been suggested over the years to explain the occurrence of this syndrome (vascular and / or myocardial). One of the mechanisms suggested is that there is a systemic response, by the body, to a severe stress which causes a sudden increase of catecholamines endogenous and exogenous; this increase has an effect on the cardiovascular system leading to acute heart failure.

Stress is one of the most common causes behind the onset of this syndrome, and emotional stress (eg. Mourning,quarrel, etc.) and physical (eg. Surgical emergencies, obstetric or psychiatric), but it is not always a present condition.