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Anesthetic implications of perioperative Takotsubo syndrome: a retrospective cohort study

Implications anesthésiques du syndrome périopératoire de Takotsubo : une étude de cohorte rétrospective

Abstract

Purpose

Takotsubo syndrome is a reversible cardiomyopathy triggered by emotional or physical stressors. Although surgeries could be physical triggers, this has been scantily investigated. We aimed to describe the baseline characteristics, surgical/anesthesia-related triggering events, clinical presentation, and in-hospital outcomes of a cohort of patients diagnosed with perioperative Takotsubo syndrome.

Methods

In this retrospective study, we included all consecutive adult patients who were admitted to Hospital Italiano de Buenos Aires between 1 June 2008 and 30 November 2017 and diagnosed with Takotsubo syndrome according to the revised criteria of the European Society of Cardiology during hospitalization.

Results

We diagnosed 21 patients with perioperative Takotsubo syndrome out of 305,906 patients undergoing procedures with anesthesia care. The median (interquartile range [IQR]) patient age was 75 (55–82) yr, and 16 (76%) were women. The median (IQR) left ventricular ejection fraction was 35 (35–42)% at diagnosis and 55 (46–55)% at discharge. Fifteen patients (71%) required inotropic/vasopressor support; however, this is a controversial treatment considering the physiopathology of the syndrome. Severe complications such as unexplained syncope/cardiac arrest, cardiogenic shock, and ventricular thrombus formation occurred in seven (33%) patients, and two (10%) patients died. These results were compared with 31 patients who experienced non-perioperative Takotsubo syndrome during the same period of time.

Conclusion

Perioperative Takotsubo syndrome is a reversible cardiomyopathy. Nevertheless, it seems to be associated with severe complications, the need for aggressive treatment, and non-negligible mortality.

Résumé

Objectif

Le syndrome de Takotsubo est une cardiomyopathie réversible déclenchée par des facteurs de stress émotionnels ou physiques. Bien que les chirurgies puissent constituer des déclencheurs physiques, cela n’a été que peu étudié. Nous avons cherché à décrire les caractéristiques de base, les événements déclencheurs chirurgicaux / anesthésiques, la présentation clinique et les devenirs hospitaliers d’une cohorte de patients ayant reçu un diagnostic de syndrome périopératoire de Takotsubo.

Méthode

Dans cette étude rétrospective, nous avons inclus tous les patients adultes consécutifs qui ont été admis à l’Hôpital Italiano de Buenos Aires entre le 1er juin 2008 et le 30 novembre 2017 et qui ont reçu un diagnostic de syndrome de Takotsubo selon les critères révisés de la Société européenne de cardiologie pendant leur hospitalisation.

Résultats

Nous avons diagnostiqué 21 patients atteints d’un syndrome de Takotsubo périopératoire sur 305 906 patients subissant des interventions nécessitant des soins d’anesthésie. L’âge médian des patients (écart interquartile [ÉIQ]) était de 75 ans (55-82 ans) et 16 (76 %) étaient des femmes. La médiane de la fraction d’éjection ventriculaire gauche (ÉIQ) était de 35 (35 à 42) % au moment du diagnostic et de 55 (46 à 55 ) % au congé. Quinze patients (71 %) ont eu besoin d’un soutien inotrope/vasopresseur; cependant, il s’agit d’un traitement controversé compte tenu de la physiopathologie du syndrome. Des complications graves telles qu’une syncope / un arrêt cardiaque inexpliqué, un choc cardiogénique et la formation de thrombus ventriculaire, sont survenues chez sept patients (33 %), et deux (10 %) patients sont décédés. Ces résultats ont été comparés à 31 patients ayant présenté un syndrome de Takotsubo non périopératoire au cours de la même période.

Conclusion

Le syndrome de Takotsubo périopératoire est une cardiomyopathie réversible. Néanmoins, il semble être associé à des complications graves, à la nécessité d’un traitement agressif et à une mortalité non négligeable.

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Author contributions

María Eugenia García Guzzo and Delfina Sánchez Novas contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Daniel Deluca Bisurgi, Gonzalo Domenech, and Sergio Adrián Terrasa contributed to the conception and design of the study, and analysis and interpretation of data. Federico Ángel Iglesias contributed to acquisition of data and analysis and interpretation of data.

Acknowledgement

The authors would like to thank Dr. Carlos A. Teijido for his thorough revision of the final version of the manuscript.

Disclosures

None.

Funding statement

The submitted work has no funding sources to disclose (departmental, hospital, institutional). The authors have no commercial or noncommercial affiliations that may be perceived as a conflict of interest. Maria Eugenia Garcia and Gonzalo Domenech have made consultancies for Merck Sharp & Dohme.

Editorial responsibility

This submission was handled by Dr. Alana M. Flexman, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Correspondence to María Eugenia García Guzzo MD.

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This article is accompanied by an editorial. Can J Anesth 2022; this issue.

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García Guzzo, M.E., Sánchez Novas, D., Iglesias, F.Á. et al. Anesthetic implications of perioperative Takotsubo syndrome: a retrospective cohort study. Can J Anesth/J Can Anesth 68, 1747–1755 (2021). https://doi.org/10.1007/s12630-021-02109-9

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Keywords

  • Cardiomyopathy
  • Perioperative
  • Takotsubo syndrome