What is the clinical evidence from this study?

Study design: Observational. Population: Tako-tsubo-like left ventricular dysfunction (n=5). Intervention: Tako-tsubo-like left ventricular dysfunction. Primary outcome: Local release of norepinephrine from the heart (coronary sinus vs aortic root levels).

December 25, 2007Open Access

Local Release of Catecholamines From the Hearts of Patients With Tako-Tsubo-Like Left Ventricular Dysfunction

Key Result

All 5 patients with tako-tsubo-like left ventricular dysfunction demonstrated increased local release of norepinephrine from the heart, suggesting a role in transient apical ballooning.

Study Design

Type

Observational (n=5)

Multicenter

Structured PICO

Is there evidence of local release of catecholamines from the hearts of patients with tako-tsubo-like left ventricular dysfunction?

Population

5 older adults (median age 76, 60% female) with tako-tsubo-like left ventricular dysfunction and normal coronary angiograms, evaluated for local cardiac catecholamine release.

Exposure

Measurement of plasma catecholamine levels at the aortic root and coronary sinus

Outcome

Plasma catecholamine (norepinephrine) levels at the aortic root and coronary sinussurrogate

Increased local release of norepinephrine from the heart is documented in patients with tako-tsubo-like LV dysfunction, suggesting a role for cardiac catecholamines in transient LV apical ballooning.

Limitations

Small, observational case series with no comparison group

Abstract

BACKGROUND: The precise mechanism of tako-tsubo-like left ventricular (LV) dysfunction remains unclear, although recent studies have shown that activation of sympathetic tone might be involved. However, local release of catecholamines from cardiac sympathetic efferent neurons in patients with tako-tsubo-like LV dysfunction remains poorly understood. The purpose of this study was to investigate evidence of local release of catecholamines from the hearts of patients with tako-tsubo-like LV dysfunction. METHODS AND RESULTS: Five consecutive patients with tako-tsubo-like LV dysfunction were studied. After confirming LV apical ballooning and a normal coronary angiogram, sampling of blood for the measurement of plasma catecholamine levels was performed at the aortic root (Ao) and coronary sinus (CS). In all 5 cases, increased local release of norepinephrine from the heart was documented (597, 4,238, 2,121, 486, 371 pg/ml at the Ao; 836, 5,719, 3,386, 658, 472 pg/ml at the CS, respectively). CONCLUSIONS: Increased cardiac catecholamines might cause the transient LV apical ballooning in patients with tako-tsubo-like LV dysfunction.

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