Key result
Direct or indirect catecholamine stimulation was the underlying etiology in 68.2% of the 157 identified cases of drug-induced takotsubo cardiomyopathy.
Why the study?
What are the common pharmacological triggers and mechanisms of drug-induced takotsubo cardiomyopathy?
Systematic Review (n=157)
What are the common pharmacological triggers and mechanisms of drug-induced takotsubo cardiomyopathy?
Answers are grounded in this paper and cite their sources.
Over two-thirds of drug-induced takotsubo cardiomyopathy cases are driven by direct or indirect catecholamine stimulation, highlighting the need for cautious use of these agents.
BACKGROUND: The most plausible hypothesis for takotsubo cardiomyopathy (TCM) is a catecholamine surge. Direct administration of catecholamines or medications causing catecholamine surge is frequently used in clinical practice. METHODS: A Medline/PubMed database search was conducted for case reports or series of drug-induced TCM. All reported cases of drug-induced TCM were systemically identified and analyzed. RESULTS: We identified 157 cases of drug-induced TCM. Fifty-seven (36.3%) cases were related to the administration of exogenous catecholamines. In 50 (31.9%) other cases, there was potential adrenergic effect. This included drugs with adrenergic vasoconstriction properties (3.2%), hyperadrenergic state due to alcohol or opioid withdrawal (7.7%), inhibitors of catecholamine reuptake (14.7%), anaphylactic reaction that is accompanied by catecholamine release (3.2%), and psychological or somatic stress coinciding with the administration of a drug that was thought to be the culprit (3.2%). Overall, 68.2% of these drug-induced TCM cases were catecholamine related. In 14 (8.9%) cases, the likely etiology of cardiomyopathy was chemotherapy-induced coronary vasospasm. CONCLUSION: Our systematic review showed that over two-thirds of drug-induced TCM cases were due to direct or indirect catecholamine stimulation. The lowest effective dose and shortest duration of catecholamines should be utilized, and alternative therapies should be considered if feasible.
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Kido et al. (2017) conducted a systematic review in Drug-induced takotsubo cardiomyopathy (n=157). Direct or indirect catecholamine stimulation was evaluated on Proportion of cases related to catecholamines. Direct or indirect catecholamine stimulation was the underlying etiology in 68.2% of the 157 identified cases of drug-induced takotsubo cardiomyopathy.
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