Presentazione di PowerPoint - mcrferrara.org · Murakami et al, PLoS ONE 2015 Stepwise multiple...
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Cardiomiopatia Tako-Tsubo: solo una malattia della donna?
Roberto Manfredini
Clinica Medica, Università di Ferrara
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Playlist
Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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Cardiomiopatia Tako-Tsubo
Descritta per la prima volta in Giappone nel 1990. Il nome deriva dalle parole Tako (polpo) e Tsubo (giara)
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Altre definizioni
• Stress-induced cardiomyopathy
• Transient left ventricular apical ballooning syndrome
• Apical ballooning syndrome
• Ampulla cardiomyopathy
• Broken Heart Syndrome
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Argomento ‘hot’ per la ricerca
Sharkey et al, Circulation 2011
PubMed (April 30, 2016): 2929
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Cardiomiopatia Tako-Tsubo
Disfunzione transitoria delle sezioni apicale e medio-ventricolare del ventricolo sx, in assenza di malattia coronarica significativa, e spesso scatenata da uno stress (emotivo o fisico).
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Cardiomiopatia Tako-Tsubo
• Fino al 2% delle sospette sindromi coronariche acute (SCA) (donne 6-9%, uomini 0.5%)
• Più frequente nelle donne (~90%), >80% dei casi in postmenopausa
• Mortalità intra-ospedaliera: 1-2%
• Recupero della funzione del Vsx: 1-4 sett.
• Recidive (10% ad un follow-up di 4 anni)
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Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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Fight or Flight
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Triggers ‘emotivi’
• Morte, malattia grave o grave lesione riguardante un membro della famiglia, un amico, il proprio animale
• Cattive notizie (diagnosi di grave malattia, divorzio di un famigliare)
• Grave litigio
• Aggressione
• Coinvolgimento in azione legale
• Incidente d’auto
• Trasloco
• Perdita economica (affari, gioco, licenziamento)
• Disastri naturali (terremoti..)
• Party a sorpresa
• Public speaking
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57-year-old African American woman, presenting with severe dyspnea
following the shooting death of her son. Discharged on day 6.
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86-year-old retired teacher recognized with a prestigious lifetime teaching
award, with many of her former students present at the ceremony.
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Triggers ‘fisici’
• Procedure chirurgiche e cardiochirurgiche
• Cause respiratorie
• Patologie gastroenteriche
• Patologie reumatologiche
• Patologie endocrine
• Patologie ematologiche
• Patologie infettive
• Dialisi
• Patologie neurologiche
• Sostanze illecite o farmaci: cocaina, abuso di antidepressivi, β2 stimolanti, adrenalina…
• Altri: traumi, ustioni, colpo di calore, abuso di energy drinks, puntura di medusa, ..
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Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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Prasad et al, Am Heart J 2008
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High levels of circulating E might trigger
a switch in intracellular signal trafficking,
from G8 protein to Gi protein signaling
through the AR. This change in
signaling is negatively inotropic, and the
effect is greatest at the apical
myocardium, in which the density of
-adrenoceptors is highest.
Lyon et al, Nat Clin Pract Cardiovasc Med 2009
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Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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Manfredini et al, Encyclopedia Stress, Elsevier 2007
AUMENTATA
RICHIESTA DI O2
RIDOTTA
DISPONIBILITA’ DI O2
ematocrito
viscosità
fibrinogeno
PTT, APTT
PAI-1
t-PA
tono coronarico
flusso
cortisolo
tono vasale
PA
catecolamine
sonno REM
risveglio
attività fisica
FC
placca instabile
rottura di placca
stress ossidativo
funzione endoteliale
interleukina-6
infarto miocardico acuto
STRESS
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Citro et al, J Am Coll Cardiol 2009
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Manfredini et al, Am J Emerg Med 2010 Manfredini et al, Am J Emerg Med 2009
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Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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Non solo donne…..
81-year-old man, smoker, no CV risk factors,
referred for chest pain 12 hours after an adulterous
intercourse with a young woman. Complete recovery
in 6 days, asymptomatic at 6-month follow-up.
Brunetti et al, Int J Cardiol 2011
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Oppure proprio donne…..
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Chou & Saw, Can J Cardiol 2014
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Esistono differenze di genere?
Gli uomini hanno più spesso uno stress fisico, le donne uno emotivo
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Patel et al, J Cardiac Fail 2013
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Patel et al, J Cardiac Fail 2013
N=224
M=12 (RR 0%)
F<50=12 (RR 16%)
F>50=200 (RR 3%)
RR recurrence rate
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Murakami et al, PLoS ONE 2015
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Murakami et al, PLoS ONE 2015
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Murakami et al, PLoS ONE 2015
Stepwise multiple logistic regression analysis.
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Schneider et al, Int J Cardiol 2016
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Brinjikji et al, Am Heart J 2012
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Brinjikji et al, Am Heart J 2012
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Isogai et al, Int J Cardiol 2014
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Singh et al, Am J Cardiol 2014
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Krishnamoorthy et al, Cardiology 2015
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Manfredini et al, Am J Emerg Med 2015
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Cardiomiopatia Tako-Tsubo Ruolo dello stress Meccanismi patogenetici Aspetti cronobiologici Aspetti di genere Take-home messages
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