Takotsubo Cardiomyopathy Resulting in Cardiac Arrest in a Patient Undergoing Liver Transplantation

doi:10.1016/j.transproceed.2017.09.033

Transplantation Proceedings

Volume 49, Issue 10, December 2017, Pages 2392-2394

https://doi.org/10.1016/j.transproceed.2017.09.033 Get rights and content

Highlights

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Takotsubo cardiomyopathy is a recently described cause of reversible left ventricle dysfunction commonly occurring after physical or emotional stress.
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Metabolic changes seen in cirrhotic patients can increase the risk of perioperative cardiovascular complications.
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Patients with cirrhosis usually demonstrate increased cardiac output and a compromised ventricular response to stress.

Abstract

Cardiac complications during and after liver transplantation are a common cause of death. Although considered to be uncommon, takotsubo cardiomyopathy, which is characterized by reversible left ventricular akinesis without coronary artery obstruction, is becoming increasingly reported. Herein we have presented a case of reversible stress-induced takotsubo cardiomyopathy resulting in cardiac arrest in a patient undergoing liver transplantation.

Section snippets

Case Presentation

A 25-year-old man (height, 168 cm; weight, 50 kg) was scheduled for living-donor liver transplantation because of Budd-Chiari syndrome (Model for End-Stage Liver Disease score, 30) with no comorbidity. Despite anticoagulant treatment and high doses of furosemide and spironolactone, the patient had been hospitalized several times for abdominal pain, tension ascites, and diffuse refractory edema. Preoperative physical examination was within normal limits except for massive ascites with a drainage

Discussion

Patients with cirrhosis usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These changes can increase the risk of cardiovascular complications, especially when patients are exposed to metabolic or emotional stress.

TC is a recently described cause of reversible left ventricle dysfunction, and it commonly occurs after physical or emotional stress [9]. A new set of 7 diagnostic criteria was proposed by a task

References (20)

M. Pozzi et al.
Evidence of functional and structural cardiac abnormalities in cirrhotic patients with and without ascites
Hepatology
(1997)
G. Laffi et al.
Altered cardiovascular responsiveness to active tilting in nonalcoholic cirrhosis
Gastroenterology
(1997)
K. Tsuchihashi et al.
Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina pectoris–myocardial infarction investigations in Japan
J Am Coll Cardiol
(2001)
A. Prasad et al.
Apical ballooning syndrome: a mimic of acute myocardial infarction
Am Heart J
(2008)
G. Parodi et al.
Tuscany Registry of Tako-Tsubo Cardiomyopathy. Natural history of tako-tsubo cardiomyopathy
Chest
(2011)
A.A. Elesber et al.
Four-year recurrence rate and prognosis of the apical ballooning syndrome
J Am Coll Cardiol
(2007)
L.J. Tachotti Pires et al.
Stress-induced cardiomyopathy after liver transplantation-report of two cases
Transplant Proc
(2012)
V. Valeriano et al.
Modification of cardiac function in cirrhotic patients with and without ascites
Am J Gastroenterol
(2000)
G. Finucci et al.
Left ventricular diastolic function in liver cirrhosis
Scand J Gastroenterol
(1996)
F. Wong et al.
The cardiac response to exercise in cirrhosis
Gut
(2001)

There are more references available in the full text version of this article.

Cited by (5)

Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports
2023, Transplantation Proceedings
Takotsubo syndrome (TTS) has been reported in solid-organ transplant recipients. However, the pooled data regarding TTS after liver transplant remain limited.
A systematic review was performed through February 2022 using PubMed, Embase, Scopus, and Google Scholar to review case reports/series and original studies on liver transplant–associated TTS. Descriptive analysis was performed for case reports and pooled analysis for the prevalence using random effects models.
A total of 56 case reports were included from 30 articles (51.8 % male; mean age, 53 years; India 56%, US 27%, and Europe 8.93%) and 10 original studies (US 88.65%, India 10.92%) revealing liver transplant–associated TTS. The pooled prevalence of TTS was 1.1% (95% Cl, 0.6%-1.7%) of all liver transplants with comparable rates in studies from India and the US (P = .92). Indications for liver transplant included end-stage liver disease due to alcohol-related cirrhosis (25%), hepatitis C virus infection (17.9%), hepatocellular carcinoma (10.7%), and non–alcohol-related steatohepatitis (8.9%); the average Model for End-Stage Liver Disease score was 24.75. TTS commonly presented as hypotension (30%), dyspnea (14%), and oliguria, occurring mostly post-transplant (82%), whereas 14% were intraoperative. Common electrocardiogram findings were ST changes, ventricular tachycardia, and atrial fibrillation. Common echocardiogram findings showed left ventricular apical ballooning in 46.5% of cases and reduced ejection fraction < 20% in 41.9% of cases. Common complications were cardiogenic shock (32.1 %), acute kidney injury (12.5%), arrhythmia, stroke, cardiac arrest, and hepatic artery thrombosis. Mechanical circulatory support was required in 30.3%. Recurrence was reported in 15, and mortality in 30.4% of patients.
Takotsubo syndrome prevalence after liver transplant is significantly higher than TTS prevalence in general US hospitalizations with potentially worse outcomes. Prospective registries reporting TTS in liver transplant recipients are warranted.
Acute Cardiac Failure Due to Takotsubo Cardiomyopathy Secondary to a Phone Call for Lung Transplantation: A Case Report
2019, Transplantation Proceedings
Citation Excerpt :
An increasing number of articles have reported on TTC occurring during solid organ engraftment or soon thereafter. Most publications concern liver transplant patients [9,10,11], although kidney [12,13] and lung transplant patients are also being discussed [7,14,15]. There is a possible link between respiratory diseases and the onset of takotsubo cardiomyopathy [16], with acute respiratory failure leading to stress cardiomyopathy [17], COPD exacerbations, or acute asthma attacks in particular.
Lung transplantation is a therapeutic option for certain end-stage lung diseases. The phone call for lung transplantation is a major event in the life of these patients; as a result, it can generate significant stress. We herein present the case of a 58-year-old female patient with end-stage chronic obstructive pulmonary disease (COPD) who, while on the lung transplantation waiting list, received such a call. Complete transplant work-up, including cardiac tests undertaken shortly before, had revealed no contraindication to lung transplantation. She was admitted with severe acute respiratory failure, and her extensive work-up was compatible with pulmonary edema due to takotsubo cardiomyopathy. The lung transplantation was thus cancelled, owing to the patient’s health condition and the poor quality of the graft as well. The patient stayed in the intensive care unit for several days, requiring noninvasive ventilation. The left ventricular function recovered completely within 10 days postdiagnosis, and the patient was discharged 13 days after her admission. The patient was transplanted 1 month thereafter, without any particular problems; she is currently, 8 months post-transplantation, in good condition. In the given case, the call for lung transplantation could have generated emotional stress severe enough to lead to takotsubo cardiomyopathy.
Takotsubo syndrome after liver transplantation: An association with intraoperatively administered epinephrine and fentanyl
2021, Clinical Transplantation
An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block
2021, European Heart Journal - Case Reports
Hepatic artery thrombosis and takotsubo syndrome after liver transplantation – Which came first?
2020, American Journal of Case Reports

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Original Contributions: Case ReportsLiver transplantationTakotsubo Cardiomyopathy Resulting in Cardiac Arrest in a Patient Undergoing Liver Transplantation

Highlights

Abstract

Section snippets

Case Presentation

Discussion

Hepatology

Gastroenterology

J Am Coll Cardiol

Am Heart J

Chest

J Am Coll Cardiol

Transplant Proc

Modification of cardiac function in cirrhotic patients with and without ascites

Am J Gastroenterol

Left ventricular diastolic function in liver cirrhosis

Scand J Gastroenterol

The cardiac response to exercise in cirrhosis

Gut

Original Contributions: Case Reports
Liver transplantation
Takotsubo Cardiomyopathy Resulting in Cardiac Arrest in a Patient Undergoing Liver Transplantation