Letter to the Editor
Takotsubo cardiomyopathy and chronic obstructive pulmonary disease – Reply
Miocardiopatia Takotsubo e doença pulmonar obstrutiva crónica – Resposta
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Editor</span>" "titulo" => "Takotsubo cardiomyopathy and chronic obstructive pulmonary disease – Reply" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "661" "paginaFinal" => "662" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Filipa Melão, José Pedro L. 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"apellidos" => "Nunes" "email" => array:1 [ 0 => "jplnunes@med.up.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Hospital São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Miocardiopatia Takotsubo e doença pulmonar obstrutiva crónica – Resposta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the comments by Dr. Dias and Dr. Franco on our recently published case report “Stress-induced cardiomyopathy associated with ipratropium bromide in a patient with chronic obstructive pulmonary disease” (COPD).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We agree with Dr. Dias and Dr. Franco that factors such as the presence of pneumonia may have contributed to the clinical picture. The point of divergence is the most likely acute trigger for the stress cardiomyopathy. As we state in the text, we think that the time-course of the association between the administration of ipratropium bromide and Takotsubo cardiomyopathy is suggestive of a causal role, and this view is strengthened by the second episode of bronchospasm.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Epidemiological studies are generally speaking unable to provide proof of causality (only showing that an association exists). Causality can only be established in the context of controlled studies, such as a controlled clinical trial.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, from a practical standpoint, it is important to evaluate the possible causal role of a given drug in a possible adverse drug reaction scenario, since the same patient, as well as others, may be treated in the future in the same type of context and with the same drug. Several methods have been put forward for this purpose, although most have shortcomings.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The time-course, the temporal relation between drug administration and the suspected reaction, is critical in evaluating an adverse drug reaction – and the time course, in this particular case, in our view suggests that ipratropium bromide had a causal role. The parameters of temporal sequence, pattern of response, withdrawal and re-exposure<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> may be seen as favoring our view.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Previous reports of stress cardiomyopathy in COPD patients have described the use of ipratropium, namely the case reported by Pham et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and one of the cases by White and Stewart.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However, it can be argued that this falls short of establishing that there are previous conclusive reports of this reaction.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Concerning drugs that act on adrenergic mechanisms, Sharkey et al. described a series of 136 patients with stress cardiomyopathy, including 13 patients treated with adrenergic agonists that could have acted as triggers.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, 25 patients of the same series were taking beta-blockers,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> raising doubts concerning the role of adrenergic mechanisms in this setting.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, the association between ipratropium bromide use and stress cardiomyopathy in the case we reported was quite clear, and we think that it is reasonable to suggest that ipratropium bromide had a causal role in this case. Since ipratropium bromide use has been associated to stress cardiomyopathy in several individual COPD patients, a more systematic evaluation of this association could be justified.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-09" "fechaAceptado" => "2014-09-16" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress-induced cardiomyopathy associated with ipratropium bromide therapy in a patient with chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Melao" 1 => "J.P.L. Nunes" 2 => "M. Vasconcelos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2014" "volumen" => "33" "paginaInicial" => "175e1" "paginaFinal" => "1754e" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical therapeutics: from induction to scientific evolution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P.L. 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Ribeiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pharmacoepidemiol Drug Safety" "fecha" => "2005" "volumen" => "14" "paginaInicial" => "885" "paginaFinal" => "890" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A method for estimating the probability of adverse drug reactions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.A. Naranjo" 1 => "U. Busto" 2 => "E.M. Sellers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacol Ther" "fecha" => "1981" "volumen" => "30" "paginaInicial" => "239" "paginaFinal" => "245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7249508" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COPD exacerbation with concurrent stress cardiomyopathy: a case of double dyspnoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Pham" 1 => "S.R. Bruhl" 2 => "M. Sheikh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Br J Medical Practitioners" "fecha" => "2011" "paginaInicial" => "4" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Troponin elevation during exacerbations of chronic obstructive airways disease due to stress cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. White" 1 => "R.A. Stewart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2012.06.049" "Revista" => array:7 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2012" "volumen" => "160" "paginaInicial" => "206" "paginaFinal" => "207" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22762782" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939411000626" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.W. Sharkey" 1 => "D.C. Windenburg" 2 => "J.R. Lesser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2009.08.057" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "333" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20117439" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002359/v1_201411060106/en/main.assets" "Apartado" => array:4 [ "identificador" => "29282" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000010/v1_201411060106/S2174204914002359/v1_201411060106/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002359?idApp=UINPBA00004E" ]
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| 2021 May | 29 | 28 | 57 |
| 2021 April | 44 | 15 | 59 |
| 2021 March | 50 | 8 | 58 |
| 2021 February | 43 | 16 | 59 |
| 2021 January | 18 | 9 | 27 |
| 2020 December | 35 | 11 | 46 |
| 2020 November | 21 | 9 | 30 |
| 2020 October | 7 | 3 | 10 |
| 2020 September | 34 | 10 | 44 |
| 2020 August | 9 | 4 | 13 |
| 2020 July | 30 | 3 | 33 |
| 2020 June | 30 | 6 | 36 |
| 2020 May | 34 | 3 | 37 |
| 2020 April | 36 | 13 | 49 |
| 2020 March | 37 | 6 | 43 |
| 2020 February | 43 | 14 | 57 |
| 2020 January | 24 | 5 | 29 |
| 2019 December | 36 | 3 | 39 |
| 2019 November | 38 | 6 | 44 |
| 2019 October | 25 | 6 | 31 |
| 2019 September | 20 | 7 | 27 |
| 2019 August | 20 | 5 | 25 |
| 2019 July | 40 | 13 | 53 |
| 2019 June | 21 | 7 | 28 |
| 2019 May | 34 | 7 | 41 |
| 2019 April | 17 | 14 | 31 |
| 2019 March | 18 | 14 | 32 |
| 2019 February | 45 | 8 | 53 |
| 2019 January | 13 | 8 | 21 |
| 2018 December | 49 | 9 | 58 |
| 2018 November | 74 | 8 | 82 |
| 2018 October | 111 | 10 | 121 |
| 2018 September | 39 | 12 | 51 |
| 2018 August | 37 | 10 | 47 |
| 2018 July | 50 | 1 | 51 |
| 2018 June | 60 | 9 | 69 |
| 2018 May | 73 | 6 | 79 |
| 2018 April | 76 | 11 | 87 |
| 2018 March | 89 | 7 | 96 |
| 2018 February | 51 | 5 | 56 |
| 2018 January | 38 | 10 | 48 |
| 2017 December | 69 | 9 | 78 |
| 2017 November | 29 | 16 | 45 |
| 2017 October | 16 | 16 | 32 |
| 2017 September | 27 | 12 | 39 |
| 2017 August | 25 | 22 | 47 |
| 2017 July | 20 | 10 | 30 |
| 2017 June | 30 | 7 | 37 |
| 2017 May | 24 | 7 | 31 |
| 2017 April | 14 | 10 | 24 |
| 2017 March | 23 | 74 | 97 |
| 2017 February | 23 | 5 | 28 |
| 2017 January | 23 | 0 | 23 |
| 2016 December | 26 | 5 | 31 |
| 2016 November | 14 | 6 | 20 |
| 2016 October | 34 | 5 | 39 |
| 2016 September | 25 | 6 | 31 |
| 2016 August | 7 | 1 | 8 |
| 2016 July | 8 | 4 | 12 |
| 2016 June | 11 | 8 | 19 |
| 2016 May | 17 | 6 | 23 |
| 2016 April | 25 | 1 | 26 |
| 2016 March | 19 | 3 | 22 |
| 2016 February | 40 | 13 | 53 |
| 2016 January | 26 | 12 | 38 |
| 2015 December | 24 | 4 | 28 |
| 2015 November | 24 | 3 | 27 |
| 2015 October | 36 | 6 | 42 |
| 2015 September | 29 | 7 | 36 |
| 2015 August | 26 | 8 | 34 |
| 2015 July | 24 | 9 | 33 |
| 2015 June | 6 | 2 | 8 |
| 2015 May | 29 | 5 | 34 |
| 2015 April | 32 | 6 | 38 |
| 2015 March | 18 | 7 | 25 |
| 2015 February | 20 | 1 | 21 |
| 2015 January | 27 | 7 | 34 |
| 2014 December | 37 | 9 | 46 |
| 2014 November | 48 | 10 | 58 |
Show all
