Letter to the Editor
Takotsubo cardiomyopathy and chronic obstructive pulmonary disease – Reply
Miocardiopatia Takotsubo e doença pulmonar obstrutiva crónica – Resposta
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class="elsevierStyleTextfn">Letter to the 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. Nunes" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Filipa" "apellidos" => "Melão" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "José Pedro L." "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 "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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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:6 [ "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" ] ] ] ] ] ] ] ] 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" => "/08702551/0000003300000010/v1_201410290045/S0870255114002327/v1_201410290045/en/main.assets" "Apartado" => array:4 [ "identificador" => "19305" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Cartas ao Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000010/v1_201410290045/S0870255114002327/v1_201410290045/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002327?idApp=UINPBA00004E" ]
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| 2021 Junho | 23 | 23 | 46 |
| 2021 Maio | 26 | 27 | 53 |
| 2021 Abril | 61 | 22 | 83 |
| 2021 Maro | 66 | 17 | 83 |
| 2021 Fevereiro | 61 | 10 | 71 |
| 2021 Janeiro | 24 | 13 | 37 |
| 2020 Dezembro | 26 | 10 | 36 |
| 2020 Novembro | 27 | 10 | 37 |
| 2020 Outubro | 16 | 8 | 24 |
| 2020 Setembro | 34 | 3 | 37 |
| 2020 Agosto | 20 | 8 | 28 |
| 2020 Julho | 37 | 6 | 43 |
| 2020 Junho | 17 | 9 | 26 |
| 2020 Maio | 23 | 13 | 36 |
| 2020 Abril | 24 | 9 | 33 |
| 2020 Maro | 23 | 4 | 27 |
| 2020 Fevereiro | 29 | 14 | 43 |
| 2020 Janeiro | 39 | 6 | 45 |
| 2019 Dezembro | 20 | 7 | 27 |
| 2019 Novembro | 26 | 7 | 33 |
| 2019 Outubro | 28 | 5 | 33 |
| 2019 Setembro | 6 | 8 | 14 |
| 2019 Agosto | 20 | 11 | 31 |
| 2019 Julho | 34 | 15 | 49 |
| 2019 Junho | 13 | 3 | 16 |
| 2019 Maio | 26 | 12 | 38 |
| 2019 Abril | 21 | 17 | 38 |
| 2019 Maro | 14 | 15 | 29 |
| 2019 Fevereiro | 26 | 11 | 37 |
| 2019 Janeiro | 14 | 6 | 20 |
| 2018 Dezembro | 19 | 16 | 35 |
| 2018 Novembro | 83 | 5 | 88 |
| 2018 Outubro | 163 | 13 | 176 |
| 2018 Setembro | 32 | 9 | 41 |
| 2018 Agosto | 37 | 14 | 51 |
| 2018 Julho | 29 | 7 | 36 |
| 2018 Junho | 42 | 9 | 51 |
| 2018 Maio | 76 | 5 | 81 |
| 2018 Abril | 43 | 3 | 46 |
| 2018 Maro | 98 | 7 | 105 |
| 2018 Fevereiro | 34 | 0 | 34 |
| 2018 Janeiro | 40 | 11 | 51 |
| 2017 Dezembro | 75 | 7 | 82 |
| 2017 Novembro | 29 | 12 | 41 |
| 2017 Outubro | 31 | 8 | 39 |
| 2017 Setembro | 32 | 8 | 40 |
| 2017 Agosto | 31 | 8 | 39 |
| 2017 Julho | 22 | 11 | 33 |
| 2017 Junho | 28 | 7 | 35 |
| 2017 Maio | 29 | 5 | 34 |
| 2017 Abril | 20 | 3 | 23 |
| 2017 Maro | 20 | 43 | 63 |
| 2017 Fevereiro | 22 | 6 | 28 |
| 2017 Janeiro | 19 | 3 | 22 |
| 2016 Dezembro | 17 | 4 | 21 |
| 2016 Novembro | 17 | 4 | 21 |
| 2016 Outubro | 16 | 2 | 18 |
| 2016 Setembro | 14 | 3 | 17 |
| 2016 Agosto | 15 | 1 | 16 |
| 2016 Julho | 9 | 3 | 12 |
| 2016 Junho | 15 | 6 | 21 |
| 2016 Abril | 10 | 2 | 12 |
| 2016 Maro | 21 | 6 | 27 |
| 2016 Fevereiro | 41 | 18 | 59 |
| 2016 Janeiro | 26 | 8 | 34 |
| 2015 Dezembro | 32 | 9 | 41 |
| 2015 Novembro | 36 | 9 | 45 |
| 2015 Outubro | 27 | 10 | 37 |
| 2015 Setembro | 32 | 12 | 44 |
| 2015 Agosto | 24 | 7 | 31 |
| 2015 Julho | 26 | 20 | 46 |
| 2015 Junho | 15 | 4 | 19 |
| 2015 Maio | 39 | 8 | 47 |
| 2015 Abril | 23 | 9 | 32 |
| 2015 Maro | 14 | 2 | 16 |
| 2015 Fevereiro | 31 | 10 | 41 |
| 2015 Janeiro | 43 | 18 | 61 |
| 2014 Dezembro | 85 | 16 | 101 |
| 2014 Novembro | 104 | 51 | 155 |
| 2014 Outubro | 13 | 7 | 20 |
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