que se leu este artigo
array:25 [ "pii" => "S0870255123000537" "issn" => "08702551" "doi" => "10.1016/j.repc.2023.01.004" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "2103" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2023;42:247-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S087025512300046X" "issn" => "08702551" "doi" => "10.1016/j.repc.2022.02.011" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "2096" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2023;42:251-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Investigating the association between ambient particulate matter (PM<span class="elsevierStyleInf">10</span>) exposure and blood pressure values: Results from the link between the Portuguese Health Examination Survey and air quality data" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "251" "paginaFinal" => "258" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1388 "Ancho" => 3240 "Tamanyo" => 120775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Boxplot of the PM<span class="elsevierStyleInf">10</span> distribution according to sex. The dashed lines represent the daily limit value given by the EU Ambient Air Quality Directives (not to be exceed on more than 35 days/year) and also by the World Health Organization air quality guidelines (not exceeded more than 3 days/year).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vânia Gaio, Rita Roquette, Alexandra Monteiro, Joana Ferreira, Carlos Matias Dias, Baltazar Nunes" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Vânia" "apellidos" => "Gaio" ] 1 => array:2 [ "nombre" => "Rita" "apellidos" => "Roquette" ] 2 => array:2 [ "nombre" => "Alexandra" "apellidos" => "Monteiro" ] 3 => array:2 [ "nombre" => "Joana" "apellidos" => "Ferreira" ] 4 => array:2 [ "nombre" => "Carlos" "apellidos" => "Matias Dias" ] 5 => array:2 [ "nombre" => "Baltazar" "apellidos" => "Nunes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025512300046X?idApp=UINPBA00004E" "url" => "/08702551/0000004200000003/v1_202303051609/S087025512300046X/v1_202303051609/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0870255123000458" "issn" => "08702551" "doi" => "10.1016/j.repc.2022.02.010" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "2095" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2023;42:237-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Long-term prognostic impact of beta-blockers in patients with Takotsubo syndrome: Results from the RETAKO Registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "237" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Impacto prognóstico a longo prazo do uso de beta-bloqueantes em doentes com síndrome de Takotsubo: resultados do Registo RETAKO" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 116157 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves adjusted by inverse probability weighting (IPW) propensity score analysis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sergio Raposeiras-Roubín, Iván J. Núñez-Gil, Karim Jamhour, Emad Abu-Assi, David Aritza Conty, Oscar Vedia, Manuel Almendro-Delia, Alessandro Sionis, Agustin C. Martin-Garcia, Miguel Corbí-Pascual, Manuel Martínez-Sellés, Aitor Uribarri, Marta Guillén, José María García Acuña, Javier Lopez País, Emilia Blanco, José A. Linares Vicente, Alejandro Sánchez Grande Flecha, Mireia Andrés, Alberto Pérez-Castellanos, Joaquín Alonso, Xavier Rosselló, Andrés Iñiguez Romo, Gisela Feltes" "autores" => array:25 [ 0 => array:2 [ "nombre" => "Sergio" "apellidos" => "Raposeiras-Roubín" ] 1 => array:2 [ "nombre" => "Iván J." "apellidos" => "Núñez-Gil" ] 2 => array:2 [ "nombre" => "Karim" "apellidos" => "Jamhour" ] 3 => array:2 [ "nombre" => "Emad" "apellidos" => "Abu-Assi" ] 4 => array:2 [ "nombre" => "David Aritza" "apellidos" => "Conty" ] 5 => array:2 [ "nombre" => "Oscar" "apellidos" => "Vedia" ] 6 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almendro-Delia" ] 7 => array:2 [ "nombre" => "Alessandro" "apellidos" => "Sionis" ] 8 => array:2 [ "nombre" => "Agustin C." "apellidos" => "Martin-Garcia" ] 9 => array:2 [ "nombre" => "Miguel" "apellidos" => "Corbí-Pascual" ] 10 => array:2 [ "nombre" => "Manuel" "apellidos" => "Martínez-Sellés" ] 11 => array:2 [ "nombre" => "Aitor" "apellidos" => "Uribarri" ] 12 => array:2 [ "nombre" => "Marta" "apellidos" => "Guillén" ] 13 => array:2 [ "nombre" => "José María García" "apellidos" => "Acuña" ] 14 => array:2 [ "nombre" => "Javier Lopez" "apellidos" => "País" ] 15 => array:2 [ "nombre" => "Emilia" "apellidos" => "Blanco" ] 16 => array:2 [ "nombre" => "José A." "apellidos" => "Linares Vicente" ] 17 => array:2 [ "nombre" => "Alejandro Sánchez Grande" "apellidos" => "Flecha" ] 18 => array:2 [ "nombre" => "Mireia" "apellidos" => "Andrés" ] 19 => array:2 [ "nombre" => "Alberto" "apellidos" => "Pérez-Castellanos" ] 20 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Alonso" ] 21 => array:2 [ "nombre" => "Xavier" "apellidos" => "Rosselló" ] 22 => array:2 [ "nombre" => "Andrés Iñiguez" "apellidos" => "Romo" ] 23 => array:2 [ "nombre" => "Gisela" "apellidos" => "Feltes" ] 24 => array:1 [ "colaborador" => "on behalf of RETAKO Investigators" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123000458?idApp=UINPBA00004E" "url" => "/08702551/0000004200000003/v1_202303051609/S0870255123000458/v1_202303051609/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0870255123000458" "issn" => "08702551" "doi" => "10.1016/j.repc.2022.02.010" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "2095" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2023;42:237-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Long-term prognostic impact of beta-blockers in patients with Takotsubo syndrome: Results from the RETAKO Registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "237" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Impacto prognóstico a longo prazo do uso de beta-bloqueantes em doentes com síndrome de Takotsubo: resultados do Registo RETAKO" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 116157 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves adjusted by inverse probability weighting (IPW) propensity score analysis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sergio Raposeiras-Roubín, Iván J. Núñez-Gil, Karim Jamhour, Emad Abu-Assi, David Aritza Conty, Oscar Vedia, Manuel Almendro-Delia, Alessandro Sionis, Agustin C. Martin-Garcia, Miguel Corbí-Pascual, Manuel Martínez-Sellés, Aitor Uribarri, Marta Guillén, José María García Acuña, Javier Lopez País, Emilia Blanco, José A. Linares Vicente, Alejandro Sánchez Grande Flecha, Mireia Andrés, Alberto Pérez-Castellanos, Joaquín Alonso, Xavier Rosselló, Andrés Iñiguez Romo, Gisela Feltes" "autores" => array:25 [ 0 => array:2 [ "nombre" => "Sergio" "apellidos" => "Raposeiras-Roubín" ] 1 => array:2 [ "nombre" => "Iván J." "apellidos" => "Núñez-Gil" ] 2 => array:2 [ "nombre" => "Karim" "apellidos" => "Jamhour" ] 3 => array:2 [ "nombre" => "Emad" "apellidos" => "Abu-Assi" ] 4 => array:2 [ "nombre" => "David Aritza" "apellidos" => "Conty" ] 5 => array:2 [ "nombre" => "Oscar" "apellidos" => "Vedia" ] 6 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almendro-Delia" ] 7 => array:2 [ "nombre" => "Alessandro" "apellidos" => "Sionis" ] 8 => array:2 [ "nombre" => "Agustin C." "apellidos" => "Martin-Garcia" ] 9 => array:2 [ "nombre" => "Miguel" "apellidos" => "Corbí-Pascual" ] 10 => array:2 [ "nombre" => "Manuel" "apellidos" => "Martínez-Sellés" ] 11 => array:2 [ "nombre" => "Aitor" "apellidos" => "Uribarri" ] 12 => array:2 [ "nombre" => "Marta" "apellidos" => "Guillén" ] 13 => array:2 [ "nombre" => "José María García" "apellidos" => "Acuña" ] 14 => array:2 [ "nombre" => "Javier Lopez" "apellidos" => "País" ] 15 => array:2 [ "nombre" => "Emilia" "apellidos" => "Blanco" ] 16 => array:2 [ "nombre" => "José A." "apellidos" => "Linares Vicente" ] 17 => array:2 [ "nombre" => "Alejandro Sánchez Grande" "apellidos" => "Flecha" ] 18 => array:2 [ "nombre" => "Mireia" "apellidos" => "Andrés" ] 19 => array:2 [ "nombre" => "Alberto" "apellidos" => "Pérez-Castellanos" ] 20 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Alonso" ] 21 => array:2 [ "nombre" => "Xavier" "apellidos" => "Rosselló" ] 22 => array:2 [ "nombre" => "Andrés Iñiguez" "apellidos" => "Romo" ] 23 => array:2 [ "nombre" => "Gisela" "apellidos" => "Feltes" ] 24 => array:1 [ "colaborador" => "on behalf of RETAKO Investigators" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123000458?idApp=UINPBA00004E" "url" => "/08702551/0000004200000003/v1_202303051609/S0870255123000458/v1_202303051609/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Takotsubo syndrome: We are still “halfway”. A complex heart-brain duality?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "249" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Catarina Ferreira" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Catarina" "apellidos" => "Ferreira" "email" => array:1 [ 0 => "catarina.m.ferreira.cf@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Cardiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Síndrome de Takotsubo: ainda estamos a «meio do caminho» … <span class="elsevierStyleItalic">Uma complexa dualidade coração-cérebro?</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome (TTS) was first described in the early 1990s in the Japanese population. It was named takotsubo because of the resemblance of the shape of the left ventricle (LV) in systole to a Japanese octopus trap called a takotsubo.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although more than 30 years have passed, it is still not fully understood. There are different hypotheses for the underlying mechanism, one of the most commonly accepted being the theory of catecholamine-induced cardiotoxicity in response to an emotional or physical stimulus.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This syndrome has previously been associated with a benign course, but more recent data have shown that a significant rate of in-hospital complications may be seen, and that the short- and medium-term prognosis may be less favorable than previously thought.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Data from studies in Portugal, including registries, have certainly contributed to a better understanding of this condition.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,5</span></a> The initial results published from the International Takotsubo (InterTAK) Registry showed that more than half of the patients with TTS (55.8%) had a history or an acute episode of a neurologic or psychiatric disorder, conditions that were evident in only 25.7% of patients with an acute coronary syndrome.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The spectrum of TTS was wide, with low to very high risk in the acute phase. The physical triggers and acute neurologic or psychiatric diseases were among the factors associated with an increased incidence of acute complications. Also, patients had substantial rates of death and complications after the acute phase. Regarding medical therapy, the use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), but not of beta-blockers, was associated with improved survival at one year.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Another observational, retrospective study, that evaluated the use of beta-blockers in the acute phase, found neither a beneficial nor harmful association between early beta-blocker use and in-hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In this edition of the Portuguese Journal of Cardiology, Raposeiras-Roubín et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> present an interesting study which aims to assess the impact of beta-blocker therapy (patients that have received beta-blockers at discharge) in long-term mortality and TTS recurrence. The cohort used was from the national Spanish Registry on TTS (RETAKO Registry). It is a partially retrospective and prospective (since 2012) observational study from 38 centers in Spain. Considering the exclusion criteria, 970 (from 1095) patients were included and divided into groups according to the types of preceding stressors (emotional stress, physical stress and no identifiable trigger); the pattern of LV dysfunction was classified in apical and non-apical type. The considered follow-up outcomes, after hospital discharge, were defined as the first non-fatal TTS recurrence or the occurrence of all-cause of death (mean follow-up of 2.5±3.3 years). The main results were:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">(a)</span><p id="par0040" class="elsevierStylePara elsevierViewall">60% of the patients were treated with beta-blockers;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">(b)</span><p id="par0045" class="elsevierStylePara elsevierViewall">there were 87 deaths (3.6 per 100 patients/year) and 29 TTS recurrences (1.2 per 100 patients/year);</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(c)</span><p id="par0050" class="elsevierStylePara elsevierViewall">even after multivariate adjustment, no significant differences in the composite outcome of mortality or TTS recurrence between patients treated and untreated with beta-blockers were found (the same result in a propensity score analysis);</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">(d)</span><p id="par0055" class="elsevierStylePara elsevierViewall">no benefit of beta-blockers in follow-up mortality and/or TTS recurrence, across all TTS types;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">(e)</span><p id="par0060" class="elsevierStylePara elsevierViewall">regarding the trigger, beta-blocker therapy was most frequently prescribed in the TTS group related to emotional stress, but no significant differences in the follow-up outcomes were found;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">(f)</span><p id="par0065" class="elsevierStylePara elsevierViewall">in a subgroup analysis (considering age, gender, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease (COPD), Killip class, cardiogenic shock, ACE inhibitors/ARB at discharge) no benefit of beta-blockers was found in any subgroup, with an increase in mortality and recurrence rates of TTS in COPD.</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">The results presented by Raposeiras-Roubín et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> are in line with other earlier studies.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The several study limitations are addressed by the authors and consist of, among others, the heterogeneity of beta-blocker therapy (dose and type), and rates of discontinuation or new prescriptions during follow-up. These data were not collected and might have affected the outcomes.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There are very few studies that have evaluated the impact of the type of beta-blocker on clinical outcomes in TTS, but beta-blockers that activate β2 adrenoceptor (to inhibitory G protein signaling) may be deleterious, as they might exacerbate the epinephrine-induced negative inotropic effect.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Although there have been no randomized trials to define the optimal management in this syndrome, beta-blockers are one of the most frequently prescribed therapies at discharge.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding this problematic, studies like the one presented by Raposeiras-Roubín et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> also alert the clinician to the need for more investigation and trials, for a better understanding of the pathophysiology and therapeutic management of TTS, in order to use a more appropriate approach, with possible implications for its course.</p><p id="par0095" class="elsevierStylePara elsevierViewall">TTS is heterogeneous, not only with different clinical profiles, triggers, and anatomical shapes but also with different recovery times. Another study from InterTAK Registry addresses this issue. In-hospital outcomes and one-year mortality were compared for patients with versus without early recovery of LV wall motion abnormalities (the cut off for early recovery was defined as 10 days after the acute event). The authors found that 53% of the patients presented late LV improvement. The absence of an early recovery showed unfavorable one-year outcomes compared with an early recovery. Male sex, lower LV ejection fraction and acute neurologic disorders were among the factors associated with the absence of an early recovery.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Besides the issue of the therapeutic approach, maybe we should ask a broader question: how can we improve the management of such a complex entity? We certainly still have some way to go. One of the gaps is in the knowledge of the pathogenic mechanisms.</p><p id="par0105" class="elsevierStylePara elsevierViewall">A recent position paper on pathophysiology of TTS mentioned that all the complex mechanisms and changes that can happen within the heart need to be integrated at a systems biology level, with peripheral vasculature, the brain, and autonomic and peripheral nervous system. Given this, the recognition of key pathways in the heart, vasculature and brain could be future targets for new treatments, with possible diagnostic and therapeutic impact in TTS, in the acute phase and subsequently. A correct and earlier diagnosis may also be of relevance to the better management of this syndrome.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">More data from prospective studies, randomized and controlled trials are warranted to better identify the mechanisms underlying this syndrome, its treatment and follow-up.</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is of special interest whether medical treatment influences the outcome, especially after the acute phase. This will also require a better understanding of this complex heart–brain duality in order to clarify the pathophysiology and, consequently, the therapy and prevention in this syndrome.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Takotsubo syndrome is as complex and challenging as it is fascinating.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The author has 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" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo-type cardiomyopathy due to multivessel spasm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Sato" 1 => "H. Tateishi" 2 => "T. Uchida" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "K.Kodama, K.Haze, M.Hon" "titulo" => "Clinical aspect of myocardial injury: from ischemia to heart failure" "paginaInicial" => "56" "paginaFinal" => "64" "serieFecha" => "1990" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y.J. Akashi" 1 => "D.S. Goldstein" 2 => "G. Barbaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.108.767012" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "118" "paginaInicial" => "2754" "paginaFinal" => "2762" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19106400" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and outcomes of Takotsubo (stress) cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Templin" 1 => "J.R. Ghadri" 2 => "J. Diekmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1406761" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "929" "paginaFinal" => "938" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26332547" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical predictors and prognostic impact of recovery of wall motion abnormalities in Takotsubo syndrome: results from the International Takotsubo Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Jurisic" 1 => "S. Gili" 2 => "V.L. Cammann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/JAHA.118.011194" "Revista" => array:5 [ "tituloSerie" => "J Am Heart Assoc" "fecha" => "2019" "volumen" => "8" "paginaInicial" => "e011194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31672100" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short- and medium-term prognosis of Takotsubo syndrome in a Portuguese population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Bento" 1 => "O. Azevedo" 2 => "R. Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2018.07.010" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "349" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31221486" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early beta-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Isogai" 1 => "H. Matsui" 2 => "H. Tanaka" 3 => "K. Fushimi" 4 => "H. Yasunaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2015-308712" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2016" "volumen" => "102" "paginaInicial" => "1029" "paginaFinal" => "1035" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26879240" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term prognostic impact of β-blockers in patients with Takotsubo syndrome: results from the RETAKO Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Raposeiras-Roubín" 1 => "I. Núñez-Gil" 2 => "K. Jamhour" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2023" "volumen" => "42" "paginaInicial" => "237" "paginaFinal" => "246" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High levels of circulating epinephrine trigger apical cardiodepression in a beta2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Paur" 1 => "P.T. Wright" 2 => "M.B. Sikkel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.112.111591" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2012" "volumen" => "126" "paginaInicial" => "697" "paginaFinal" => "706" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22732314" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Medina de Chazal" 1 => "M.G. Del Buono" 2 => "L. Keyser-Marcus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2018.07.072" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2018" "volumen" => "72" "paginaInicial" => "1955" "paginaFinal" => "1971" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30309474" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of Takotsubo syndrome – a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology – Part 2: Vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Omerovic" 1 => "R. Citro" 2 => "E. Bossone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.2368" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2022" "volumen" => "24" "paginaInicial" => "274" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34655287" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004200000003/v1_202303051609/S0870255123000537/v1_202303051609/en/main.assets" "Apartado" => array:4 [ "identificador" => "93359" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004200000003/v1_202303051609/S0870255123000537/v1_202303051609/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255123000537?idApp=UINPBA00004E" ]
Ano/Mês | Html | Total | |
---|---|---|---|
2024 Novembro | 6 | 4 | 10 |
2024 Outubro | 46 | 32 | 78 |
2024 Setembro | 47 | 23 | 70 |
2024 Agosto | 52 | 31 | 83 |
2024 Julho | 45 | 31 | 76 |
2024 Junho | 36 | 24 | 60 |
2024 Maio | 35 | 16 | 51 |
2024 Abril | 39 | 26 | 65 |
2024 Maro | 32 | 31 | 63 |
2024 Fevereiro | 30 | 21 | 51 |
2024 Janeiro | 35 | 13 | 48 |
2023 Dezembro | 37 | 18 | 55 |
2023 Novembro | 37 | 40 | 77 |
2023 Outubro | 31 | 21 | 52 |
2023 Setembro | 25 | 14 | 39 |
2023 Agosto | 26 | 17 | 43 |
2023 Julho | 36 | 19 | 55 |
2023 Junho | 33 | 14 | 47 |
2023 Maio | 44 | 33 | 77 |
2023 Abril | 38 | 16 | 54 |
2023 Maro | 105 | 89 | 194 |
2023 Fevereiro | 29 | 25 | 54 |
2023 Janeiro | 20 | 24 | 44 |