Author
Clément Delmas
Other affiliations: Paul Sabatier University, University of Toulouse, Centre Hospitalier Universitaire de Toulouse
Bio: Clément Delmas is an academic researcher from French Institute of Health and Medical Research. The author has contributed to research in topics: Cardiogenic shock & Medicine. The author has an hindex of 20, co-authored 112 publications receiving 2536 citations. Previous affiliations of Clément Delmas include Paul Sabatier University & University of Toulouse.
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University of Zurich1, Hannover Medical School2, University of California, Davis3, Heidelberg University4, Ludwig Maximilian University of Munich5, Charité6, University of Kentucky7, University of Cologne8, Saarland University9, University of Duisburg-Essen10, University of Göttingen11, University of Hamburg12, University of Ulm13, Technische Universität München14, Otto-von-Guericke University Magdeburg15, John Radcliffe Hospital16, Winterthur Museum, Garden and Library17, University of Turku18, Gdańsk Medical University19, University of Warmia and Mazury in Olsztyn20, Medical University of Warsaw21, University of Cambridge22, University of Basel23, Catholic University of the Sacred Heart24, Innsbruck Medical University25, University of Greifswald26, Leiden University27, University of Glasgow28
TL;DR: Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome and physical triggers, acute neurologics or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications.
Abstract: BackgroundThe natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. MethodsThe International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome. ResultsOf 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were ...
1,721 citations
University of Zurich1, University of California, San Diego2, University of Bremen3, University of Turin4, University Hospital Heidelberg5, University of Southern California6, Hannover Medical School7, Gdańsk Medical University8, Martin Luther University of Halle-Wittenberg9, Technische Universität München10, Leipzig University11, Charité12, HealthPartners13, University of Cologne14, University of Göttingen15, University of Kiel16, University of Ulm17, Otto-von-Guericke University Magdeburg18, John Radcliffe Hospital19, Winterthur Museum, Garden and Library20, Turku University Hospital21, Medical University of Warsaw22, University Hospital of Basel23, Catholic University of the Sacred Heart24, Greifswald University Hospital25, Heidelberg University26, University of Adelaide27, Charles University in Prague28, University of Florida29, Leiden University30, Mayo Clinic31, Imperial College London32
TL;DR: It is demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor, and a new classification based on triggers is proposed, which can serve as a clinical tool to predict short- and long-term outcomes of TTS.
192 citations
Sapienza University of Rome1, University of St. Gallen2, Marche Polytechnic University3, University of Toulouse4, Yale University5, Mount Sinai Hospital6, University of Ulsan7, University of Giessen8, Hospital Clínico San Carlos9, St George's, University of London10, Konkuk University11, Austin Hospital12, Monash University13, Mahidol University14
TL;DR: Patients with takotsubo syndrome have a relevant prevalence of cardiovascular risk factors and associated comorbidities and such of associations needs to be evaluated in further studies.
156 citations
TL;DR: This review will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature, and propose a strategy to optimize the weaning process.
Abstract: Refractory cardiogenic shock patients may be rescued by veno-arterial extracorporeal membrane oxygenation (VA ECMO). After a few days of mechanical assistance, the device can sometimes be successfully removed if the patient has partially or fully recovered from the condition that required the use of ECMO. The percentage of patients with refractory cardiogenic shock who are successfully weaned from ECMO varies from 31% to 76%. Weaning does not mean survival, because 20% to 65% of patients weaned from VA ECMO support do not survive to hospital discharge. The high death rate after successful weaning shows that many questions remain unresolved in this field. In this review, we will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature. Based on this information, we will propose a strategy to optimize the weaning process.
71 citations
University of Zurich1, University of Turin2, University of Southern California3, University of California, San Diego4, University Hospital Heidelberg5, Hannover Medical School6, Gdańsk Medical University7, Martin Luther University of Halle-Wittenberg8, Technische Universität München9, Leipzig University10, Charité11, HealthPartners12, University of Cologne13, University of Göttingen14, University of Ulm15, Otto-von-Guericke University Magdeburg16, John Radcliffe Hospital17, Winterthur Museum, Garden and Library18, Turku University Hospital19, Medical University of Warsaw20, University Hospital of Basel21, Catholic University of the Sacred Heart22, Greifswald University Hospital23, Heidelberg University24, University of Adelaide25, Charles University in Prague26, University of Florida27, University of Bremen28, Leiden University29, Mayo Clinic30, Imperial College London31
TL;DR: Clinical and electrocardiographic parameters independently predicted mortality after cardiac arrest in takotsubo syndrome and cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality.
Abstract: AIMS
We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS).
METHODS AND RESULTS
We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission.
CONCLUSIONS
Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.
65 citations
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University of Zurich1, Johns Hopkins University2, Mayo Clinic3, St. Marianna University School of Medicine4, Catholic University of the Sacred Heart5, Katholieke Universiteit Leuven6, University of Ferrara7, University of Lübeck8, Yokohama City University9, University of Giessen10, Wakayama Medical University11, University of Padua12, Hiroshima University13, University of Florida14, Imperial College London15, University of Gothenburg16, Leiden University17, Karolinska Institutet18, University of Adelaide19, Tohoku University20
TL;DR: The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology.
Abstract: Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.
903 citations