Author
Lawrence Rajan
Other affiliations: University of Kentucky
Bio: Lawrence Rajan is an academic researcher from HealthPartners. The author has contributed to research in topics: Acute coronary syndrome & Percutaneous coronary intervention. The author has an hindex of 10, co-authored 19 publications receiving 1663 citations. Previous affiliations of Lawrence Rajan include University of Kentucky.
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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
University of Turin1, University of Zurich2, 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
University of Zurich1, University of Turin2, University of Southern California3, Heidelberg University4, Hannover Medical School5, Gdańsk Medical University6, Martin Luther University of Halle-Wittenberg7, Technische Universität München8, Leipzig University9, Charité10, HealthPartners11, University of Cologne12, University of Göttingen13, University of Ulm14, John Radcliffe Hospital15, Winterthur Museum, Garden and Library16, Turku University Hospital17, Medical University of Warsaw18, University Hospital of Basel19, Catholic University of the Sacred Heart20, Greifswald University Hospital21, University of Adelaide22, Charles University in Prague23, University of Florida24, Mayo Clinic25, Leiden University26, Imperial College London27
TL;DR: The International Takotsubo Registry (www.takotubo-registry.com) is an observational, prospective, and retrospective registry established at the University Hospital Zurich in 2011, with the largest TTS database worldwide.
Abstract: The clinical course of takotsubo syndrome (TTS) can be complicated by several life-threatening conditions. In particular, cardiogenic shock (CS) represents one of the leading causes of mortality in the acute phase and occurs in a considerable number of patients with TTS, with an incidence of ≈10%. At present, no established guidelines are available to support specific treatment recommendations,and the conventional therapy for CS leads to uncertain results in TTS cases. The International Takotsubo Registry (www.takotsubo-registry.com) is an observational, prospective, and retrospective registry established at the University Hospital Zurich in 2011, with the largest TTS database worldwide. Patients were included in the registry between 2011 and 2017 based on modified Mayo Clinic Diagnostic criteria. Hospitalization data were recorded through standardized forms on admission or during revision of clinical charts; follow-up data were obtained from medical records, telephone follow-up, or clinical visits. The study population was categorized into 2 groups: patients with TTS with and without CS. The study protocol was reviewed by the respective local ethics committees or investigational review boards at each collaboration site. Where informed consent was required, formal written consent was obtained from patients.
61 citations
Hannover Medical School1, University of Zurich2, Gdańsk Medical University3, University of Bremen4, University of Turin5, University Hospital Heidelberg6, Martin Luther University of Halle-Wittenberg7, Technische Universität München8, Charité9, University of California, San Francisco10, HealthPartners11, University of Cologne12, University of Göttingen13, University of Ulm14, John Radcliffe Hospital15, Winterthur Museum, Garden and Library16, Turku University Hospital17, University Hospital Regensburg18, Nippon Medical School19, Chiba University20, Medical University of Warsaw21, University of Cambridge22, University Hospital of Basel23, Catholic University of the Sacred Heart24, Christchurch Hospital25, Greifswald University Hospital26, Heidelberg University27, University of Adelaide28, Charles University in Prague29, University of Florida30, University of Lisbon31, Mayo Clinic32, University of Jena33, Otto-von-Guericke University Magdeburg34, Leipzig University35, Leiden University36, Brigham and Women's Hospital37, Imperial College London38
TL;DR: Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.
Abstract: AIMS
Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS.
METHODS AND RESULTS
Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort.
CONCLUSIONS
Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.
TRIAL REGISTRATION
ClinicalTrials.gov number: NCT01947621.
48 citations
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TL;DR: This dissertation aims to provide a history of web exceptionalism from 1989 to 2002, a period chosen in order to explore its roots as well as specific cases up to and including the year in which descriptions of “Web 2.0” began to circulate.
Abstract: Kristian Thygesen∗ (Denmark)
Joseph S. Alpert∗ (USA)
Allan S. Jaffe (USA)
Bernard R. Chaitman (USA)
Jeroen J. Bax (The Netherlands)
David A. Morrow (USA)
Harvey D. White∗ (New Zealand)
Hans Mickley (Denmark)
Filippo Crea (Italy)
Frans Van de Werf (Belgium)
Chiara Bucciarelli-Ducci (
3,355 citations
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TL;DR: From the Department of Medicine, Division of Translational Medicine and Human Genetics, Center for Cytokine Storm Treatment and Laboratory, and the Center for Cellular Immunotherapies and the Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia.
Abstract: From the Department of Medicine, Division of Translational Medicine and Human Genetics, Center for Cytokine Storm Treatment and Laboratory (D.C.F.), and the Center for Cellular Immunotherapies and the Parker Institute for Cancer Immunotherapy (C.H.J.), Perelman School of Medicine, University of Pennsylvania, Philadelphia. Address reprint requests to Dr. Fajgenbaum at davidfa@ pennmedicine . upenn . edu or to Dr. June at cjune@ upenn . edu.
1,517 citations
01 May 2009
1,262 citations
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
National Institutes of Health1, University of Salerno2, Bosch3, St. George's University4, Royal North Shore Hospital5, University of Sydney6, St. Marianna University School of Medicine7, University of Zurich8, National and Kapodistrian University of Athens9, Paris Diderot University10, University of Gothenburg11
TL;DR: Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision‐making by practising clinicians in the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation.
Abstract: Takotsubo syndrome is an acute reversible heart failure syndrome that is increasingly recognized in modern cardiology practice. This Position Statement from the European Society of Cardiology Heart Failure Association provides a comprehensive review of the various clinical and pathophysiological facets of Takotsubo syndrome, including nomenclature, definition, and diagnosis, primary and secondary clinical subtypes, anatomical variants, triggers, epidemiology, pathophysiology, clinical presentation, complications, prognosis, clinical investigations, and treatment approaches. Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision-making by practising clinicians. These also cover more complex areas (e.g. uncertain diagnosis and delayed presentation) and the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation. The unmet needs and future directions for research in this syndrome are also discussed.
784 citations