Takotsubo cardiomyopathy in locally advanced rectosigmoid junction cancer: a case report

Background. takotsubo cardiomyopathy (tcm) occurs more frequently in cancer patients than in the general population. The triggers for tcm in cancer patients include not only the inflammatory state of the cancer itself, but also the significant emotional stress of a cancer diagnosis and the physical stress associated with invasive diagnostic and treatment procedures.

Case presentation. We describe the case of a 54-yearold woman with histologically verified rectosigmoid junction cancer (cT4bcN2M0) complicated by acute intestinal obstruction. In the early postoperative period, a sudden drop in blood pressure, t-wave inversion and Qt-interval prolongation on ecg, decrease in the left ventricle contractility and presence of wall motion abnormalities on echocardiography (ecHo), as well as an increase in biomarkers of myocardial damage were initially regarded as acute coronary syndrome, which was subsequently excluded according to the findings of coronary angiography, which did not reveal coronary artery obstruction. taking into account the rapid and complete inverse dynamics of changes, acute myocardial infarction without coronary artery obstruction and acute myocarditis were excluded. Ultimately, the diagnosis of takotsubo cardiomyopathy was established.

Conclusion. this case report indicates that cancer can be a trigger for the development of tcm; therefore, the assessment of cardiological status and timely detection of cardiac complications in cancer patients during cancer treatment is extremely important and is aimed at increasing the overall survival in this category of patients.

1. Boldueva S.A., Evdokimov D.S. Takotsubo cardiomyopathy. Literature review: concept, epidemiology, pathogenesis. Part I. Russian Journal of Cardiology. 2022; 27(3s): 4993. (in Russian). doi:10.15829/1560-4071-2022-4993.

2. Ghadri J.R., Kato K., Cammann V.L., Gili S., Jurisic S., Di Vece D., Candreva A., Ding K.J., Micek J., Szawan K.A., Bacchi B., Bianchi R., Levinson R.A., Wischnewsky M., Seifert B., Schlossbauer S.A., Citro R., Bossone E., Münzel T., Knorr M., Heiner S., D’Ascenzo F., Franke J., Sarcon A., Napp L.C., Jaguszewski M., Noutsias M., Katus H.A., Burgdorf C., Schunkert H., Thiele H., Bauersachs J., Tschöpe C., Pieske B.M., Rajan L., Michels G., Pfister R., Cuneo A., Jacobshagen C., Hasenfuß G., Karakas M., Koenig W., Rottbauer W., Said S.M., Braun-Dullaeus R.C., Banning A., Cuculi F., Kobza R., Fischer T.A., Vasankari T., Airaksinen K.E.J., Opolski G., Dworakowski R., MacCarthy P., Kaiser C., Osswald S., Galiuto L., Crea F., Dichtl W., Empen K., Felix S.B., Delmas C., Lairez O., El-Battrawy I., Akin I., Borggrefe M., Horowitz J., Kozel M., Tousek P., Widimský P., Gilyarova E., Shilova A., Gilyarov M., Winchester D.E., Ukena C., Bax J.J., Prasad A., Böhm M., Lüscher T.F., Ruschitzka F., Templin C. Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol. 2018; 72(8): 874–82. doi: 10.1016/j.jacc.2018.06.016.

3. Deshmukh A., Kumar G., Pant S., Rihal C., Murugiah K., Mehta J.L. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J. 2012; 164(1): 66–71. doi: 10.1016/j.ahj.2012.03.020.

4. Kato K., Lyon A.R., Ghadri J.R., Templin C. Takotsubo syndrome: aetiology, presentation and treatment. Heart. 2017; 103(18): 1461–9. doi: 10.1136/heartjnl-2016-309783.

5. Vitale C., Rosano G.M., Kaski J.C. Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy. Circ J. 2016; 80(2): 299–305. doi: 10.1253/circj.CJ-15-1364.

6. Rawish E., Stiermaier T., Santoro F., Brunetti N.D., Eitel I. Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1-Pathophysiology and Diagnosis. J Clin Med. 2021; 10(3): 479. doi: 10.3390/jcm10030479.

7. Del Buono M.G., Montone R.A., Camilli M., Carbone S., Narula J., Lavie C.J., Niccoli G., Crea F. Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases: JACC State-of-theArt Review. J Am Coll Cardiol. 2021; 78(13): 1352–71. doi: 10.1016/j.jacc.2021.07.042.

8. Ghadri J.R., Wittstein I.S., Prasad A., Sharkey S., Dote K., Akashi Y.J., Cammann V.L., Crea F., Galiuto L., Desmet W., Yoshida T., Manfredini R., Eitel I., Kosuge M., Nef H.M., Deshmukh A., Lerman A., Bossone E., Citro R., Ueyama T., Corrado D., Kurisu S., Ruschitzka F., Winchester D., Lyon A.R., Omerovic E., Bax J.J., Meimoun P., Tarantini G., Rihal C., Y-Hassan S., Migliore F., Horowitz J.D., Shimokawa H., Lüscher T.F., Templin C. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management. Eur Heart J. 2018; 39(22): 2047–62. doi: 10.1093/eurheartj/ehy077.

9. Kotsiou O.S., Douras A., Makris D., Mpaka N., Gourgoulianis K.I. Takotsubo cardiomyopathy: A known unknown foe of asthma. J Asthma. 2017; 54(8): 880–6. doi: 10.1080/02770903.2016.1276586.

10. Jin Q., Luo Q., Zhao Z., Zhao Q., Yu X., Yan L., Gao L., Liu Z. Takotsubo syndrome with pulmonary embolism: a case report and literature review. BMC Cardiovasc Disord. 2018; 18(1): 229. doi: 10.1186/s12872-018-0953-7.

11. Agarwal S., Bean M.G., Hata J.S., Castresana M.R. Perioperative Takotsubo Cardiomyopathy: A Systematic Review of Published Cases. Semin Cardiothorac Vasc Anesth. 2017; 21(4): 277–90. doi: 10.1177/1089253217700511.

12. Desai A., Noor A., Joshi S., Kim A.S. Takotsubo cardiomyopathy in cancer patients. Cardiooncology. 2019; 5: 7. doi: 10.1186/s40959-019-0042-9.

13. Ayoub C., Chang M., Kritharides L. A case report of ventricular dysfunction post pericardiocentesis: stress cardiomyopathy or pericardial decompression syndrome? Cardiovascular Ultrasound. 2015; 13: 32. doi: 10.1186/s12947-015-0026-3.

14. Lyon A.R., López-Fernández T., Couch L.S., Asteggiano R., Aznar M.C., Bergler-Klein J., Boriani G., Cardinale D., Cordoba R., Cosyns B., Cutter D.J., de Azambuja E., de Boer R.A., Dent S.F., Farmakis D., Gevaert S.A., Gorog D.A., Herrmann J., Lenihan D., Moslehi J., Moura B., Salinger S.S., Stephens R., Suter T.M., Szmit S., Tamargo J., Thavendiranathan P., Tocchetti C.G., van der Meer P., van der Pal H.J.H.; ESC Scientific Document Group. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022; 43(41): 4229–361. doi: 10.1093/eurheartj/ehac244. Erratum in: Eur Heart J. 2023; 44(18): 1621.

15. Stanoevich U.S., Gorelik S.G., Zvyagin I.N., Polyansky M.B., Rukavishnikov A.S. Prevalence of colorectal cancer in older age patients. Current problems of health care and medical statistics. 2021; 4: 235–50. (in Russian).

16. Botto F., Alonso-Coello P., Chan M.T., et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014; 120(3): 564–78. doi: 10.1097/ALN.0000000000000113.

17. Akashi Y.J., Nef H.M., Lyon A.R. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015; 12(7): 387–97. doi: 10.1038/nrcardio.2015.39.

18. Watanabe M., Izumo M., Akashi Y., J. Novel Understanding of Takotsubo Syndrome. Int Heart J. 2018; 59(2): 250–5. doi: 10.1536/ihj.17-586.

19. Stanoevich U. Risk factors correction of colorectal cancer – the way to the primary pathogenetic prevention. Bulletin of the Russian Scientific Center of Radiology. 2016; 16(3): 8. (in Russian).