Takotsubo Syndrome in Orthotopic Liver Transplantation: A Systematic Review and Meta-Analysis of Published Studies and Case Reports

16 Pages Posted: 12 Aug 2022

See all articles by Milana Bachayev

Milana Bachayev

International University of the Health Sciences

Brian J. Brereton

Jersey General Hospital

Avilash Mondal

Nazareth Hospital

Bibi Amena Alli-Ramsaroop

Georgetown Public Hospital Corporation

Roshan Dhakal

Nepal Medical College

Maria C. Buhl Leon

Universidad De San Martin De Porres

Camila M. Quinones

Universidad De San Martin De Porres

Mohamed Eyad Abdelall

International University of the Health Sciences

Akhil Jain

Mercy Medical Center

Kartik Dhaduk

Geisinger Wyoming Valley Medical Center - Department of Internal Medicine

Rupak Desai

Independent Researcher

Abstract

Orthotopic liver transplantation (OLT) is a major surgical procedure that presents significant physical stress to recipients. Despite the extensive pre-transplant cardiac workup, cardiovascular (CV) complications are significant, and they impact the short-term and longterm outcomes. A meta-analysis on overall CV outcomes in OLT patients reported a 22.6% average incidence of CV events within 6 months and 11.8% after six months post-transplant.

A few cases of Takotsubo Syndrome (TTS) in OLT recipients have been reported in the literature, however, pooled data on the incidence, risk factors, mortality, and prognosis remain underreported. TTS, First discovered in 1991 in Japan, is a cardiac syndrome characterized as an acute and transient regional left ventricular (LV) systolic dysfunction in the absence of obstructive coronary artery disease (CAD)2. Electrical changes are also seen on the electrocardiogram (EKG) which may notably mimic myocardial infarction, however, there is a minimal release of myocardial enzymes3. Despite the dramatic presentation with a significant drop in the left ventricular ejection fraction (LVEF), there is usually a full recovery, however, thenunderstanding of etiological mechanism is still evolving. It is thought to be stress-induced, reversible cardiomyopathy related to periods of great physical or psychological burden. This systematic review aims to gain more information regarding such clinical correlations (TTS in OLT), appropriate investigation and management to better serve this group of patients. This analysis also aims to gain an understanding of the morbidity and mortality of TTS in OLTpatients and the impact on the post-operative course as well as possible emerging clinical predictors.

Note:

Funding Information: None.

Declaration of Interests: None.

Keywords: Liver transplantation, orthotopic liver transplantation, takotsubo syndrome, takotsubo cardiomyopathy, systematic review, meta-analysis

Suggested Citation

Bachayev, Milana and Brereton, Brian J. and Mondal, Avilash and Alli-Ramsaroop, Bibi Amena and Dhakal, Roshan and Buhl Leon, Maria C. and Quinones, Camila M. and Abdelall, Mohamed Eyad and Jain, Akhil and Dhaduk, Kartik and Desai, Rupak, Takotsubo Syndrome in Orthotopic Liver Transplantation: A Systematic Review and Meta-Analysis of Published Studies and Case Reports. Available at SSRN: https://ssrn.com/abstract=4181250

Milana Bachayev

International University of the Health Sciences ( email )

Brian J. Brereton

Jersey General Hospital ( email )

Avilash Mondal

Nazareth Hospital ( email )

Arbuthnot Rd., Near Police Point
India

Bibi Amena Alli-Ramsaroop

Georgetown Public Hospital Corporation ( email )

Roshan Dhakal

Nepal Medical College ( email )

Maria C. Buhl Leon

Universidad De San Martin De Porres ( email )

Camila M. Quinones

Universidad De San Martin De Porres ( email )

Mohamed Eyad Abdelall

International University of the Health Sciences ( email )

Akhil Jain

Mercy Medical Center ( email )

Kartik Dhaduk (Contact Author)

Geisinger Wyoming Valley Medical Center - Department of Internal Medicine ( email )

Rupak Desai

Independent Researcher ( email )

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