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Reply to: Diabetes mellitus and Takotsubo syndrome: Dissecting the paradox
International Journal of Cardiology 229 (2017) 135
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Reply to: Diabetes mellitus and Takotsubo syndrome: Dissecting the paradox Ibrahim El-Battrawy a,b,⁎,1, Verena Bill a,⁎,1, Martin Borggrefe a,b, Ibrahim Akin a,b a b
First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
We thank Madias for his interest in our work describing the prevalence and outcome of diabetic patients diagnosed with Takotsubo cardiomyopathy (TC) [1]. The pathogenesis of TC is yet to be fully understood, however, a popular hypothesis does suggest the involvement of a catecholamine-mediated mechanism. Additionally, the possible role of a patho-physiological inflammatory and energeticmetabolic pathway has also been reported [2]. The influence of polyneuropathy affecting the outcome in diabetic TC patients is highly debatable. The article by Stiermaier et al. describing the predictors, cause, clinical outcomes and mortality among diabetics diagnosed with TC presented interesting data. Stiermaier effectively contradicted the diabetic paradox in TC, whilst describing DM in his cohort as an independent predictor of mortality [3]. Most published studies have observed TC patients retrospectively, with patients essentially matched to cohorts diagnosed with coronary artery disease. This has led to any suggestions pertaining to prevalence and clinical outcomes in the DM group being subject to controversy [4]. TC patients represented in our cohort were primarily diagnosed with Type 2 DM. The retrospective study did not include any Type 1 DM patients. A limiting factor is that the evaluation of polyneuropathy and period of disease was based on patient history. Collected data at the time of TC diagnosis did not include details concerning polyneuropathy
DOI of original article: http://dx.doi.org/10.1016/j.ijcard.2016.10.019. ⁎ Corresponding authors at: First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. E-mail addresses: [email protected] (I. El-Battrawy), [email protected] (V. Bill). 1 Contributed equally.
http://dx.doi.org/10.1016/j.ijcard.2016.12.014 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
or associated clinical tests. Our data outlined only two patients suffering from polyneuropathy and an additional nine diagnosed with kidney failure. A majority of the patients were known diabetics for at least 10 years. These results reaffirm the need to evaluate data in larger prospective patients' groups helping us finally understand the patho-physiology of this phenomenon. Conflict of interest None. References [1] V. Bill, I. El-Battrawy, M. Behnes, S. Baumann, T. Becher, E. Elmas, et al., “Diabetes paradox” in Takotsubo cardiomyopathy, Int. J. Cardiol. 224 (2016) 88–89. [2] I. Eitel, F. von Knobelsdorff-Brenkenhoff, P. Bernhardt, I. Carbone, K. Muellerleile, A. Aldrovandi, et al., Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy, JAMA 306 (2011) 277–286. [3] T. Stiermaier, C. Moeller, K. Oehler, S. Desch, T. Graf, C. Eitel, et al., Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences, Eur. J. Heart Fail. 18 (2016) 650–656. [4] J.E. Madias, Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible ‘protective’ effect with pathophysiologic connotations, Eur. Heart J. Acute Cardiovasc. Care 5 (2016) 164–170.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Reply to: Diabetes mellitus and Takotsubo syndrome: Dissecting the paradox Ibrahim El-Battrawy a,b,⁎,1, Verena Bill a,⁎,1, Martin Borggrefe a,b, Ibrahim Akin a,b a b
First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
We thank Madias for his interest in our work describing the prevalence and outcome of diabetic patients diagnosed with Takotsubo cardiomyopathy (TC) [1]. The pathogenesis of TC is yet to be fully understood, however, a popular hypothesis does suggest the involvement of a catecholamine-mediated mechanism. Additionally, the possible role of a patho-physiological inflammatory and energeticmetabolic pathway has also been reported [2]. The influence of polyneuropathy affecting the outcome in diabetic TC patients is highly debatable. The article by Stiermaier et al. describing the predictors, cause, clinical outcomes and mortality among diabetics diagnosed with TC presented interesting data. Stiermaier effectively contradicted the diabetic paradox in TC, whilst describing DM in his cohort as an independent predictor of mortality [3]. Most published studies have observed TC patients retrospectively, with patients essentially matched to cohorts diagnosed with coronary artery disease. This has led to any suggestions pertaining to prevalence and clinical outcomes in the DM group being subject to controversy [4]. TC patients represented in our cohort were primarily diagnosed with Type 2 DM. The retrospective study did not include any Type 1 DM patients. A limiting factor is that the evaluation of polyneuropathy and period of disease was based on patient history. Collected data at the time of TC diagnosis did not include details concerning polyneuropathy
DOI of original article: http://dx.doi.org/10.1016/j.ijcard.2016.10.019. ⁎ Corresponding authors at: First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. E-mail addresses: [email protected] (I. El-Battrawy), [email protected] (V. Bill). 1 Contributed equally.
http://dx.doi.org/10.1016/j.ijcard.2016.12.014 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved.
or associated clinical tests. Our data outlined only two patients suffering from polyneuropathy and an additional nine diagnosed with kidney failure. A majority of the patients were known diabetics for at least 10 years. These results reaffirm the need to evaluate data in larger prospective patients' groups helping us finally understand the patho-physiology of this phenomenon. Conflict of interest None. References [1] V. Bill, I. El-Battrawy, M. Behnes, S. Baumann, T. Becher, E. Elmas, et al., “Diabetes paradox” in Takotsubo cardiomyopathy, Int. J. Cardiol. 224 (2016) 88–89. [2] I. Eitel, F. von Knobelsdorff-Brenkenhoff, P. Bernhardt, I. Carbone, K. Muellerleile, A. Aldrovandi, et al., Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy, JAMA 306 (2011) 277–286. [3] T. Stiermaier, C. Moeller, K. Oehler, S. Desch, T. Graf, C. Eitel, et al., Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences, Eur. J. Heart Fail. 18 (2016) 650–656. [4] J.E. Madias, Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible ‘protective’ effect with pathophysiologic connotations, Eur. Heart J. Acute Cardiovasc. Care 5 (2016) 164–170.