Table 1.
Baseline demographic and clinical characteristics, laboratory markers in COVID-19 patients with TTS
| Author | Country | Age/sex | Comorbidities/PMH | Clinical features during admission | ECG finding | Echocardiograhy/ventriculography/TTE | Troponin | CRP (mg/L) | D-DIMER (ng/ml) | Ejection Fraction (%) |
|---|---|---|---|---|---|---|---|---|---|---|
| Roca | Italy | 87/F | Breast cancer | Fever, chills, fatigue, dry cough, SOB | Negative T waves and repolarization phase alteration | Alterations in the left ventricle: apical akinetic expansion (apical ballooning) and hypokinesia of the mid-ventricular segments | 5.318 ng/mL | 205.6 | – | 48 |
| Moderato | Italy | 59/F | HTN, DM, obesity, and anxiety disorders | Fever, acute dyspnea, chest pain | Lateral elevation of the ST tract with lateral giant symmetric negative T waves in front and elongated QTc (511 ms) | Apical akinesia with “apical ballooning” as per TTE | 1.137 ng/mL | 160 | – | 40–45 |
| Debbagh | USA | 67/F | Non-ischemic cardiomyopathy with LVEF 15% managed with improvement of 40% pericardial effusion | Left shoulder pain, cough, SOB, worsening dyspnea and orthopnea | Deep T wave inversion in precordial leads (V2 to V6) | Hypokinesis of the apical and periapical walls | 2.410 ng/mL | 159 | 6520 | 40 |
| Fadi | USA | 52/M | Fever, shortness of breath | ST segment elevations in the inferior leads—II, III, aVF; | Apical ballooning on ventriculography | <0.015 ng/mL | 276 | 3450 | 45 | |
| Minhas | USA | 58/F | DM type 2, HTN, and dyslipidemia | Fever, fatigue, productive cough, diarrhea, SOB | Sinus tachycardia and 1-mm upsloping ST segment elevations in leads 1 and aVL, mild diffuse PR interval | Akinetic middle to distal anterior, anteroseptal, anterolateral, and apical segments, moderately hypokinetic middle and distal inferolateral segments, and hyperdynamic basal segments. Apical ballooning and distal third or apical right ventricular (RV) free wall was akinetic, with hyperdynamic RV basal wall motion | 11.02 ng/mL | – | – | 20 |
| Nguyen | Belgium | 71/F | Hypercholesterolemia, normotensive hydrocephalus with VP shunt, HTN | Dyspnea, afebrile, fainting | ECG showed sinus rhythm with prolonged QT interval (QTc 521 ms) | Ventriculogaram: regional wall motion abnormality unrelated to the coronary lesions, compatible with a median Takotsubo | 0.412 ng/mL | – | – | – |
| Sattar | USA | 67/F | HTN, type 2 DM | Fever, chill, cough, malaise, and myalgias, anxious on examination | T inversion in V1,V3; RBBB; atrial fibrillation at rapid ventricular response | Diffuse anterior wall, apical akinesia, and apical ballooning | 0.423 ng/mL | 222 | 1681 | 30 |
| Tsao | USA | 59/F | Obesity | Fever, chills, fatigue, myalgia, cough | ST segment elevation with non-specific T wave inversion | Severe hypokinesia of mid left ventricular cavity, normal contractility of basal, and apical segment | 1 ng/mL | >300 | 2184 | 36 |
| Sala | Italy | 43/F | None | Chest pain, dyspnea | Mild ST elevation in V1-V2 and aVR, Reciprocal ST depression in V4-V6, QT prolongation | Hypokinesia LV mid and basal segment normal apical contraction S/Oreverse TTS | hs 135 ng/mL | 18 | – | 43 |
| Mayer p | Switzerland | 83/F | HTN | Acute chest pain, dry cough, SOB | ST elevation in precordial leads with T wave inversion | Apical ballooning with hyperkinetic basal segment | 1.142 ng/mL | NR | ||
| Pasqualetto | Italy | 84/M | HTN, DM | Fever, dyspnea, cough, chest pain | NR | Apical ballooning with basal wall hypercontractility and systolic dysfunction | hs 70 ng/mL | 168.8, | 1381 | 53 |
| 85/F | HTN | Fever, dyspnea, cough, chest pain | 647 ng/mL | 170.9 | 1227 | 30 | ||||
| 81/M | HTN, DM | Fever, dyspnea, cough, chest pain | 596 ng/mL | 190.4 | 3340 | 42 | ||||
| Kariyanna | USA | 72/F | Obesity, DM, HTN, hyperlipidemia, penicillin allergy | Dry cough, loss of appetite, STROKE | Q waves in V1-V2 leads suggestive of septal infarct and Q waves with ST segment elevation V3,V4,V5, and deep T wave inversion in V6 | Apical ballooning with basal wall hypercontractility and systolic dysfunction | 4250 ng/mL | 270 | 6518 | 30 |
| S Lopez | Spain | 50/M | Benign mediastina tumor | Fever, dyspnea, cough, chest pain | 2-mm ST segment elevation in the inferior and lateral leads |
LV angiography: presented basal segment akinesia and hypercontractility of the mid-apical segments with elevated diastolic pressure s/o Inverted TTS TTE: akinesia of all basal segments |
64 ng/mL | – | – | 42 |
| Recalde | Spain | 50/M | Copper metabolism disorder, benign right mediastinal tumor | Fever, dyspnea, cough | Sinus tachycardia with lateral ST segment elevation, 2 mm |
No LV dilation, akinesis of all basal segments and hypercontractility of mid-apical segments Normal right chambers No pericardial effusion Ventriculography shows an inverted takotsubo pattern |
64.1 ng/mL | 379.5 | 2442 | NR |
| Bernardi | Italy | 74/M | Hypertension, dyslipidemia, and impaired fasting blood sugar | Fever, dyspnea, cough | ST segment elevation in anterolateral leads |
TTE: Dilated left ventricle with akinesis of the mid and apical ventricle segments with hyperkinesis of the basal segments and severe systolic dysfunction. + first grade diastolic dysfunction, partial LVOT obstruction, SAM of mitral valve, a/w severe MR + 2 large apical thrombotic formations: the posterior one was elongated (maximum: 31 mm) and mobile, and the anterior one was wide and oval |
0.775 ng/mL | 14.2 mg/l | 2931 | 30 |
| Bopat A | USA | 61/F | HTN | Exertional dyspnea,tachycardic | T wave inversions (V3-V6) with progressive deepening of TWI and progressive Prolongstion in QT interval, ST elevations and biphasic T | apical hypokinesis | 10 ng/L | 138.4 mg/L | – | 61 |
| Chitturi K | USA | 65/F | HTN, DM, hyperlipidemia, obesity, ischemic heart disease | Fever, dyspnea, dry cough | T wave inversion in leads V1-V2 and QTc 457 ms | severe global right and left ventricular hypokinesis with paradoxical septal motion | 1.9 ng/mL | 368.2 | 20,000 | 25 |
| Faqihi F | USA | 40/M | – | Chest pain, fatigue, myalgia, dry cough, dyspnea | Non-specific ST segment and T wave abnormalities in the precordial leads | basal and midventricular LV akinesia with apical sparing and “ace of spades” configuration typical of RTTC | 4.7 ng/mL | 82.5 | Normal | 30 |
| Juusela A | USA | 45/F | Obesity and materal age | Fever, tachycardia | Non-specific T wave abnormalities | Global hypokinesis | 0.9 ng/mL | – | – | 40 |
| 26/F | PCOD, maternal age | SOB, dyspnea | – | – | 76.8 | 40 |
NR not reported, M male, F female, TTE transthoracic echocardiography, HTN hypertension, DM diabetes mellitus, TTS Takotsubo syndrome, LV left ventricle, EF ejection fraction, MR mitral regurgitation, SAM systemic anterior motion, S/O signs of, SOB shortness of breath