TAKOTSUBO CARDIOMYOPATHY INDUCED BY GUILLAIN-BARRE SYNDROME: A SYSTEMATIC REVIEW

Abstract

Therapeutic Area: Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research Background: Guillain-Barré Syndrome (GBS) has the potential to induce both acute and chronic cardiac complications. Takotsubo cardiomyopathy (TCM) is a life-threatening presentation of dysautonomia in GBS, albeit rarely reported. Our study provides the first and most detailed systemic review of GBS-induced TCM. Methods: We conducted a systemic literature search in PubMed, EMBASE, and Google Scholar up to January 6, 2024, using MeSH terms for ''Guillain-Barre syndrome'' and ''takotsubo cardiomyopathy'' to identify the cases of GBS-induced TCM (Figure 1). Results: Our study identified 23 patients with a median age of 60 ± 14.16 years. Of those, 73.9% were female. All patients had no previous cardiac disease. Dyspnea (60.8%) and chest pain (26%) were the most reported symptoms of TCM in GBS patients, with a median time of 5.5 ± 6.46 days from the first GBS symptom to TCM symptom onset. Two TCM patients were presented as an initial manifestation of GBS. Cardiac troponins were elevated in all patients. ST-segment change (52.1%) and T-wave inversion (56.5%) were the most reported ECG findings. All patients had reduced left ventricular ejection fraction (LVEF) (< 50%), with severe cardiomyopathy (EF: < 30%) in 60.9% of patients. On echocardiogram, LV dysfunction (akinesia, hypokinesia) was the most common finding. Of those, 91.3% were discharged with improved symptoms, except for two patients who died (Figure 2). Conclusions: Although rare, TCM is a fatal complication of GBS. Sudden onset hemodynamic instability coupled with new onset ECG changes raises the suspicion of TCM in GBS, particularly in older patients, necessitating urgent evaluation. Although cardiac function can be restored in most patients, some cases of GBS-induced TCM are fatal.