{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T03:14:57Z","timestamp":1771298097382,"version":"3.50.1"},"reference-count":15,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy or Broken Heart Syndrome, is a reversible, transient state of myocardial dyskinesis and apical ballooning. Infrequently, TCM may progress to severe life-threatening complications such as cardiogenic shock. Early mechanical circulatory support (MCS) is crucial to myocardial recovery in these cases. We present one of the first cases of TCM successfully treated with the advanced micro-axial minimally invasive Impella 5.5 with SmartAssist MCS device. Case Presentation: A female in her late 70s with a history of hypothyroidism, atrial fibrillation post-ablation, and cholelithiasis was referred to our facility for an elective cholecystectomy. Post-anesthesia induction with propofol 2.1 mg\/kg (140 mg bolus), she became bradycardic and hypotensive, eventually leading to asystole, requiring CPR and termination of the procedure. Echocardiography revealed a left ventricular ejection fraction (LVEF) of 24% with mid-ventricular akinesis and apical ballooning with mild mitral regurgitation, suggesting the diagnosis of TCM. Cardiac catheterization showed RA 20 and mean PA 42 mmHg. Lactate was 18.7 mmol\/L and LDH 1776 U\/L, suggesting progressive shock. Continuous epinephrine 0.1 mcg\/kg\/min and norepinephrine 0.06 mcg\/kg\/min were titrated for BP 97\/58, and she was initially supported with the Impella CP device. Despite aggressive efforts, rising LDH levels and increased vasopressor needs indicated inadequate organ perfusion, requiring an upgrade to Impella 5.5. Impella 5.5 support for 11 days led to impressive myocardial recovery, leading to reductions, and eventual discontinuation, of inotropes and vasopressors. Post-Impella 5.5 explantation, her LVEF was 59\u201365% and she was discharged with Mobile Cardiac Outpatient Telemetry (MCOT) monitoring for her arrhythmias and reinitiation of guideline-directed medical therapies (GDMTs) for her comorbidities. Her 2-month follow-up shows sustained LVEF greater than 45% with functional improvements. Conclusions: Early escalation within 24 h of Impella CP to Impella 5.5 provided stabilization of cardiometabolic shock, preventing end-organ damage, allowing recovery of native heart function while maintaining ambulatory status, and allowing for optimizing medical therapy. It presents a safe, minimally invasive, and cost-effective intervention in TCM cases refractory to GDMT or when additional time is needed for decision-making in cases presenting with CS.<\/jats:p>","DOI":"10.3390\/jcm14176278","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T14:53:01Z","timestamp":1757083981000},"page":"6278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Empowering Early Recovery: The Role of Impella 5.5 in Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2502-6153","authenticated-orcid":false,"given":"Aarti","family":"Desai","sequence":"first","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-6321","authenticated-orcid":false,"given":"Jose","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9239-3022","authenticated-orcid":false,"given":"Anna","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8866-7143","authenticated-orcid":false,"given":"Rebecca","family":"Klingbeil","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archer","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0921-1416","authenticated-orcid":false,"given":"Rohan","family":"Goswami","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.25122\/jml-2018-0067","article-title":"Takotsubo Cardiomyopathy: A Brief Review","volume":"13","author":"Amin","year":"2020","journal-title":"J. Med. Life"},{"key":"ref_2","unstructured":"Ahmad, S.A., Brito, D., Khalid, N., and Ibrahim, M.A. (2025). Takotsubo Cardiomyopathy. StatPearls, StatPearls Publishing LLC."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jointm.2022.10.002","article-title":"The role of temporary mechanical circulatory support in de novo heart failure syndromes with cardiogenic shock: A contemporary review","volume":"3","author":"Eftychiou","year":"2023","journal-title":"J. Intensive Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/s13019-023-02459-z","article-title":"Successful treatment of cardiogenic shock due to Takotsubo syndrome with implantation of a temporary microaxial left ventricular assist device in transaxillary approach","volume":"18","author":"Shazly","year":"2023","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1002\/ejhf.1922","article-title":"Epidemiology, pathophysiology and contemporary management of cardiogenic shock\u2013a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Chioncel","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Desai, A., Sharma, S., Luce, C., Ruiz, J., and Goswami, R. (2024). Case Report: Unmasking sustainable left ventricular recovery in chronic heart failure with axillary temporary mechanical circulatory support. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1407552"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Iliakis, P., Pitsillidi, A., Pyrpyris, N., Fragkoulis, C., Leontsinis, I., Koutsopoulos, G., Mantzouranis, E., Soulaidopoulos, S., Kasiakogias, A., and Dimitriadis, K. (2025). Pregnancy-Associated Takotsubo Syndrome: A Narrative Review of the Literature. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072356"},{"key":"ref_8","first-page":"24","article-title":"Takotsubo cardiomyopathy: Review of broken heart syndrome","volume":"33","author":"Boyd","year":"2020","journal-title":"J. Am. Acad. Physician Assist."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy","volume":"373","author":"Templin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e003418","DOI":"10.1161\/JAHA.116.003418","article-title":"ECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction","volume":"5","author":"Frangieh","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1097\/00005344-200312001-00024","article-title":"Estrogen attenuates the emotional stress-induced cardiac responses in the animal model of Tako-tsubo (Ampulla) cardiomyopathy","volume":"42","author":"Ueyama","year":"2003","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ijcard.2017.07.053","article-title":"Prevalence and prognostic relevance of atrial fibrillation in patients with Takotsubo syndrome","volume":"245","author":"Stiermaier","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.carrev.2021.11.018","article-title":"Impella Mechanical Circulatory Support for Takotsubo Syndrome With Shock: A Retrospective Multicenter Analysis","volume":"40","author":"Napp","year":"2022","journal-title":"Cardiovasc. Revasc Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1536\/ihj.21-299","article-title":"Favorable Effects of Impella on Takotsubo Syndrome Complicated with Cardiogenic Shock","volume":"62","author":"Nishikawa","year":"2021","journal-title":"Int. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Jang, J.M., Jarmi, T., Sareyyupoglu, B., Nativi, J., Patel, P.C., Leoni, J.C., Landolfo, K., Pham, S., Yip, D.S., and Goswami, R.M. (2023). Axillary mechanical circulatory support improves renal function prior to heart transplantation in patients with chronic kidney disease. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-46901-7"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6278\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:40:20Z","timestamp":1760035220000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":15,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176278"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176278","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]}}}