Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry

Aims Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes.Methods and results Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes.Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002).Conclusions The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.Cardiolog

Critical assessment of the application of the J-integral and CTOD concepts to circumferentially cracked copper bars

The aim of this work is to explore experimentally the validity of the concepts of J-integral and crack tip opening displacement for characterizing the stress and strain state at the tip of an axisymmetrical crack in a bar undergoing large plastic strain before crack extension. The tests are made on extruded copper round bars presenting a very high ductility. Three different analytical formulations of the J-integral proposed in the literature for circumferentially cracked bars are compared at initiation of cracking. The limit between shallow crack and deep crack geometries is experimentally demonstrated. It is found that, in neither of these geometries, J and delta CTOD are dominant. However, the ratio J(c)/delta(c) is constant for deep cracks, which suggests an alternative fracture criterion consisting in postulating the dissipation of an average critical energy per unit volume until crack extension

Experimental and numerical investigation of fracture in double-edge notched steel plates

Double-edge notched (DENT) steel plates were pulled until complete fracture and several experimental observations were made (using profilometry and scanning electron microscopy). The essential work of fracture (EWF) model was found to be well verified. Numerical simulations - up to the maximum load only - of some experiments were performed using the finite element method (FEM), and incorporating geometric and material non-linearities (large deformation elasto-plasticity). Some experimental measurements were compared with the corresponding numerical computations and excellent agreement was found