Background: Takotsubo cardiomyopathy is an acute cardiomyopa-thy characterized by transient left ventricular systolic dysfunction induced by emotional or physical stress, including respiratory failure. Aim: The aim of this study was to analyze the clinical features of patients who developed takotsubo cardiomyopathy in respiratory department. Methods: We retrospectively evaluated the characteristics, causes, and outcomes of takotsubo cardiomyopathy experienced in our respiratory department Results: Of 14 patients, 35% were women over 50 years of age. The most frequent trigger was bronchoscopy. Laryngeal reflex in response to irritation of trachea results in elevation of catecholamine level, thereby inducing takotsubo cardiomyopathy. At onset, more than half of the patients did not show typical symptoms such as chest discomfort. 57.1% of cases showed type 2 respiratory failure and 42.9% showed acidosis which might related to elevation of catecholamine level as well. 50.0% of patients had comorbidities of chronic obstructive pulmonary disease (COPD) or asthma, treated regularly with β2stimulant. Since there are abundant β2-stimulant receptors in apical myocardium, repeated treatment with β2-stimulant may have contributed to the disease onset. Some cases complicated with heart failure, but all patients improved. Conclusions: In respiratory department, it is necessary to be aware of takotsubo cardiomyopathy especially when conducting procedures including tracheal manipulation, when using repetitive β2-stimulant, and when a patient shows exacerbation of respiratory failure with hypercap-nia, even without any chest complaints. AP093 SAPS II OR APACHE II IS BETTER TO PREDICT MORTALITY IN MEDICAL ICU PATIENTS

Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227).

A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. The creatine kinase and creatine kinase-MB concentrations were elevated at admission and reached maximum levels 6 hours after admission. The plasma level of brain natriuretic peptide was 10.7 pg/mL (reference range, <18.4 pg/mL) on the first hospital day. ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6 persisted at 72 hours after admission. On the third hospital day, sudden rupture of the left ventricle occurred, and despite extensive resuscitation efforts, the patient died. Takotsubo cardiomyopathy presents in a manner similar to that of acute myocardial infarction, but ventricular systolic function usually returns to normal within a few weeks. To our knowledge, this is the first reported case of fatal left ventricular rupture associated with takotsubo cardiomyopathy. We suggest that takotsubo cardiomyopathy may be a newly recognized cause of sudden cardiac death.

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