Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Abstract

BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age-and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

“…We also performed a supplemental analysis where we used restricted cubic spline transformations of age and year of admission using 5 knots to model the nonlinear relationship with mortality. Because TTC is observed more often in females and in middle‐aged patients,1 we also evaluated for an interaction term between sex and age with the presence of TTC in the model to see whether there was a differential effect of sex/age on in‐hospital mortality attributed to TTC.…”

“…Takotsubo cardiomyopathy (TTC) was first described in 1990 and has been increasingly recognized in clinical practice 1. Labeled variably as apical‐ballooning syndrome, stress cardiomyopathy, and broken‐heart syndrome, TTC is characterized by transient regional left ventricular systolic dysfunction without obstructive coronary artery disease, precipitated by emotional and physical triggers 1, 2.…”

“…Labeled variably as apical‐ballooning syndrome, stress cardiomyopathy, and broken‐heart syndrome, TTC is characterized by transient regional left ventricular systolic dysfunction without obstructive coronary artery disease, precipitated by emotional and physical triggers 1, 2. It is diagnosed most commonly in postmenopausal females, though it does occur in young women and males 1, 3. Postulated pathogenesis includes myocardial stunning, catecholamine toxicity, and impaired myocyte metabolism 4.…”

“…Cardiovascular dysfunction in sepsis can manifest as septic cardiomyopathy, TTC, refractory shock, and myocardial injury, resulting in worse mortality and morbidity 10, 11, 12, 13, 14. Despite extensive data on septic cardiomyopathy, there are limited large‐scale epidemiological data on TTC in patients with severe sepsis 1, 15. The aim of this study was to evaluate the trends and outcomes of TTC in patients with severe sepsis from a large US cohort.…”

Risk Stratification Using the CHA 2 DS 2 ‐VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network

“…Several major cardiovascular and cerebrovascular events can complicate TTS, which should be considered as an acute heart failure syndrome with substantial morbidity and mortality 7, 8, 9, 10. In particular, a stroke or transient ischemic attack rate of 1.7% per patient‐year in a recent multicenter Registry was reported 10…”