Gender differences in the manifestation of tako-tsubo cardiomyopathy

Schneider, Barbara; Athanasiadis, Anastasios; Stöllberger, Claudia; Pistner, Wolfgang; Schwab, Johannes; Gottwald, Uta; Schoeller, Ralph; Gerecke, Birgit; Hoffmann, Ellen; Wegner, Christian; Sechtem, Udo

doi:10.1016/j.ijcard.2011.11.027

Cited by 167 publications

(150 citation statements)

References 33 publications

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“…Despite being predominantly a disease of female sex, there was higher frequency of males, and males were younger but with higher comorbidities. Consistent with other studies, we showed higher severity of illness and a trend toward worse outcomes in males as compared with females with severe sepsis 36, 37. Importantly, this study noted improving mortality in patients with TTC with every subsequent year during the study period.…”

Section: Discussionsupporting

confidence: 92%

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

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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BackgroundThere are limited data on the presentation of Takotsubo cardiomyopathy (TTC) in severe sepsis.Methods and ResultsThis was a retrospective cohort study using the National Inpatient Sample database (2007–2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in‐hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity‐matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC. During this 7‐year period, in 7.1‐million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65‐ to 79‐year‐old individuals. TTC was independently associated with lower in‐hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51–0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44–0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55–0.85]). Presentation in later years of the study period, middle‐age, female sex, and white race were independent predictors for the diagnosis of TTC. Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in‐hospital mortality among TTC admissions.Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in‐hospital mortality compared with patients without TTC. Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.

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Section: Discussionsupporting

confidence: 92%

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

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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“…The uneven sex distribution among the patients with takotsubo cardiomyopathy that we observed (female-to-male ratio, 9:1) is in line with most previous reports from Western countries. 9,16 In Japan, takotsubo cardiomyopathy is more prevalent among men, 17 for unclear reasons. Previous studies have suggested that takotsubo cardiomyopathy is predominantly preceded by emotional triggers.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Templin¹,

et al. 2015

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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.).

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“…For example, one series of 136 consecutive cases identified intense emotional stress in 47% of cases and physical stress (including comorbid illness) in 42% (95), whereas a study of 324 cases in Germany reported emotional stress in 47% of female and 28% of male patients (92). Elevated catecholamines stimulated by stress (e.g., high norepinephrine levels) have been postulated as a cause of this cardiomyopathy, and many of the cardiac features of the syndrome can be mimicked by intravenous catecholamines or beta-receptor agonists; however, other mechanisms may also be involved (121).…”

Section: Stress Cardiomyopathymentioning

confidence: 99%

Stress and Cardiovascular Disease: An Update on Current Knowledge

Steptoe

Kivimäki

2013

Annu. Rev. Public Health

649

443

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Considerable progress has been made during the past decade in research on cardiovascular effects of stress. Early-life stressors, such as childhood abuse and early socioeconomic adversity, are linked to increased cardiovascular morbidity in adulthood. Our updated meta-analyses of prospective studies published until 2011 show a 1.5-fold (95% confidence interval 1.2-1.9) increased risk of coronary heart disease among adults experiencing social isolation and a 1.3-fold (1.2-1.5) excess risk for workplace stress; adverse metabolic changes are one of the underlying plausible mechanisms. Stress, anger, and depressed mood can act as acute triggers of major cardiac events; the pooled relative risk of acute coronary syndrome onset being preceded by stress is 2.5 (1.8-3.5) in case-crossover studies. Stress is also implicated in the prognosis of cardiovascular disease and in the development of stress (takotsubo) cardiomyopathy. A major challenge over the next decade is to incorporate stress processes into the mainstream of cardiovascular pathophysiological research and understanding.

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Gender differences in the manifestation of tako-tsubo cardiomyopathy

Cited by 167 publications

References 33 publications

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

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

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Stress and Cardiovascular Disease: An Update on Current Knowledge

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