Stress-induced cardiomyopathy (Tako-Tsubo syndrome) in Austria

Abstract

Background: Tako-Tsubo syndrome (TS) is a still rarely diagnosed clinical syndrome, which is characterized by acute onset of chest pain, transient cardiac dysfunction with (frequently) reversible wall motion abnormalities (WMAs), but with no relevant obstructive coronary artery disease. Methods and results: Among 179 consecutive patients with proven diagnosis of TS that were retrospectively analysed in this multicentre registry, women represented the majority of patients (94%) while only 11 men (6%) developed TS. Mean age was 69.1±11.5 years (range 35-88 years). Cardinal symptoms of TS, which led to admission, were acute chest pain (82%) and dyspnoea (32%), respectively. All patients demonstrated typical WMAs, whereby four different types of WMAs could be defined: (1) a more common apical type of TS (n=89; 50%); (2) a combined apical and midventricular form of TS (n=23; 13%); (3) the midventricular TS (n=6; 3%); and (4) an unusual type of basal WMAs of the left ventricle (n=3). Only in 101 patients (57%), a clear causative trigger for onset of symptoms could be identified. In-hospital cardiovascular complications occurred in 25 patients (14%) and consisted of cardiac arrhythmias in 10 patients (40%), cardiogenic shock in six patients (24%), cardiac decompensation in eight patients (32%) and cardiovascular death in one patient, respectively. Echocardiographic control of left ventricular function after the initial measurement was available in almost 70% of the patients: complete recovery of WMAs was found in 73 patients (58.87%); 49 patients (39.52%) showed persistent WMAs. Recurrences of TS were only seen in four patients. During the follow-up period, 13 patients died: three of cardiovascular causes and 10 of non-cardiac causes. In-hospital mortality was 0.6%, 30-day mortality was 1.3% and 2-year mortality was 6.7%. Conclusions: This study represents to date the largest series of patients suffering from TS in Austria and worldwide. Similar to others, in our series the prevalence of TS was significantly higher in women than in men, while in contrast to other studies, the apical type of TS was detected most frequently. The similar clinical presentation of TS patients to the clinical picture of acute myocardial infarction demonstrates the importance of immediate coronary angiography for adequate differential diagnosis of TS. TS is not necessarily a benign disease due to cardiovascular complications as well as persistent WMAs with delayed recovery.

Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 Patients

“…38 As a matter of fact, patients with Takotsubo Syndrome have a prevalence of comorbid cardiovascular risk factors higher than the general population and similar to that seen in patients with acute myocardial infarction. 39 In a large series of 305 women with acute left ventricular dysfunction, Parodi et al found no difference in the prevalence of hypertension, hypercholesterolemia, and smoking between those with Takotsubo Syndrome and those with anterior myocardial infarction. 40 The possibility exists therefore that the susceptibility to Takotsubo Syndrome may, in part, be related to a high prevalence of risk factors leading to premorbid endothelial dysfunction, 41 The pratical implication of the findings of the COUNTS study is of relevance.…”

Long‐term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences

“…Prognosis of patients with TTC is generally thought to be favourable with complete recovery of LV function within several weeks . However, the initial presentation can be accompanied by fatal complications, including cardiogenic shock, congestive heart failure, and lethal arrhythmias, leading to an in‐hospital disease‐related mortality of 2–8.7% …”

“…Recently, a registry‐based study suggested a similar long‐term prognosis in TTC patients compared with patients with myocardial infarction . Overall, long‐term mortality rates after >2 years of follow‐up are heterogeneous ranging from 5% to 17%, and it is unclear whether or not clinical characteristics, stress types, and/or ballooning patterns affect long‐term prognosis.…”

Parametry echokardiograficzne wpływające na rokowanie pacjentów z kardiomiopatią takotsubo

“…Istnieje udokumentowany przypadek pacjentki, u której choroba wystąpiła 4-krotnie [7]. W więk-szości przypadków rokowanie jest korzystne, u niektórych chorych jednak dochodzi do groźnych powikłań, które mogą być nawet przyczyną zgonu [8][9][10][11][12][13][14].…”