Takotsubo (Stress) Cardiomyopathy
What are the clinical features, prognostic predictors, and the clinical course and outcome of takotsubo cardiomyopathy?
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. The investigators used the Kaplan–Meier method to provide survival estimates, which were assessed with a log-rank test.
Of 1,750 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.
The authors concluded that takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome, and represents an acute heart failure syndrome with substantial morbidity and mortality.
This study reports that takotsubo (stress) cardiomyopathy represents an acute heart failure syndrome that is associated with a substantial risk for adverse events. Furthermore, patients had substantial rates of death and complications after the acute phase of the disease, with a rate of death per patient-year of 5.6% and a rate of stroke or transient ischemic attack of 1.7% per patient-year. In this observational study, the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, but not of beta-blockers, was associated with improved survival.
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