Takotsubo (Stress) Cardiomyopathy

Study Questions:

What are the clinical features, prognostic predictors, and the clinical course and outcome of takotsubo cardiomyopathy?

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. The investigators used the Kaplan–Meier method to provide survival estimates, which were assessed with a log-rank test.

Results:

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.

Conclusions:

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.

Perspective:

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.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Cardiomyopathies, Heart Failure, Outcome Assessment (Health Care), Stroke, Takotsubo Cardiomyopathy, Troponin


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