Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy.
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Templin Christian, Ghadri Jelena R, Diekmann Johanna, Napp L Christian, Bataiosu Dana R, Jaguszewski Milosz, Cammann Victoria L, Sarcon Annahita, Geyer Verena, Neumann Catharina A, Seifert Burkhardt, Hellermann Jens, Schwyzer Moritz, Eisenhardt Katharina, Jenewein Josef, Franke Jennifer, Katus Hugo A, Burgdorf Christof, Schunkert Heribert, Moeller Christian, Thiele Holger, Bauersachs Johann, Tschöpe Carsten, Schultheiss Heinz-Peter, Laney Charles A, Rajan Lawrence, Michels Guido, Pfister Roman, Ukena Christian, Böhm Michael, Erbel Raimund, Cuneo Alessandro, Kuck Karl-Heinz, Jacobshagen Claudius, Hasenfuss Gerd, Karakas Mahir, Koenig Wolfgang, Rottbauer Wolfgang, Said Samir M, Braun-Dullaeus Ruediger C, Cuculi Florim, Banning Adrian, Fischer Thomas A, Vasankari Tuija, Airaksinen K E Juhani, Fijalkowski Marcin, Rynkiewicz Andrzej, Pawlak Maciej, Opolski Grzegorz, Dworakowski Rafal, MacCarthy Philip, Kaiser Christoph, Osswald Stefan, Galiuto Leonarda, Crea Filippo, Dichtl Wolfgang, Franz Wolfgang M, Empen Klaus, Felix Stephan B, Delmas Clément, Lairez Olivier, Erne Paul, Bax Jeroen J, Ford Ian, Ruschitzka Frank, Prasad Abhiram, Lüscher Thomas F
Аннотация
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.).