title: Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.
abstract: OBJECTIVE
  This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event.
  
  
  BACKGROUND
  Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning.
  
  
  METHODS
  Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients.
  
  
  RESULTS
  Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were <or=50 years of age. In 121 patients (89%), SC was precipitated by intensely stressful emotional (n = 64) or physical (n = 57) events, including 22 associated with sympathomimetic drugs or medical/surgical procedures; 15 other patients (11%) had no evident stress trigger. Twenty-five patients (18%) were taking beta-blockers at the time of SC events. Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance (CMR) imaging, usually with rapid return to normal systolic function, although delayed >2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year.
  
  
  CONCLUSIONS
  In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male, <or=50 years of age, without a stress trigger, or with in-hospital death, nonfatal recurrence, embolic stroke, or delayed normalization of ejection fraction. Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality. These data support expanded management and surveillance strategies including CMR imaging and consideration for anticoagulation.
authors.affiliation: Hypertrophic Cardiomyopathy Center and Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Sharkey
authors.forename: Denise C
authors.initials: DC
authors.lastname: Windenburg
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.forename: Martin S
authors.initials: MS
authors.lastname: Maron
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hauser
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Lesser
authors.forename: Tammy S
authors.initials: TS
authors.lastname: Haas
authors.forename: James S
authors.initials: JS
authors.lastname: Hodges
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D014336:Troponin / Q000097:blood; D016276:Ventricular Function
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D014336:Troponin