Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.
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.
Sharkey
Scott W
SW
Hypertrophic Cardiomyopathy Center and Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
Windenburg
Denise C
DC
Lesser
John R
JR
Maron
Martin S
MS
Hauser
Robert G
RG
Lesser
Jennifer N
JN
Haas
Tammy S
TS
Hodges
James S
JS
Maron
Barry J
BJ
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
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D014336:Troponin