title: Clinical characteristics and prognostic factors of stress-induced cardiomyopathy.
abstract: OBJECTIVE
  Stress-induced cardiomyopathy (SCM) is characterized by a transient left ventricular (LV) dysfunction due to emotional and physical stress. There are limited data about the clinical characteristics in Korean patients. We sought to clarify the clinical features and prognosis in patients with SCM.
  
  
  METHODS
  We reviewed 39 cases diagnosed with SCM in a tertiary hospital. The SCM was diagnosed as: 1) no previous history of cardiac disease, 2) acute onset, 3) regional wall motion abnormality, typically in the takotsubo or inverted takotsubo shape by echocardiography, and 4) no significant stenosis in the coronary angiogram. We evaluated clinical characteristics, biomarkers, and prognosis.
  
  
  RESULTS
  Mean age was 61.3+/-16.1 years (female 69%). The triggering factors were physical stress in 32 patients (82%) and emotional stress in 5 patients (13%). The initial symptom was dyspnea (n=18, 46%) rather than chest pain (n=10, 26%). An initial electrocardiogram (EKG) presented T-wave inversion (n=18, 46%), ST-elevation (n=11, 28%), and ST-depression (n=2, 5%). Multivariate logistic regression analysis showed that initial high sensitive C-reactive protein (hs-CRP) {odds ratio (OR) 1.41, 95% confidence interval (CI); 1.02-1.97} and initial left ventricular ejection fraction (LVEF) (OR 0.89, 95% CI; 0.80-0.98) were significantly associated with death or cardiogenic shock, respectively.
  
  
  CONCLUSIONS
  The major triggering factor of SCM is physical stress due to illness or surgical procedures, and the first manifestation is dyspnea rather than chest pain. Elevated hs-CRP and decreased LVEF at admission were independent risk factors for death or cardiogenic shock.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Jang-Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Youn
authors.forename: Joong-Kyung
authors.initials: JK
authors.lastname: Sung
authors.forename: Nam-Seok
authors.initials: NS
authors.lastname: Lee
authors.forename: Kyoung-Hoon
authors.initials: KH
authors.lastname: Lee
authors.forename: Byung-Su
authors.initials: BS
authors.lastname: Yoo
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Kyung-Hoon
authors.initials: KH
authors.lastname: Choe