title: Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital.
abstract: BACKGROUND
  Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital.
  
  
  METHODS
  Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed.
  
  
  RESULTS
  Over a 63-month period, 56 consecutive patients (median age and interquartile range=64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P=.021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n=2), LV thrombus (n=2), and right ventricular dysfunction (n=12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P=.009) and absence of LV function recovery within 1 week (ejection fraction<50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P=.036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC.
  
  
  CONCLUSIONS
  SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Pil Hyung
authors.initials: PH
authors.lastname: Lee
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Sun
authors.forename: Hyung Oh
authors.initials: HO
authors.lastname: Choi
authors.forename: Jeong-Sook
authors.initials: JS
authors.lastname: Seo
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Na
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D014463:Ultrasonography