Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital.
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.
Lee
Pil Hyung
PH
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Song
Jae-Kwan
JK
Sun
Byung Joo
BJ
Choi
Hyung Oh
HO
Seo
Jeong-Sook
JS
Na
Jin Oh
JO
Kim
Dae-Hee
DH
Song
Jong-Min
JM
Kang
Duk-Hyun
DH
Kim
Jae-Joong
JJ
Park
Seong-Wook
SW
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