title: Natural history of tako-tsubo cardiomyopathy.
abstract: BACKGROUND
  Stress-induced or tako-tsubo cardiomyopathy (TTC) is a rare acute cardiac syndrome characterized by transient left ventricular (LV) dysfunction of uncertain cause and outcome. This study sought to assess the long-term outcome of patients with TTC.
  
  
  METHODS
  One-hundred sixteen consecutive patients were prospectively included in the study and observed at long-term follow-up. Primary end points were death, TTC recurrence, and hospitalization from any cause.
  
  
  RESULTS
  Mean initial LV ejection fraction (LVEF) at admission was 36% ± 9%. Two patients died of refractory heart failure during hospitalization. Of the patients who were discharged alive all except one showed complete LV functional recovery. At follow-up (2.0 ± 1.3 years), only 64 (55%) patients were asymptomatic. Rehospitalization rate was high (25%), with chest pain (n = 6) and dyspnea (n = 5) as the most common causes. Only two patients had a recurrence of TTC. Eleven patients died (seven from cardiovascular cause). There was no significant difference in mortality (12% vs 7%; P = .284) and in the other clinical events between patients with and without severe LV dysfunction at presentation (LVEF ≤ 35%). Mortality observed in patients with TTC was compared with age and sex-specific mortality of the general population using the standardized mortality ratio (SMR) method. The SMR was 3.40 (95% CI, 1.83-6.34) in the TTC population. The only independent predictor of death at Cox analysis was Charlson comorbidity index (hazard ratio, 1.786; P = .0001), but the degree of initial LV dysfunction was not an independent predictor of death.
  
  
  CONCLUSIONS
  The recurrence of TTC is rare, but recurrences of chest pain or dyspnea are common in patients with TTC and frequently lead to hospital readmission. Long-term mortality is higher as compared with the control general population and at least in part related to patients' comorbidities. Initial LV dysfunction severity does not seem to impact long-term event rates.
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy. Electronic address: parodiguido@gmail.com.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bellandi
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Pace
authors.affiliation: Epidemiology Unit, Azienda Sanitaria Firenze, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Zampini
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Velluzzi
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate / Q000639:trends; D054549:Takotsubo Cardiomyopathy / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*