title: The impact of stressor patterns on clinical features in patients with tako-tsubo cardiomyopathy: experiences of two tertiary cardiovascular centers.
abstract: BACKGROUND
  Tako-tsubo cardiomyopathy (TTC) is typically triggered by an acute emotional or physical stress event. The aim of this study was to investigate the impact of stressor patterns on clinical features, laboratory parameters, and electrocardiographic and echocardiographic findings in patients with TTC.
  
  
  OBJECTIVE
  Clinical features are different according to stressor patterns.
  
  
  METHODS
  Of 137 patients enrolled from the TTC registry database, 14 patients had emotional triggers (E group), 96 had physical triggers (P group), and 27 had no triggers (N group).
  
  
  RESULTS
  Most clinical presentations and in-hospital courses were similar among the groups. However, the E group had a higher prevalence of chest pain (P = 0.006) and palpitation (P = 0.006), whereas the P group had a higher prevalence of cardiogenic shock (P = 0.040), than other groups. The P group had a significantly higher heart rate (P = 0.001); higher high-sensitivity C-reactive protein (P = 0.006), creatine kinase MB fraction (P = 0.045), and N terminal-probrain natriuretic peptide (P = 0.036) levels; higher left ventricular end-diastolic pressure (P = 0.019) and left ventricular end-systolic diameter (P = 0.002); but lower left ventricular ejection fraction (P = 0.018). The E group had lesser prevalence of apical ballooning pattern (P = 0.038) than other groups. The P group required more frequent use of inotropics (P = 0.041) and diuretics (P = 0.047) and had significantly longer intensive care unit (P = 0.014) and in-hospital stays (P = 0.001).
  
  
  CONCLUSIONS
  The clinical features of TTC are different according to preceding stressor patterns. The TTC group with preceding physical stressors was less likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than other groups. The overall prognosis of TTC is excellent, regardless of triggering stressors.
authors.affiliation: Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Bong Gun
authors.initials: BG
authors.lastname: Song
authors.forename: Hyun Suk
authors.initials: HS
authors.lastname: Yang
authors.forename: Hweung Kon
authors.initials: HK
authors.lastname: Hwang
authors.forename: Gu Hyun
authors.initials: GH
authors.lastname: Kang
authors.forename: Yong Hwan
authors.initials: YH
authors.lastname: Park
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Chun
authors.forename: Ju Hyeon
authors.initials: JH
authors.lastname: Oh
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D052279:Creatine Kinase, MB Form / Q000097:blood; D003422:Critical Care; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D004644:Emotions; D005260:Female; D006339:Heart Rate; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000150:complications*; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D062606:Tertiary Care Centers; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form