title: Dissociation between severity of takotsubo cardiomyopathy and presentation with shock or hypotension.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) is increasingly well-recognized as a cause of chest-pain syndromes, especially in aging females. The most common complications of TTC occur in the first 24 hours post onset of symptoms and include shock and/or arrhythmias.
  
  
  OBJECTIVE
  We tested the hypothesis that the severity of early hypotension in TTC reflects the extent of myocardial involvement and dysfunction.
  
  
  METHODS
  In 80 consecutive TTC patients, correlates of blood pressure on the day of admission were sought via univariate followed by multivariate analysis.
  
  
  RESULTS
  Mean systolic blood pressure (SBP) on day 1 was 120 ± 24 (SD) mm Hg. During the first 3 days of admission, 39% of patients had SBP <90 mm Hg, and 9% died and/or required intra-aortic balloon pump insertion. The extent of release of N-terminal pro-brain natriuretic peptide, with its potential correlate of associated vasodilator activity, varied inversely with pulmonary-artery saturation, a measure of cardiac output. However, there was no significant relationship between normetanephrine release and SBP. On multivariate analyses there was no significant relationship between SBP and (1) wall-motion score index (as an index of left-ventricular systolic dysfunction) or (2) T2 enhancement on cardiac magnetic resonance imaging and peak N-terminal pro-brain natriuretic peptide (as indices of myocardial inflammation).
  
  
  CONCLUSIONS
  Although severe hypotension and shock occur commonly during acute stages of TTC, these complications are multifactorial in origin, probably representing a combination of impaired inotropic state and vasodilatation. Importantly, initial hypotension does not imply severe left ventricular inflammation or systolic dysfunction.
authors.affiliation: Clinical Pharmacology and Cardiology Department, Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Cher-Rin
authors.initials: CR
authors.lastname: Chong
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Neil
authors.forename: Thanh H
authors.initials: TH
authors.lastname: Nguyen
authors.forename: Jeanette
authors.initials: J
authors.lastname: Stansborough
authors.forename: Gin Way
authors.initials: GW
authors.lastname: Law
authors.forename: Kuljit
authors.initials: K
authors.lastname: Singh
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007423:Intra-Aortic Balloon Pumping; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010343:Patient Admission; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013599:Systole; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D014664:Vasodilation; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain