title: Distinctive clinical characteristics according to age and gender in apical ballooning syndrome (takotsubo/stress cardiomyopathy): an analysis focusing on men and young women.
abstract: BACKGROUND
  Apical ballooning syndrome (ABS) predominantly affects postmenopausal women. There is a paucity of data regarding ABS in men and young women. The aim of this study was to compare the clinical characteristics and outcomes of men and young women (<50 y) to older women (≥50 y).
  
  
  RESULTS
  We retrospectively reviewed the records of 224 patients and divided them into men (n = 12), young women (n = 12), and older women (n = 200). Older women were further subdivided into those who were and were not on hormone replacement therapy (HRT) at the time of presentation. Men were more likely to present after a physical trigger (100% vs 46%; P = .009), have lower ejection fractions (30.1 ± 8.0% vs 40 ± 13.9%; P = .04), and have greater need for mechanical ventilation (67% vs 17%; P < .0001) compared with older women. Younger women were more likely to have a history of psychiatric disorders (75% vs 24%; P = .0001) at presentation and a higher rate of recurrence (16% vs 3%; P = .017) compared with older women. Of the older women, 15 developed ABS while on chronic HRT. Those without HRT were more likely to require mechanical hemodynamic (7.7% and 0%; P = .002) and ventilatory (18.1% and 0%; P = .017) support compared with older women who were on HRT.
  
  
  CONCLUSIONS
  Men appeared to develop ABS as a consequence of a physical trigger, whereas young women had a higher rate of psychiatric comorbidities and a greater propensity for recurrence. Treatment with HRT in older women does not preclude the development of ABS.
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Sandeep M
authors.initials: SM
authors.lastname: Patel
authors.forename: Ramesh G
authors.initials: RG
authors.lastname: Chokka
authors.forename: Kavita
authors.initials: K
authors.lastname: Prasad
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D020249:Hormone Replacement Therapy; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012008:Recurrence; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000453:epidemiology* / Q000209:etiology
chemical_list: D020097:Natriuretic Peptide, Brain