title: Complications in the clinical course of tako-tsubo cardiomyopathy.
abstract: OBJECTIVE
  This study evaluated the frequency, severity and outcome of complications in the clinical course of tako-tsubo cardiomyopathy (TTC).
  
  
  BACKGROUND
  TTC is regarded as a benign disease since left ventricular (LV) function returns to normal within a short time. However, severe complications have been reported in selected patients.
  
  
  METHODS
  From 37 hospitals, 209 patients (189 female, age 69 ± 12 years) were prospectively included in a TTC registry.
  
  
  RESULTS
  Complications developed in 108/209 patients (52%); 23 (11%) had >2 complications. Complications occurred median 1 day after symptom onset, and 77% were seen within 3 days. Arrhythmias were documented in 45/209 patients (22%) including atrial fibrillation in 32 (15%) and ventricular tachycardia in 17 (8%). Of 8 patients resuscitated (4%), 6 survived. Additional complications were right ventricular involvement (24%), pulmonary edema (13%), cardiogenic shock (7%), transient intraventricular pressure gradients (5%), LV thrombi (3%) and stroke (1%). During hospitalization, 5/209 patients (2.5%) died. Patients with complications were older (70 ± 13 vs 67 ± 10 years, p=0.012), had a higher heart rate (91 ± 26 vs 83 ± 19/min, p=0.025), more frequently Q\ waves on the admission ECG (36% vs 21%, p=0.019) and a lower LV ejection fraction (47 ± 15 vs 54 ± 14%, p = 0.002). Multivariate regression analysis identified Q-waves on admission (OR 2.49, 95% CI 1.23-5.05, p=0.021) and ejection fraction ≤ 30% (OR 4.03, 95% CI 1.04-15.67, p=0.022) as independent predictors for complications.
  
  
  CONCLUSIONS
  TTC may be associated with severe complications in half of the patients. Since the majority of complications occur up to day 3, monitoring is advisable for this time period.
authors.affiliation: Medizinische Klinik II, Sana Kliniken Lübeck, Germany. Electronic address: birke.schneider@sana.de.
authors.forename: Birke
authors.initials: B
authors.lastname: Schneider
authors.affiliation: Abteilung für Kardiologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Athanasiadis
authors.affiliation: Medizinische Klinik 8, Klinikum Nürnberg Süd, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwab
authors.affiliation: Medizinische Klinik 1, Klinikum Aschaffenburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pistner
authors.affiliation: Klinik für Kardiologie, Allgemeines Krankenhaus Celle, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Gottwald
authors.affiliation: Medizinische Klinik II, DRK-Kliniken Westend, Berlin, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Schoeller
authors.affiliation: Medizinische Klinik II, Klinikum Idar-Oberstein, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Toepel
authors.affiliation: Klinik für Innere Medizin/Kardiologie, Hermann-Josef-Krankenhaus, Erkelenz, Germany.
authors.forename: Klaus-D
authors.initials: KD
authors.lastname: Winter
authors.affiliation: Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bielefeld Mitte, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stellbrink
authors.affiliation: Medizinische Klinik, Klinikum Augsburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Müller-Honold
authors.affiliation: Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Wegner
authors.affiliation: Abteilung für Kardiologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D004562:Electrocardiography / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology
keywords: Acute coronary syndrome; Apical ballooning; Atrial fibrillation; Cardiogenic shock; Tako-tsubo cardiomyopathy; Ventricular tachycardia