title: Stress (Tako-tsubo) cardiomyopathy in critically-ill patients.
abstract: BACKGROUND
  Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting.
  
  
  OBJECTIVE
  To evaluate the mechanisms, incidence, treatment and prognosis of SC.
  
  
  METHODS
  This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years.
  
  
  RESULTS
  Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients.
  
  
  CONCLUSIONS
  SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France champion.seb@wanadoo.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Champion
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Belcour
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: David
authors.initials: D
authors.lastname: Vandroux
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Drouet
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Gaüzère
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bouchet
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bossard
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Sabina
authors.initials: S
authors.lastname: Djouhri
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Jabot
authors.affiliation: Service d'imagerie cardio-vasculaire, Hôpital Cochin, Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Champion
authors.affiliation: Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Lefort
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002395:Catecholamines / Q000378:metabolism; D016638:Critical Illness; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D017508:Reunion / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002395:Catecholamines
keywords: Tako-tsubo; brain–heart connection; catecholamine; critical illness; seizures; stress cardiomyopathy