title: Clinical Profile of Patients With High-Risk Tako-Tsubo Cardiomyopathy.
abstract: Although tako-tsubo cardiomyopathy (TTC) is regarded as a reversible condition with favorable outcome, a malignant clinical course evolves in some subjects. In this single-institution experience, we describe the clinical profile of patients with adverse TTC outcome. A cohort of 249 consecutive patients with TTC was interrogated for those with acute unstable presentation during the first 24 hours. Forty-seven patients (19%) experienced early complicated clinical course with cardiac arrest in 9 (ventricular fibrillation, n = 4, pulseless electrical activity, n = 3, and asystole, n = 2) or marked hypotension in 38 (systolic blood pressure ≤90 mm Hg requiring vasopressors and/or balloon pump). Of the 47 patients, Killip class III to IV heart failure was present in 30 (64%). Despite treatment, 8 patients (3%; all women) died inhospital due to respiratory failure, cardiogenic shock, or anoxic brain injury. All 8 inhospital deaths occurred among the 47 patients with unstable presentation, including 2 after cardiac arrest and 6 with marked hypotension. Post-TTC event mortality for a period of 4.7 ± 3.4 years significantly exceeded that in a matched general US population (standardized mortality ratio 1.4; 95% confidence interval 1.1 to 1.9; p = 0.005) largely due to noncardiac co-morbidities. In conclusion, contrary to widespread perception, TTC is not an entirely benign and reversible condition. Among this large cohort, a high-risk subgroup was identified with cardiac arrest or hemodynamic instability, accounting for all hospital deaths. Hospital nonsurvivors had a variety of irreversible co-morbid conditions with the potential to compromise clinical status and adversely affect short-term survival. Long-term survival after hospital discharge was also reduced compared with the general population because of noncardiac co-morbidities.
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: scott.sharkey@allina.com.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Sharkey
authors.affiliation: The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Pink
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: Ross F
authors.initials: RF
authors.lastname: Garberich
authors.affiliation: Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Maron
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota; The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate / Q000639:trends; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*