title: Incidence, determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) can be accompanied by various life-threatening complications, including cardiogenic shock. The exact incidence and prognostic relevance of cardiogenic shock in TTC patients has not been studied in detail.
  
  
  METHODS
  The frequency and determinants of cardiogenic shock were evaluated in 178 patients with TTC. The clinical course and treatment strategies of TTC patients with cardiogenic shock were systematically analysed. Furthermore, short and long-term mortality rates were assessed with a structured telephone follow-up.
  
  
  RESULTS
  The incidence of cardiogenic shock in this large TTC population was 12.4%. Multivariable logistic regression analysis identified left ventricular ejection fraction as the only significant predictor of cardiogenic shock (odds ratio 0.80; 95% confidence interval (CI) 0.73-0.88; P<0.01). The majority of the TTC patients with cardiogenic shock were treated with catecholamine therapy (86%) and 59% received early initiated mechanical circulatory support. TTC patients with cardiogenic shock showed significantly increased 28-day mortality rates compared to patients without cardiogenic shock (28.6% vs. 4.1%; relative risk 7.05, 95% CI 2.50-19.84; P<0.01). Furthermore, cardiogenic shock patients were at ongoing increased risk of death beyond the first 28 days resulting in considerably elevated 1-year (61.9% vs. 7.4%; P<0.01) and long-term mortality rates at 3.6 years of follow-up (66.7% vs. 19%; P<0.01).
  
  
  CONCLUSIONS
  Cardiogenic shock is a frequent complication in TTC patients and is associated with increased short and long-term mortality rates. Patients at risk of developing cardiogenic shock may be identified by means of a severely impaired left ventricular function.
authors.affiliation: University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Germany University Heart Center of Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany thomas.stiermaier@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stiermaier
authors.affiliation: University Heart Center of Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.affiliation: University Heart Center of Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: University Heart Center of Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University Heart Center of Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: University Heart Center of Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Germany German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
mesh_terms: D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000401:mortality*; D013318:Stroke Volume / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000401:mortality*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Takotsubo cardiomyopathy; apical ballooning syndrome; cardiogenic shock; prognosis; stress cardiomyopathy; treatment