Management of Takotsubo cardiomyopathy in non-academic hospitals in France: The Observational French SyndromEs of TakoTsubo (OFSETT) study.
BACKGROUND
Takotsubo cardiomyopathy (TTC) is a rare condition characterized by a sudden temporary weakening of the heart. TTC can mimic acute myocardial infarction and is associated with a minimal release of myocardial biomarkers in the absence of obstructive coronary artery disease.


OBJECTIVE
To provide an extensive description of patients admitted to hospital for TTC throughout France and to study the management and outcomes of these patients.


METHODS
In 14 non-academic hospitals, we collected clinical, electrocardiographic, biological, psychological and therapeutic data in patients with a diagnosis of TTC according to the Mayo Clinic criteria.


RESULTS
Of 117 patients, 91.5% were women, mean ± SD age was 71.4 ± 12.1 years and the prevalence of risk factors was high (hypertension: 57.9%, dyslipidaemia: 33.0%, diabetes: 11.5%, obesity: 11.5%). The most common initial symptoms were chest pain (80.5%) and dyspnoea (24.1%). A triggering psychological event was detected in 64.3% of patients. ST-segment elevation was found in 41.7% of patients and T-wave inversion in 71.6%. Anterior leads were most frequently associated with ST-segment elevation, whereas T-wave inversion was more commonly associated with lateral leads, and Q-waves with septal leads. The ratio of peak B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) level to peak troponin level was 1.01. No deaths occurred during the hospital phase. After 1 year of follow-up, 3 of 109 (2.8%) patients with available data died, including one cardiovascular death. Rehospitalizations occurred in 17.4% of patients: 2.8% due to acute heart failure and 14.7% due to non-cardiovascular causes. There was no recurrence of TTC.


CONCLUSIONS
This observational study of TTC included primarily women with atherosclerotic risk factors and mental stress. T-wave inversion was more common than ST-segment elevation. There were few adverse cardiovascular outcomes in these patients after 1-year follow-up.
Department of Cardiology, Campus University Teaching Hospital, Lomé, Togo.
Komlavi
K
Yayehd
Department of Cardiology, Campus University Teaching Hospital, Lomé, Togo.
N'kenon W
NW
N'da
Department of Cardiology, Annecy Hospital, 74000 Annecy, France. Electronic address: loic.belle@wanadoo.fr.
Loïc
L
Belle
Department of Cardiology and Epidemiology, Toulouse University Hospital, 31000 Toulouse, France.
Vincent
V
Bataille
Department of Cardiology, Haguenau Hospital, 67500 Haguenau, France.
Michel
M
Hanssen
Department of Cardiology, Haguenau Hospital, 67500 Haguenau, France.
Pierre
P
Leddet
Department of Cardiology, Saint-Joseph - Saint-Luc Hospital, 69000 Lyon, France.
Jean-François
JF
Aupetit
Department of Cardiology, polyclinique Les Fleurs, 83190 Ollioules, France.
Philippe
P
Commeau
Department of Cardiology, Bretagne-Atlantique Hospital, 56000 Vannes, France.
Emmanuelle
E
Filippi
Department of Cardiology, Versailles Hospital, 78150 Le Chesnay, France.
Jean-Louis
JL
Georges
Department of Cardiology, Chartres Hospital, 28000 Chartres, France.
Franck
F
Albert
Department of Cardiology, Chartres Hospital, 28000 Chartres, France.
Grégoire
G
Rangé
Department of Cardiology, Compiègne Hospital, 60200 Compiègne, France.
Patrick
P
Meimoun
Department of Cardiology, Vichy Hospital, 03200 Vichy, France.
Xavier
X
Marcaggi
Department of Cardiology, Bretagne Hospital, 56100 Lorient, France.
Serge
S
Baleynaud
Department of Cardiology, Le Raincy-Montfermeil Intercity Hospital, 93370 Montfermeil, France.
Olivier
O
Nallet
Institut mutualiste Montsouris, 75000 Paris, France.
Alain
A
Dibie
Department of Cardiology, Pays d'Aix Hospital, 13100 Aix-en-Provence, France.
Claude
C
Barnay
Department of Cardiology, Pays d'Aix Hospital, 13100 Aix-en-Provence, France.
Bernard
B
Jouve
Department of Cardiology, Le Mans Hospital, 72000 Le Mans, France.
Maud
M
Legrand
Department of Cardiology, Le Raincy-Montfermeil Intercity Hospital, 93370 Montfermeil, France.
Simon
S
Cattan
French Society of Cardiology, 75000 Paris, France.
Geneviève
G
Mulak
Department of Clinical Pharmacology and Clinical Research, Saint-Antoine University Hospital, 75000 Paris, France.
Tabassome
T
Simon
Department of Cardiology, Georges-Pompidou University Hospital, 75000 Paris, France.
Nicolas
N
Danchin
Department of Cardiology, Douai Hospital, 59500 Douai, France.
Jean-Jacques
JJ
Dujardin
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003952:Diagnostic Imaging / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D016277:Ventricular Function, Left
D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
B-type natriuretic peptide; ST-segment elevation; Sus-décalage ST; Syndrome de Takotsubo; Takotsubo cardiomyopathy