title: Impact of Malignancies in the Early and Late Time Course of Takotsubo Cardiomyopathy.
abstract: BACKGROUND
  Although the relationship between malignancies and catecholamine-induced myocardial stunning remains largely speculative, it has been suggested that the presence of cancer may lower the threshold for stress stimuli and/or may aggravate cardiac adrenoreceptor sensitivity. We sought to investigate whether associations exist between a previous or current diagnosis of malignancy, diagnostic parameters during hospitalization and death in takotsubo.
  
  
  RESULTS
  The 154 takotsubo patients were retrospectively identified between May 2008 and December 2014. Previous history of malignancy was identified in 44 patients (28.5%). Cardiac arrest was present at admission in 13 patients (8.4%). Intra-aortic balloon pump was inserted in 16 patients (10.4%). In patients with malignancy, higher B-type natriuretic peptide (BNP), leukocyte and C-reactive protein (CRP) peaks could be observed during the hospital phase. Initial impairment of left ventricular ejection fraction was negatively related to BNP, leukocyte, and CRP peaks. At a median follow-up of 364 days, all-cause death occurred in 41 patients (26.6%) and cardiac death in 12 patients (7.7%). Multivariate Cox regression analysis identified malignancy (hazard ratio 4.77 (1.02-22.17), leukocyte peak and age as independent predictors of cardiac death. Malignancy (2.62 (1.26-5.44), leukocyte peak (1.05 (1.01-1.08) and initial cardiac arrest (6.68 (2.47-18.01) were identified as independent predictors of overall mortality.
  
  
  CONCLUSIONS
  In the present takotsubo patients, the prevalence of malignancy was high and may have affected cardiovascular outcomes through the activation of inflammatory and neurohormonal mechanisms. (Circ J 2016; 80: 2192-2198).
authors: Cardiology Department, Nouvel Hôpital Civil, University Hospital, University of Strasbourg.
authors: Mélanie
authors: M
authors: Girardey
authors: Laurence
authors: L
authors: Jesel
authors: Umberto
authors: U
authors: Campia
authors: Nathan
authors: N
authors: Messas
authors: Sébastien
authors: S
authors: Hess
authors: Alessio
authors: A
authors: Imperiale
authors: Cyrille
authors: C
authors: Blondet
authors: Annie
authors: A
authors: Trinh
authors: Patrick
authors: P
authors: Ohlmann
authors: Olivier
authors: O
authors: Morel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009369:Neoplasms / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D012189:Retrospective Studies; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein