title: Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review.
abstract: OBJECTIVE
  We investigated clinical and radiological characteristics of ischemic stroke patients with Takotsubo-like myocardial dysfunction.
  
  
  METHODS
  From multicenter stroke registry database, ischemic stroke patients who underwent transthoracic echocardiography were found. Among these, patients were classified if they had specific ventricular regional wall motion abnormalities discording with coronary artery distribution, such as apical (typical pattern) or nonapical ballooning (atypical pattern), considered as echocardiographic findings of Takotsubo cardiomyopathy. Patients with ischemic heart disease history, myocarditis, or pheochromocytoma were excluded. We compared patients with Takotsubo-like myocardial dysfunction with those without and further performed systematic literature review on those with Takotsubo cardiomyopathy.
  
  
  RESULTS
  This study included 23 patients (0.42%). The mean age was 70.7±13.9 years, with predominance of women (73.9%) and typical pattern of Takotsubo-like myocardial dysfunction (91.3%). They were associated with short-term poor functional outcomes, including high mortality, neurological deterioration, and functional status at discharge, compared with those without (39.1% versus 2.4%, 47.8% versus 7.4%; and median [interquartile range], 5 [5-6] versus 3 [2-4]; all P<0.001). They had a higher inflammatory marker level and lower triglyceride level. Ischemic lesions were more commonly found in the right anterior circulation with specific dominant regions being the insula and peri-insular areas. In addition, a trend toward a remarkable mortality rate and higher prevalence of insular involvement was observed in the propensity-score matching, subgroup fulfilling the strict Takotsubo cardiomyopath criteria, and was as reported in literature review.
  
  
  CONCLUSIONS
  Stroke patients with Takotsubo-like myocardial dysfunction may differ from those without in clinical outcomes, laboratory findings, and radiological features.
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Jin-Man
authors.initials: JM
authors.lastname: Jung
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Jae-Gyum
authors.initials: JG
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Jung Bin
authors.initials: JB
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Cho
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Sungwook
authors.initials: S
authors.lastname: Yu
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Kyungmi
authors.initials: K
authors.lastname: Oh
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Yong-Hyun
authors.initials: YH
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.).
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: From the Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Department of Neurology, Korea University Anam Hospital (J.-G.K., K.-H.C., S.Y.), Department of Cardiology, Korea University Ansan Hospital (Y.-H.K.), and Department of Neurology, Korea University Guro Hospital (J.B.K., K.O.), Korea University College of Medicine, Seoul, South Korea; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-Y.C.); and Department of Neurology and Stroke Center, Samsung Medical Center, Seoul, South Korea (W.-K.S.). mcastenosis@gmail.com.
authors.forename: Woo-Keun
authors.initials: WK
authors.lastname: Seo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: cardiomyopathies; echocardiography; patient outcome assessment; stroke; takotsubo cardiomyopathy