title: Clinical features and three-year outcomes of Takotsubo (stress) cardiomyopathy: Observational data from one center.
abstract: OBJECTIVE
  The natural history, management, and outcome of Takotsubo (stress) cardiomyopathy (TTC) is not clear. The aim of this study was to investigate clinical features, define prognostic predictors, and assess the clinical course and outcomes of patients with TTC.
  
  
  METHODS
  We analyzed 64 patients (52 women) meeting the proposed Mayo Clinic diagnostic criteria for TTC. All patients were treated at Vilnius University Hospital Santariskiu Klinikos from 2001-01-01 to 2014-11-27. Data were collected on the basis of medical records and follow-up data was collected by phone.
  
  
  RESULTS
  The mean age of analyzed patients was 63.4 ± 14.6 years; the mean follow-up was 2.9 years. More than half of the patients (52%) did not have any clear stressful triggers. During admission, symptoms such as chest pain (64%) and general weakness (45%) were reported more often than other symptoms. Almost all patients (94%) had the classical TTC form; the remaining 6% of patients had "inverted" TTC. The mean left ventricular ejection fraction (LVEF) on admission was 37.7% (± 8.2%). A pseudonormal or restrictive pattern of LV filling, moderate to severe mitral regurgitation (MR), and right ventricular involvement were uncommon in the patients. The in-hospital course showed cardiogenic shock in 23% of the cases, resulting in the death of 5 (8%) patients. We discovered that only peak concentration of troponin I was a significant predictor of in-hospital mortality (HR 1.067, 95%CI 1.022-1.113, p=0.003). At the end of the follow-up period, 45 (87%) women and 8 (67%) men were alive. This makes the overall observed mortality at 3 years approximately 17.2%. Using multivariate analysis, elevation of BNP (HR for increase by 10 ng/l 1.002, 95%CI 1-1.003, p=0.022) and cardiogenic shock on admission (HR 8.696, 95%CI 1.198-63.124, p=0.032) were significant predictors of overall mortality. Other prognostic factors assessed on admission were nonsignificant predictors of overall mortality.
  
  
  CONCLUSIONS
  Our analysis shows that in-hospital mortality is influenced by the peak concentration of troponin I, and overall mortality is affected by cardiogenic shock and the elevation of BNP during admission. The assessment of troponin I and BNP can help with the prognostication of TTC patients in our daily clinical practice.
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Lithuania; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Lithuania.
authors.forename: Sigita
authors.initials: S
authors.lastname: Glaveckaitė
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Lithuania; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Lithuania.
authors.forename: Pranas
authors.initials: P
authors.lastname: Šerpytis
authors.affiliation: Faculty of Medicine, Vilnius University, Lithuania. Electronic address: dovilelaurap@gmail.com.
authors.forename: Dovilė
authors.initials: D
authors.lastname: Pečiūraitė
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Lithuania; Centre of Informatics and Development, Vilnius University Hospitals Santariskiu Klinikos, Lithuania.
authors.forename: Roma
authors.initials: R
authors.lastname: Puronaitė
authors.affiliation: Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, Lithuania.
authors.forename: Nomeda
authors.initials: N
authors.lastname: Valevičienė
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D054549:Takotsubo Cardiomyopathy / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D019210:Troponin I / Q000378:metabolism*
chemical_list: D019210:Troponin I
keywords: Cardiovascular magnetic resonance; Echocardiography; Stress-induced cardiomyopathy; Survival; Takotsubo cardiomyopathy