title: Physically triggered Takotsubo cardiomyopathy has a higher in-hospital mortality rate.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TC) is a myopathy triggered by severe stressful events. However, little is known about the determinants of in-hospital outcomes. We prospectively determined the effect of different triggers on the prognosis of TC.
  
  
  RESULTS
  We enrolled patients who were admitted for suspected acute coronary syndrome (ACS) from January 2008 to December 2015. TC was diagnosed according to the Mayo Clinic diagnosis criteria. The outcome was in-hospital death. Among 1861 consecutive patients with suspected ACS, 82 (4.4%) patients were diagnosed with TC. There were 43 patients (52%) with physical triggers (Physical), 26 (31%) with emotional triggers, and 13 (17%) with no identifiable triggers. The latter two groups were combined and categorized as the Non-physical trigger group. Compared with non-physical triggered TC, patients with physical triggered TC were more likely to have a malignancy (p=0.008), lower blood pressure (p=0.001), lower hemoglobin (p<0.001), higher serum creatinine (p<0.001) and higher norepinephrine levels (p=0.007). During a mean hospital stay of 16±12days, 9 (20.9%) of the Physical and 1 (2.6%) of the Non-physical patients died in-hospital (log-rank p=0.007). After adjusting for the age, gender, trigger, malignancy, and hemoglobin level, being male (hazard ratio 11.9, 95% confidence interval, 2.43-58.5, p=0.002) and having a physical trigger (14.7, 1.19-166, p=0.03) were associated with in-hospital mortality.
  
  
  CONCLUSIONS
  There was a significant difference in in-hospital mortality depending on the trigger type in TC. Being male and having a physical trigger were independent risk factors of in-hospital mortality from TC.
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: sobue@fujita-hu.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sobue
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Koshikawa
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003404:Creatinine / Q000032:analysis; D004562:Electrocardiography / Q000379:methods; D015444:Exercise / Q000502:physiology*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D009638:Norepinephrine / Q000032:analysis; D015985:Precipitating Factors; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000209:etiology / Q000401:mortality
chemical_list: D003404:Creatinine; D009638:Norepinephrine
keywords: In-hospital mortality; Pathophysiology; Physical trigger; Takotsubo cardiomyopathy