Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

TY - JOUR

T1 - Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

AU - Templin, Christian

AU - Ghadri, Jelena R

AU - Diekmann, Johanna

AU - Napp, L Christian

AU - Bataiosu, Dana R

AU - Jaguszewski, Milosz

AU - Cammann, Victoria L

AU - Sarcon, Annahita

AU - Geyer, Verena

AU - Neumann, Catharina A

AU - Seifert, Burkhardt

AU - Hellermann, Jens

AU - Schwyzer, Moritz

AU - Eisenhardt, Katharina

AU - Jenewein, Josef

AU - Franke, Jennifer

AU - Katus, Hugo A

AU - Burgdorf, Christof

AU - Schunkert, Heribert

AU - Moeller, Christian

AU - Thiele, Holger

AU - Bauersachs, Johann

AU - Tschöpe, Carsten

AU - Schultheiss, Heinz-Peter

AU - Laney, Charles A

AU - Rajan, Lawrence

AU - Michels, Guido

AU - Pfister, Roman

AU - Ukena, Christian

AU - Böhm, Michael

AU - Erbel, Raimund

AU - Cuneo, Alessandro

AU - Kuck, Karl-Heinz

AU - Jacobshagen, Claudius

AU - Hasenfuss, Gerd

AU - Karakas, Mahir

AU - Koenig, Wolfgang

AU - Rottbauer, Wolfgang

AU - Said, Samir M

AU - Braun-Dullaeus, Ruediger C

AU - Cuculi, Florim

AU - Banning, Adrian

AU - Fischer, Thomas A

AU - Vasankari, Tuija

AU - Airaksinen, K E Juhani

AU - Fijalkowski, Marcin

AU - Rynkiewicz, Andrzej

AU - Pawlak, Maciej

AU - Opolski, Grzegorz

AU - Dworakowski, Rafal

AU - MacCarthy, Philip

AU - Kaiser, Christoph

AU - Osswald, Stefan

AU - Galiuto, Leonarda

AU - Crea, Filippo

AU - Dichtl, Wolfgang

AU - Franz, Wolfgang M

AU - Empen, Klaus

AU - Felix, Stephan B

AU - Delmas, Clément

AU - Lairez, Olivier

AU - Erne, Paul

AU - Bax, Jeroen J

AU - Ford, Ian

AU - Ruschitzka, Frank

AU - Prasad, Abhiram

AU - Lüscher, Thomas F

PY - 2015/9/3

Y1 - 2015/9/3

N2 - BACKGROUND: The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood.METHODS: The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome.RESULTS: Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year.CONCLUSIONS: Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

AB - BACKGROUND: The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood.METHODS: The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome.RESULTS: Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year.CONCLUSIONS: Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

KW - Acute Coronary Syndrome/complications

KW - Aged

KW - Angiotensin Receptor Antagonists/therapeutic use

KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use

KW - Echocardiography

KW - Electrocardiography

KW - Female

KW - Follow-Up Studies

KW - Heart Ventricles/diagnostic imaging

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Proportional Hazards Models

KW - Registries

KW - Retrospective Studies

KW - Takotsubo Cardiomyopathy/complications

KW - Ventricular Function, Left

U2 - 10.1056/NEJMoa1406761

DO - 10.1056/NEJMoa1406761

M3 - SCORING: Journal article

C2 - 26332547

VL - 373

SP - 929

EP - 938

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 10

ER -