Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy
Scott W Sharkey, Denise C Windenburg, John R Lesser, Martin S Maron, Robert G Hauser, Jennifer N Lesser, Tammy S Haas, James S Hodges, Barry J Maron, Scott W Sharkey, Denise C Windenburg, John R Lesser, Martin S Maron, Robert G Hauser, Jennifer N Lesser, Tammy S Haas, James S Hodges, Barry J Maron
Abstract
Objectives: This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event.
Background: Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning.
Methods: Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients.
Results: Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were <or=50 years of age. In 121 patients (89%), SC was precipitated by intensely stressful emotional (n = 64) or physical (n = 57) events, including 22 associated with sympathomimetic drugs or medical/surgical procedures; 15 other patients (11%) had no evident stress trigger. Twenty-five patients (18%) were taking beta-blockers at the time of SC events. Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance (CMR) imaging, usually with rapid return to normal systolic function, although delayed >2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year.
Conclusions: In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male, <or=50 years of age, without a stress trigger, or with in-hospital death, nonfatal recurrence, embolic stroke, or delayed normalization of ejection fraction. Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality. These data support expanded management and surveillance strategies including CMR imaging and consideration for anticoagulation.
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed