Physically triggered Takotsubo cardiomyopathy has a higher in-hospital mortality rate
Introduction
Diagnoses of Takotsubo cardiomyopathy (TC) are increasing. The prevalence is reported to be 1.7% to 2.5% in patients with suspected acute coronary syndrome (ACS) [1], [2]. The disease is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wall-motion abnormalities, typically with akinesis or dyskinesis of the apex. Mechanisms proposed to underlie the disease include catecholamine cardiotoxicity, microvascular dysfunction and coronary artery spasms, but remain inconclusive [3], [4]. The disease is commonly precipitated by severe stress [5], [6], [7], [8]. However, little is known about the significance of different types of triggers on the prognosis. Therefore, the goal of our study was to determine whether particular types of triggers were associated with the prognosis in TC, using a prospective study design.
Section snippets
Enrollment
We enrolled all patients with suspected ACS from January 2008 to December 2015. All patients underwent a baseline history taking, physical examination, collection of vital signs, laboratory data, 12-lead electrocardiogram (ECG), echocardiography and coronary angiography. A diagnosis of TC was based on the Mayo Clinic diagnosis criteria: the presence of a transient abnormality in the left ventricular wall motion beyond a single epicardial coronary artery perfusion territory, the absence of
Baseline characteristics
We screened 1861 consecutive patients with suspected ACS from January 2008 to December 2015. Of these, 1735 (93.2%) patients were excluded due to diagnosis of ACS with coronary angiography. Of the remaining 126 patients, 44 patients were excluded due to diagnosis of acute myocarditis after chart review. No patient with pheochromocytoma was included in this study. Eighty-two (4.4%) patients were enrolled in this study as diagnosed with TC by the Mayo Clinic diagnostic criteria (Fig. 1). The
Discussion
The major findings of our study are that TC had a higher mortality (10.2%) than has been reported in the past, physical and non-physical triggered TC patients differed in the number of clinical features, and physical triggered TC had a significantly higher mortality.
Conclusions
There was a significant difference in the in-hospital mortality between the triggers in TC. Physical triggers and a male gender were independent risk factors for in-hospital mortality. The pathophysiology may be a direct catecholamine toxicity of the cardiomyocytes.
Disclosure
Dr. Watanabe is a recipient of lecture fees from Daiichi-Sankyo and research funding from Boehringer Ingelheim, Takeda Pharmaceutical Company, Japan Lifeline, Medtronic Japan, Boston Scientific Japan, Biotronik Japan, and St. Jude Medical Japan. This work was supported by JSPS KAKENHI Grant Number 26461094.
Conflict of interest
The authors report no relationships that could be construed as a conflict of interest.
Acknowledgments
We thank Yuki Shiino and Shiho Ishikawa for assistance with the data collection and Dr. Yuka Kiriyama for the technical support with the histological examinations.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.