Document Detail


Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.
MedLine Citation:
PMID:  20117439     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-03-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-41     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Hypertrophic Cardiomyopathy Center and Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / adverse effects
Adult
Aged
Aged, 80 and over
Biological Markers / blood
Electrocardiography
Female
Heart Failure / etiology
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Stress, Psychological
Takotsubo Cardiomyopathy / complications,  etiology,  mortality,  physiopathology*,  therapy
Troponin / blood
Ventricular Function
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Biological Markers; 0/Troponin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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