Details

Autor(en) / Beteiligte

• Sharkey, Scott W., MD
• Windenburg, Denise C., BA
• Lesser, John R., MD
• Maron, Martin S., MD
• Hauser, Robert G., MD
• Lesser, Jennifer N
• Haas, Tammy S., RN
• Hodges, James S., PhD
• Maron, Barry J., MD

Titel

Natural History and Expansive Clinical Profile of Stress (Tako-Tsubo) Cardiomyopathy

Ist Teil von

• Journal of the American College of Cardiology, 2010-01, Vol.55 (4), p.333-341

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2010

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• 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 ≤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, ≤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.