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

Research output: Contribution to journalArticlepeer-review

559 Scopus citations

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 ≤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.

Original languageEnglish (US)
Pages (from-to)333-341
Number of pages9
JournalJournal of the American College of Cardiology
Volume55
Issue number4
DOIs
StatePublished - Jan 26 2010

Bibliographical note

Funding Information:
Supported in part by a grant from The Hearst Foundations , San Francisco, California. Dr. John Lesser receives speaker fees from Siemens and is on the scientific advisory board of Vital Images. Dr. Barry Maron is a consultant with GeneDX. Quarterly Focus Issue: Heart Failure Clinical Research

Keywords

  • cardiomyopathy
  • heart failure
  • left ventricle
  • stress

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