Outcomes of Patients with Stress-Induced Cardiomyopathy Diagnosed by Echocardiography in a Tertiary Referral Hospital

Pil Hyung Lee, Jae Kwan Song, Byung Joo Sun, Hyung Oh Choi, Jeong Sook Seo, Jin Oh Na, Dae Hee Kim, Jong Min Song, Duk Hyun Kang, Jae Joong Kim, Seong Wook Park

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Abstract

Background: Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital. Methods: Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed. Results: Over a 63-month period, 56 consecutive patients (median age and interquartile range = 64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P = .021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n = 2), LV thrombus (n = 2), and right ventricular dysfunction (n = 12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P = .009) and absence of LV function recovery within 1 week (ejection fraction < 50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P = .036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC. Conclusions: SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.

Original languageEnglish
Pages (from-to)766-771
Number of pages6
JournalJournal of the American Society of Echocardiography
Volume23
Issue number7
DOIs
Publication statusPublished - 2010 Jul 1
Externally publishedYes

Fingerprint

Takotsubo Cardiomyopathy
Tertiary Care Centers
Echocardiography
Mortality
Odds Ratio
Confidence Intervals
Right Ventricular Dysfunction
Ventricular Outflow Obstruction
Recurrence
APACHE
Chest Pain
Left Ventricular Function
Psychological Stress
Dyspnea
Sepsis
Hospitalization
Thrombosis

Keywords

  • Echocardiography
  • Outcome
  • Stress
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of Patients with Stress-Induced Cardiomyopathy Diagnosed by Echocardiography in a Tertiary Referral Hospital. / Lee, Pil Hyung; Song, Jae Kwan; Sun, Byung Joo; Choi, Hyung Oh; Seo, Jeong Sook; Na, Jin Oh; Kim, Dae Hee; Song, Jong Min; Kang, Duk Hyun; Kim, Jae Joong; Park, Seong Wook.

In: Journal of the American Society of Echocardiography, Vol. 23, No. 7, 01.07.2010, p. 766-771.

Research output: Contribution to journalArticle

Lee, Pil Hyung ; Song, Jae Kwan ; Sun, Byung Joo ; Choi, Hyung Oh ; Seo, Jeong Sook ; Na, Jin Oh ; Kim, Dae Hee ; Song, Jong Min ; Kang, Duk Hyun ; Kim, Jae Joong ; Park, Seong Wook. / Outcomes of Patients with Stress-Induced Cardiomyopathy Diagnosed by Echocardiography in a Tertiary Referral Hospital. In: Journal of the American Society of Echocardiography. 2010 ; Vol. 23, No. 7. pp. 766-771.
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AU - Song, Jae Kwan

AU - Sun, Byung Joo

AU - Choi, Hyung Oh

AU - Seo, Jeong Sook

AU - Na, Jin Oh

AU - Kim, Dae Hee

AU - Song, Jong Min

AU - Kang, Duk Hyun

AU - Kim, Jae Joong

AU - Park, Seong Wook

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N2 - Background: Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital. Methods: Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed. Results: Over a 63-month period, 56 consecutive patients (median age and interquartile range = 64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P = .021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n = 2), LV thrombus (n = 2), and right ventricular dysfunction (n = 12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P = .009) and absence of LV function recovery within 1 week (ejection fraction < 50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P = .036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC. Conclusions: SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.

AB - Background: Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital. Methods: Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed. Results: Over a 63-month period, 56 consecutive patients (median age and interquartile range = 64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P = .021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n = 2), LV thrombus (n = 2), and right ventricular dysfunction (n = 12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P = .009) and absence of LV function recovery within 1 week (ejection fraction < 50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P = .036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC. Conclusions: SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.

KW - Echocardiography

KW - Outcome

KW - Stress

KW - Takotsubo cardiomyopathy

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