Takotsubo cardiomyopathy - in-hospital mortality and serious early complications -101 case study

Abstract

Background: Takotsubo cardiomyopathy (TTC) is a clinical disorder usually triggered by intense emotional and/or physical stress, characterized by reversible severe localized left ventricular wall dyskinesia, transient changes of ST segment, without significant coronary artery stenoses. Purpose: Evaluation of in-hospital mortality and early complications in patients with TTC. Methods: 101 patients diagnosed with TTC were enrolled into the study in years 2008-2012 from 4 departments of invasive cardiology. Eventually we studied 95 patients diagnosed according to Mayo Clinic criteria. 6 (6,3%) patients were excluded; they had insignificant narrowings (less than 70%) in left anterior coronary artery or significant changes in other arteries. Results: 89,5% of the patients with TTC were women (age range 15 - 90 years, mean 67,6 years). 63,2% of the population had hypertension, 12,6% diabetes, 36,8% hypercholesterolemia, 16,8% family history, 11,6% COPD, 23,2% thyroid disorders (10,5% hyperthyroidism and 8,4% hypothyroidism), 8,4% anxiety/depression; 21% were smokers. In 83,2% of the patients retrosternal chest pain was the main symptom. On ECG in 54,7% of the patients ST segment elevation was observed, in 23,2% T wave inversion and in 4,2% ST segment depression. Mean cQT was 468,9ms. Troponin I concentration was elevated in 87,4% of the patients. On coronary angiography 44,2% of the population had no atherosclerotic changes in coronary vessels, in 55,8% stenoses were insignificant. On ventriculography and echocardiography we observed typical apical contractility disturbances in 94 patients, intraventricular variant in 1 patient. Mean ejection fraction (EF) was 39,8%. In 31,3% of the patients significant EF improvement was observed during hospitalization (mean EF - 48,8%, p<0,001). During hospitalization 3 (3,2%) patients died (2 due to cardiac rupture, 1 due to brain injury after prolonged resuscitation) and we observed following complications: 5 (5,3%) patients had cardiac arrest, 5 (5,3%) cardiogenic shock, 6 (6,3%) pulmonary oedema, 3 (3,2%) cardiac rupture, 10 (10,5%) ventricular rhythm disturbances and 19 (20%) pneumonia. Conclusions: TTC, generally considered a benign syndrome, should be reconsidered as a clinical condition at risk for serious complications like cardiac arrest, cardiogenic shock, pulmonary oedema and cardiac rupture leading to death. The population was diagnosed with surprisingly high rate of thyroid disorders. Follow-up with control group consisted of 101 women after anterior myocardial infarction is in progress.