103 Takotsubo Cardiomyopathy: Prevalence, Presentation and Co-prevalence of Coronary Artery Disease in a British Population

Abstract

<h3>Introduction</h3> Takotsubo Cardiomyopathy (TCM) was first described in Japan and has been studied in a number of Western countries, although little in the UK. There is an increasing recognition that TCM can co-exist with coronary artery disease (CAD), although it is not understood how the two conditions might interact. We describe the prevalence and presenting features in a British population, and investigate its relationship to CAD. <h3>Methods</h3> We identified patients with TCM who underwent coronary angiography at the Royal Cornwall Hospital by analysing our database of angiogram reports from 01/01/2010 to 01/11/2013, using the search terms “takot-”, “stress car-” and “apical bal-”. The paper and electronic records of these patients were examined. <h3>Results</h3> 37 reports matched our search criteria. Of these, 4 were given other diagnoses, leaving 33 which met the revised Mayo Clinic diagnostic criteria for TCM. 88% of patients were female, all were of white British origin, and the median age was 66 years (inter-quartile range: 11 years). The main presenting symptom was chest pain (69.7%), while 9.1% presented with breathlessness only. Other presenting symptoms were palpitations, syncope and vomiting. 61% of patients had documented stressful precipitating events: 25% were related to bereavement, 25% to general psychological stress, and 15% to a physical stressor. ECG changes included 49% with ST elevation, 27% with T-wave inversion only, 3% with new LBBB, 3% with ventricular ectopics, and 15% with no ECG changes. Mean peak troponin was 470.1 ng/L [normal range &lt;14 ng/L]. At angiogram, 53% had no evidence of CAD, 38% had mild to moderate disease, and 6% had severe disease (but no flow-limiting lesions). During this period, 2728 patients were admitted for troponin-positive acute coronary syndrome (ACS), giving a prevalence of 1.2% of TCM among these patients, and 3.3% among females. 36% suffered acute complications: 27% had acute pulmonary oedema, 3% suffered non-sustained VT, 6% new AF, and 6% (2 patients) experienced VF arrest after presentation, both of whom survived. 27% of the 18 patients with CAD on angiogram suffered complications, while 44% of those with no evidence of CAD suffered complications. <h3>Conclusions</h3> In the largest TCM case series from the UK to date, we found a prevalence of 1.2% of TCM among patients presenting with troponin-positive ACS, matching that of other European studies, and higher than previous UK studies. Although many patients experienced a precipitating stressful event, a large minority (39%) did not, which has implications for the condition’s alternative name: “stress cardiomyopathy”. The rate of acute pulmonary oedema, arrhythmias and cardiac arrest was high, though prognosis was good. The co-prevalence of CAD was also high, as would be expected in patients of this age group, but patients with CAD did not have a higher rate of complications than those with no CAD.