Abstract 811: Natural History and Expanded Clinical Profile of Stress (Tako-Tsubo) Cardiomyopathy in United States Women

Abstract

Stress cardiomyopathy (SC) is a newly reported condition of older women, triggered by emotionally and physically stressful events, characterized by acute heart failure with a distinctive angiographic profile, and regarded as a reversible process. To date, extended follow-up of SC patients is largely unavailable. We have assembled a substantial consecutive group of patients with SC to assess short and long-term clinical consequences of this condition. Between 2001–2008, we prospectively identified and followed (mean 2.0 years, range 0–6.7) 113 consecutive women with SC at a tertiary care United States hospital. Patients were female, aged 32–92 years (mean 68±13), and 16 (14%) were < 55 years. In 105 (93%) a triggering stressful event (emotional in 50, acute illness in 55) was identified; however, in 8 patients (7%) no such event preceded SC. The ECG showed ST-segment elevation in 58(51%) patients and ejection fraction (EF) was 31±11%. Troponin was elevated in 109 (96%); peak troponin (T) was 0.64±0.76 ng/ml. Of the 113 patients, 110(97%) survived the acute event: 3 patients (3%) died in-hospital (cardiogenic shock in 2; subarachnoid hemorrhage in 1). Other complications included: cardiac arrest 2 (2%), hypotension requiring inotropic drug and/or intra-aortic balloon pump in 22 (19%), pulmonary or cerebral embolism in 3 (3%), left ventricular (LV) or right ventricular thrombus in 7 (6%) and LV outflow obstruction in 13 (12%). CMR findings included absent delayed hyperenhancement (gadolinium) in 82/83 (99%), normal LV apical contraction in 46%, RV akinesia in 22%, and pleural effusions due to heart failure in 46%. At follow-up, EF returned to normal in all patients, but one or more SC events recurred in 7 (6%) patients (complicated by non-fatal cardiac arrest in 1), of whom 3 were taking beta-blockers. Post-hospital death occurred in 15 (13%) patients of which 14 were noncardiac and 1 of unknown cause. Among this large cohort of women, some SC events occurred atypically either without a stress trigger or in younger premenopausal patients. SC also led to death in the acute phase or to later non-fatal recurrences of SC or cardiac arrest in about 10%. Therefore, the clinical profile of SC is much broader than previously regarded.