Clinical Features and Inhospital Outcomes of Takotsubo (Stress) Cardiomyopathy: Ten Years’ Experience from a Tertiary Care Center in South India

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Abstract Background: Takotsubo cardiomyopathy is a syndrome which is characterized by transient regional systolic dysfunction, principally, of the left ventricle (LV), mimicking myocardial infarction (MI), but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. Aims and Objectives: In the present study we estimated clinical profile and assess the clinical course and short-term outcome of takotsubo cardiomyopathy. Materials and Methods: This was a single-center retrospective study conducted between April 01, 2013, and May 31, 2023. Cases were patients who were admitted in the Department of Cardiology with a diagnosis of takotsubo cardiomyopathy. Descriptive statistics were obtained for all variables and entered in MS Excel and analyzed with SPSS (SPSS for Windows, version 16.0, Chicago, IL, USA) in the study, and appropriate statistical tests like P value were employed to ascertain the significance. Results: Over 10 years (2012-2022), 55 patients of South Asian ethnicity with a diagnosis of takosubo cardiomyopathy were treated at this 2,858-bed tertiary-care hospital. Out of the study population 89.1% were female. Hypertension was seen in 58.2%, Diabetes Mellitus was seen in 45.5% and Dyslipidaemia was seen in 61.8 % of the patients. Stress factor or a precipitating event, was found in majority of the patients (63.6%). The mode of presentation was such that 63% presented with typical chest pain, 70.9% had dyspnoea, 9.1% had palpitation and 7.3% had syncope. The Cardiac enzymes were raised in 56 % patients. Coronary angiogram was done in all the patients which showed normal coronaries in 89.1% and non-flow limiting Coronaries in 10.9%. Of the study population, 25 (45.5%) patients had developed acute heart failure during their hospital stay and 17 (30.9%) patients had developed new arrhythmias. After Univariate and multivariate analysis to find the predictors of heart failure, evidence of right ventricular dysfunction was found to be an independent risk factor for developing acute heart failure. [OR = 4.14 ,95% CI (1.34 to 12.8)] and initial presentation as palpitation was an independent risk factor for developing new arrythmia. [OR =3.86 ,95% CI (1.16 to 8.84)]. Acute renal failure occurred in 6(10.9%) and there was no occurrence of cerebrovascular accident. The mean ± SD duration of hospital stay of the entire study cohort was of 4.09 ± 2.396 days. The overall mortality in this cohort was 2 (3.6%). At mean follow up time of 5.3 ± 1.4 years two patients died due to cerebrovascular accidents. 41 patients (74%) were asymptomatic, and 5 (9%) patients had intermittent episodes of dyspnoea. 2 (3.4%) patients were found to have paroxysmal atrial fibrillation episodes. At the echocardiographic follow up the mean ejection fraction improved to 56 ± 4%. Conclusions: The present study showed the high morbidity of TTS, diagnosed according to the new Inter-TAK criteria, in a tertiary center in India, especially during hospitalization, even though the overall prognosis is usually good. Often there is a preceding emotional or physical trigger, however absence of a trigger does not preclude a diagnosis of Takotsubo cardiomyopathy. Presence of RV failure had higher chances of acute heart failure and index presentation of palpitation had higher occurrence of arrythmias.