Abstract
Background: Previous studies revealed that takotsubo cardiomyopathy (TTC) is triggered by physical and emotional stresses. This study was performed to determine the short- and long-term prognostic impact of emotional- and physical stress associated with TTC.Methods and results: Our institutional database constituted a collective of 84 patients diagnosed with TTC between 2003 and 2015. The patients were divided into two groups as per the presence of emotional stress (n = 24, 21%) or physical stress (n = 60, 52.6%). The endpoint was a composite of in-hospital events (thromboembolic events and life-threatening arrhythmias), myocardial infarction, all-cause of mortality, re-hospitalization due to heart failure, stroke, and recurrence of TTC. A Kaplan–Meier analysis indicated a significantly lower event-free survival rate over a mean follow-up of 5 years in the emotional group than the physical stress group (log-rank, p < 0.01). Multivariate Cox regression analysis revealed only emotional stress (HR 0.4, 95% CI: 0.2–0.9, p < 0.05) as a negative independent predictor of the primary endpoint.Conclusion: Rates of in-hospital events and short- as well as long-term events were significantly lower in TTC patients suffering from emotional stress as compared to patients with physical stress.
Highlights
Takotsubo or stress-induced cardiomyopathy, first described in the 1990s, is an acute reversible condition, characterized by a range of wall motion abnormalities
1–2% of all patients with acute coronary syndrome are eventually diagnosed with takotsubo cardiomyopathy (TTC) (Gianni et al, 2006; Kurowski et al, 2007)
Physical stress was defined as the presence of acute medical illness, whereas emotional stress was defined by the detection of emotional stress, elicited through a detailed clinical history of the patient and precluding any form of acute illness
Summary
Takotsubo or stress-induced cardiomyopathy, first described in the 1990s, is an acute reversible condition, characterized by a range of wall motion abnormalities. Impact of Stress on Takotsubo Cardiomyopathy patients are postmenopausal women (Elesber et al, 2006; Haghi et al, 2006; Jabara et al, 2009; El-Battrawy et al, 2016) and precipitating risk factors include the presence of emotional (reported in 27%) and physical stresses (reported in 38%). An early classification system based on the ballooning pattern of ventricular walls, as diagnosed by transthoracic echocardiography and levo-cardiography, enabled to sort patients into identifiable groups (Elesber et al, 2006; Haghi et al, 2006; Templin et al, 2015; El-Battrawy et al, 2016).
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