Gender Differences in Patients with Takotsubo Cardiomyopathy: Multi-Center Registry from Tokyo CCU Network.

Tsutomu Murakami,Toshiaki Isogai,Ken Nagao,Tsutomu Yoshikawa,Takeshi Yamamoto,Konomi Sakata,Tetsuro Ueda,Yuichiro Maekawa,Morimasa Takayama,Joshua M Hare

doi:10.1371/journal.pone.0136655

Abstract

BackgroundThe clinical features of gender differences in takotsubo cardiomyopathy (TC) remain to be determined. The aim of this study was to evaluate the differences in clinical characteristics of male and female patients with TC.MethodsWe obtained the clinical information of 368 patients diagnosed with TC (84 male, 284 female) from the Tokyo CCU Network database collected from 1 January 2010 to 31 December 2012; the Network is comprised of 71 cardiovascular centers in the Tokyo (Japan) metropolitan area. We attempted to characterize clinical differences during hospitalization, comparing male and female patients with TC.ResultsThere were no significant differences in apical ballooning type, median echocardiography ejection fraction, serious ventricular arrhythmias (such as ventricular tachycardia or fibrillation), or cardiovascular death between male and female patients. Male patients were younger than female patients (median age at hospitalization for male patients was 72 years vs. 76 years for female patients; p = 0.040). Prior physical stress was more common in male than female patients (50.0% vs.31.3%; p = 0.002), while emotional stress was more common in female patients (19.0% vs. 31.0%; p = 0.039). Severe pump failure (defined as Killip Class > III) (20.2% vs. 10.6%; p = 0.020) and cardiopulmonary supportive therapies (28.6% vs. 12.7%, p < 0.001) were more common in male than female patients. Multivariate analysis revealed that male gender (odds ratio = 4.32, 95% CI = 1.41–13.6, p = 0.011) was an independent predictor of adverse composite cardiac events, including cardiovascular death, severe pump failure, and serious ventricular arrhythmia.ConclusionsCardiac complications in our dataset appeared to be more common in male than female patients with TC during their hospitalization. Further investigation is required to clarify the underlying mechanisms responsible for the observed gender differences.

Highlights

Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricular dysfunction with predominance in women, especially those who are postmenopausal [1,2,3]
We obtained the clinical information of 368 patients diagnosed with TC (84 male, 284 female) from the Tokyo CCU Network database collected from 1 January 2010 to 31 December 2012; the Network is comprised of 71 cardiovascular centers in the Tokyo (Japan) metropolitan area
Prior physical stress was more common in male than female patients (50.0% vs.31.3%; p = 0.002), while emotional stress was more common in female patients (19.0% vs. 31.0%; p = 0.039)

Summary

Introduction

Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricular dysfunction with predominance in women, especially those who are postmenopausal [1,2,3]. The Tokyo CCU Network database is an ongoing multicenter registry that prospectively collects information from emergency admissions to acute cardiac care facilities [4,5,6,7]. This database, including 71 large-volume cardiovascular centers in the Tokyo metropolitan area, provides us a unique opportunity to characterize fundamental features of the disease. Using this database, our study sought to characterize gender-specific differences in hospitalized patients with TC.

Objectives

Results

Conclusion