Takotsubo cardiomyopathy induced during Dobutamine Stress Echocardiography (TTC-DSE): A complex world

Abstract

Dobutamine stress echocardiography (DSE) is widely used, TTC-DSE is extremely rare. Our purpose was to compare TTC-DSE reports with DSE exams, to identify triggers of TTC. Retrospective study: – systematic analysis of TTC-DSE observations from 2006 to 2020; – over a 3-year period (2013-2015), selection (data base) of consecutive DSE patients; – comparison of the two groups. An extensive search identified 30 TTC-DSE observations, mean age 64 years (52-74) and a high proportion of women (86.6%), all with TTC criteria: Predominance of female > 50 years (93.3%); Depression, or anxiety (26.7%); EKG ST elevation (70%); Normal coronary angiography and depressed angio left ventricular ejection fraction (LVEF)< 40% (14/18 pts); Typical segmental LV impairment: apical (77.3%); mid-ventricular (13.6%); reverse (9%); Low troponin peak; Rapid recovery of LVEF (29/30 pts), but one death (acute heart failure). The 2nd group of 578 consecutive DSE patients was characterized by older patients (70 vs. 64), and a smaller proportion of women (44 vs. 64%) all P < 0;01). The comparison between TTC-DSE vs. DSE showed a greater proportion of smoker (16 vs. 36.6%), the onset of TTC at a higher mean peak dose Dobutamine (40 vs. 30 g/kg/mn), but at a lower Maximum Peak Heart Rate (81% vs. 94%), all P < 0.01). In a multivariate analysis, female sex (OR = 9.6;95%CI: 3-28), smoking (OR = 4.8;95%CI: 2-11) and Dobutamine posology (OR = 1.07; 95%CI: 1.02-1.12) were independent predictors of TTC-DSE (all P < 0;01). Dobutamine posology > 30 gammas/kg/mn was the best cut-off (AUC 0.7 ± 0.04, P < 0.01) to predict TTC-DSE. By comparison with DSE patients, independent factors (female sex, smoker, Dobutamine posology > 30 gammas/kg/mn) are predictive of TTC-DSE. Superimposable to the usual TTC, TTC-DSE remains, however, poorly explained.