Takotsubo Cardiomyopathy Patients Research Articles

A Comparative Analysis of Positive and Negative Stimuli for Takotsubo Cardiomyopathy: A Pooled Analysis of Two Studies and a Systematic Review.

Takotsubo cardiomyopathy (TTC) is characterized by transient myocardial dysfunction triggered by both negative and positive emotional experiences, known respectively as broken heart syndrome (BHS) and happy heart syndrome (HHS). Despite the scarcity of comparative analyses between HHS and BHS in the literature, our pooled analysis, incorporating two retrospective registry analyses of 1395 TTC patients (57 HHS and 1338 BHS), reveals that while BHS is more prevalent, both conditions exhibit similar clinical presentations and outcomes. Statistical analyses, utilizing binary random effects models, indicate that diabetes mellitus is less common in HHS patients and serves as a predictor for BHS. Furthermore, there are differences in cardiac imaging between the two groups; individuals with HHS have higher odds of experiencing midventricular ballooning, whereas those with BHS are more likely to have apical ballooning. These findings highlight the similarities in clinical features and outcomes between HHS and BHS, while also illustrating distinct imaging profiles. The study emphasizes the need for future prospective studies to delve deeper into the implications of these TTC subtypes, offering valuable insights into their comparative aspects and underlying mechanisms.

Clinical characteristics and risk factors of in-hospital mortality in patients with Takotsubo syndrome

Takotsubo cardiomyopathy is a condition of transient systolic dysfunction triggered by emotional or physical stress. Nowadays, Takotsubo cardiomyopathy is gaining attention and has been detected more frequently. However, there is no collected data on Vietnamese subjects. This study aims to describe the clinical characteristics of patients diagnosed with Takotsubo cardiomyopathy and determine of rates and independent risk factors for in-hospital mortality. A retrospective andobservational study was conducted at the University Medical Center Ho Chi Minh City, involved 103 patients diagnosed with Takotsubo cardiomyopathy between January 2015 and June 2022. The diagnosis was made based on the revised Mayo Clinic diagnostic criteria. The average age of the study population was 71.2±15.3 years, with females accounting for 64.1% of the patients. The most common comorbidities among the patients were hypertension (57.3%), diabetes mellitus (30.1%), ischemic heart disease (15.5%), and chronic obstructive pulmonary disease (15.5%). Acute heart failure was observed in 30.1% of the patients, while ventricular arrhythmias were present in 17.6% of cases. The majority of triggers were attributed to physical factors, including infection (37.9%), respiratory failure (18.4%), postoperative status (3.9%), and acute neurological disease (2.9%). The in-hospital mortality rate was 17.5%, and the independent risk factors were identified as acute heart failure (OR=20.657, 95%CI 2.306–185.008, p=0.007) and respiratory failure (OR=10.397, 95% CI 1.117–96.795, p=0.040). Takotsubo cardiomyopathy patients have many comorbidities and are often triggered by physical factors. The in-hospital mortality rate is significant, with acute heart failure and respiratory failure identified as independent risk factors.

Clinical characteristics and risk factors of in-hospital mortality in patients with Takotsubo syndrome

Takotsubo cardiomyopathy is a condition of transient systolic dysfunction triggered by emotional or physical stress. Nowadays, Takotsubo cardiomyopathy is gaining attention and has been detected more frequently. However, there is no collected data on Vietnamese subjects. This study aims to describe the clinical characteristics of patients diagnosed with Takotsubo cardiomyopathy and determine of rates and independent risk factors for in-hospital mortality. A retrospective andobservational study was conducted at the University Medical Center Ho Chi Minh City, involved 103 patients diagnosed with Takotsubo cardiomyopathy between January 2015 and June 2022. The diagnosis was made based on the revised Mayo Clinic diagnostic criteria. The average age of the study population was 71.2±15.3 years, with females accounting for 64.1% of the patients. The most common comorbidities among the patients were hypertension (57.3%), diabetes mellitus (30.1%), ischemic heart disease (15.5%), and chronic obstructive pulmonary disease (15.5%). Acute heart failure was observed in 30.1% of the patients, while ventricular arrhythmias were present in 17.6% of cases. The majority of triggers were attributed to physical factors, including infection (37.9%), respiratory failure (18.4%), postoperative status (3.9%), and acute neurological disease (2.9%). The in-hospital mortality rate was 17.5%, and the independent risk factors were identified as acute heart failure (OR=20.657, 95%CI 2.306–185.008, p=0.007) and respiratory failure (OR=10.397, 95% CI 1.117–96.795, p=0.040). Takotsubo cardiomyopathy patients have many comorbidities and are often triggered by physical factors. The in-hospital mortality rate is significant, with acute heart failure and respiratory failure identified as independent risk factors.

Abstract 12000: Prolonged Arterial Phase is Caused of the Chest Pain in Takotsubo Cardiomyopathy A Dynamics Angiography and Artificial Intelligence Analysis

Introduction: Takotsubo Cardiomyopathy (TCM) known as “Broken Heart Syndrome” is triggered by extreme emotional or physical stress. The typical TCM patient features chest pain, ST elevation, elevated troponin, reduced ejection fraction (EF), patent coronary artery, and apical ballooning. Hypothesis: Could abnormal coronary flow explain chest pain in Takotsubo patients? Methods: The patient with severe chest pain, elevated troponin, ST change, patent coronary arteries, and apical ballooning underwent angiography and review with a new dynamic recording technique. Ten patients without ACS, normal EF, and no coronary artery disease served as control. At first, the angiographic recording started when the contrast was injected into the coronary artery. Then the recording continued with the blood in white color moving in until all contrast disappeared from the arteries. The angiogram was recorded at 15 images per second. The review of coronary images focused on the blood flow in white on top of a background of black contrast. The arterial phase (AP) calculation began when the blood moved in and ended when all the contrast was flushed out of the distal arterial vasculature. The two-layer artificial intelligence program was built based on U-net and Densenet-121. The first layer, with a segmentation model and Convolutional neural network is responsible for detecting the starting frame of AP with a full index of contrast. The second layer with a segmentation model will detect the ending frame of AP. All TCM patient was followed up in one year. Results: Fifteen TCM patients met the criteria (12/15 female). The AP in the TCM group was 3.17 +/- 0.53 seconds compared with 1.62 +/- 0.26 seconds in the control group (P<0.001). The TCM group had a mean EF 33.9 +/- 7.6 %, and all recovered to 58.8 +/- 12.6 % after two weeks. At one year follow-up, all patients had no chest pain and no re-admission, except for one case of non-cardiovascular mortality associated with septic shock from pneumonia 3 months after the index event. Conclusions: Chest pain in TCM was caused by slow flow (measured as prolonged arterial phase) which was detrimental to myocardial contraction. Their prognosis was benign because all patients recovered.

Base-to-apex Gradient Pattern Assessed by Cardiovascular Magnetic Resonance in Takotsubo Cardiomyopathy.

The purpose of this study was to investigate the base-to-apex gradient strain pattern as a noncontrast cardiovascular magnetic resonance (CMR) parameter in patients with Takotsubo cardiomyopathy (TTC) and determine whether this pattern may help discriminate TTC from patients with anterior myocardial infarction (AMI). A total of 80 patients were included in the analysis: 30 patients with apical ballooning TTC and 50 patients with AMI. Global and regional ventricular function, including longitudinal (LS), circumferential (CS), and radial strain (RS), were assessed using CMR. The base-to-apex LS, RS, and CS gradients, defined as the peak gradient difference between averaged basal and apical strain, were calculated. The base-to-apex RS gradient was impaired in TTC patients compared with the AMI group (14.04 ± 15.50 vs. -0.43 ± 11.59, P=0.001). Conversely, there were no significant differences in the base-to-apex LS and CS gradients between the AMI group and TTC patients (0.14 ± 2.71 vs. -1.5 ± 3.69, P=0.054: -0.99 ± 6.49 vs. ±1.4 ± 5.43, P=0.47, respectively). Beyond the presence and extension of LGE, base-to-apex RS gradient was the only independent discriminator between TTC and AMI (OR 1.28; 95% CI 1.08, 1.52, P=0.006) in multivariate logistic regression analysis. The findings of this study suggest that the pattern of regional myocardial strain impairment could serve as an additional noncontrast CMR tool to refine the diagnosis of TTC. A pronounced base-to-apex RS gradient may be a specific left ventricle strain pattern of TTC.

Exploring the EVolution in PrognOstic CapabiLity of MUltisequence Cardiac MagneTIc ResOnance in PatieNts Affected by Takotsubo Cardiomyopathy Based on Machine Learning Analysis: Design and Rationale of the EVOLUTION Study.

Takotsubo cardiomyopathy (TTC) is a transient but severe acute myocardial dysfunction with a wide range of outcomes from favorable to life-threatening. The current risk stratification scores of TTC patients do not include cardiac magnetic resonance (CMR) parameters. To date, it is still unknown whether and how clinical, trans-thoracic echocardiography (TTE), and CMR data can be integrated to improve risk stratification. EVOLUTION (Exploring the eVolution in prognOstic capabiLity of mUlti-sequence cardiac magneTIc resOnance in patieNts affected by Takotsubo cardiomyopathy) is a multicenter, international registry of TTC patients who will undergo a clinical, TTE, and CMR evaluation. Clinical data including demographics, risk factors, comorbidities, laboratory values, ECG, and results from TTE and CMR analysis will be collected, and each patient will be followed-up for in-hospital and long-term outcomes. Clinical outcome measures during hospitalization will include cardiovascular death, pulmonary edema, arrhythmias, stroke, or transient ischemic attack.Clinical long-term outcome measures will include cardiovascular death, pulmonary edema, heart failure, arrhythmias, sudden cardiac death, and major adverse cardiac and cerebrovascular events defined as a composite endpoint of death from any cause, myocardial infarction, recurrence of TTC, transient ischemic attack, and stroke. We will develop a comprehensive clinical and imaging score that predicts TTC outcomes and test the value of machine learning models, incorporating clinical and imaging parameters to predict prognosis. The main goal of the study is to develop a comprehensive clinical and imaging score, that includes TTE and CMR data, in a large cohort of TTC patients for risk stratification and outcome prediction as a basis for possible changes in patient management.

Patients Characteristics, Predictors, And Hospital Outcomes Of Takotsubo Cardiomyopathy Patients With Concomitant Anxiety Disorders.

Patients Characteristics, Predictors, And Hospital Outcomes Of Takotsubo Cardiomyopathy Patients With Concomitant Anxiety Disorders.

Epicardial fat volume assessed with cardiac magnetic resonance imaging in patients with Takotsubo cardiomyopathy

PurposeThe aims of our study were to investigate with cardiovascular magnetic resonance (CMR) the role of Epicardial Fat Volume (EFV) and distribution in patients with Takotsubo cardiomyopathy (TTC). Moreover, we explored EFV in patients with TTC and related this to comorbidities, cardiac biomarkers, and cardiac function. MethodsThis retrospective study performed CMR scans in 30 consecutive TTC patients and 20 healthy controls. The absolute amount of EFV was quantified in consecutive short-axis cine stacks through the modified Simpson’s rule. In addition, the left atrio-ventricular groove (LV) and right ventricle (RV) Epicardial Fat Thickness (EFT) were measured as well. Besides epicardial fat, LV myocardial strain parameters and T2 mapping measurements were obtained. ResultsTTC patients and controls were of comparable age, sex, and body mass index. Compared to healthy controls, patients with TTC demonstrated a significantly increased EFV, epicardial fat mass, and EFV indexed for body 7surface area (p = 0.005; p = 0.003; p = 0.008; respectively). In a multiple regression model including age, sex, BMI, atrial fibrillation, and dyslipidemia, TTC remained an independent association with EFV (p = 0.008). Global T2 mapping and Global longitudinal strain in patients with TTC were correlated with EFV (r = 0.63, p = 0.001, and r = 0.44, p = 0.02, respectively). ConclusionPatients with TTC have increased EFV compared to healthy controls, despite a similar body mass index. The amount of epicardial fat was associated with CMR markers of myocardial inflammation and subclinical contractile dysfunction.

Abstract 9753: Outcomes of Substance Abuse Among Patients With Takotsubo Cardiomyopathy

Introduction: Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy that is precipitated by emotional or physical stress mediated by catecholamines. Drugs that modulate adrenergic tone can precipitate/ worsen TC Hypothesis: To compare the prevalence of comorbidities and incidence of complications in TC patients with substance abuse (SA) compared to those without SA Methods: The United States NIS data from 2016 to 2018 was queried to identify adult patients (≥18 years) with TC using ICD 10 code. SA was defined as use of opiates or cannabis or cocaine. Chi- square test was applied for statistical analysis Results: We identified a total of 23, 220 patients with TC. 5.3% had history of SA. The prevalence of opioid, cannabis and cocaine use was 2.4 %, 2% and 1% respectively. Comparing the two groups (SA vs no SA), mean age was 56.8y vs 67.3y. the prevalence of hypertension (56% vs 67%; p<0.001), diabetes (15% vs 19%; p=0.007), and obesity (11 % vs 13%; p=0.04) atrial fibrillation (7 % vs 13.6%; p<0.001) coronary artery disease (50% vs 54%; p= 0.02) were lower. The prevalence of any psychiatric disorder (60.6% vs 38.2%; p<0.001), heart failure (36% vs 31%; p <0.001), chronic obstructive pulmonary disease (36% vs 28.5%; p <0.001), tobacco use (71% vs 42%; p<0.001) and alcohol use(11.4% vs 4%; p <0.001) were higher. Outcomes were (SA vs no SA)- cardiogenic shock (2.4% vs 3%; p =0.31), mechanical ventilation (9% vs 4.5%; p< 0.001), acute kidney injury (3% vs 8.4%; p <0.001), cardiac arrest (2.8% vs 1.5%; p <0.001), mitral regurgitation (4.5% vs 6.4%; p =0.007), ventricular tachycardia (5.7% vs 3.3%;p< 0.001) ventricular fibrillation (2% vs 1%;p <0.001) Conclusions: TC patients with SA had a lower cardiovascular risk factors such as hypertension, type 2 diabetes, obesity, high burden of psychiatric disorders, high rates of in hospital complications like need for mechanical ventilation, cardiac arrest and ventricular arrhythmias but no difference in the rates of cardiogenic shock compared to no SA group. Prospective studies are needed to confirm the impact of SA disorder on incidence and outcomes of TC in this cohort

Takotsubo's cardiomyopathy in patients with pre-existing autoimmune diseases: a national inpatient sample analysis

Abstract Background Recent research has suggested a potential role of autoimmunity and inflammation in Takotsubo's cardiomyopathy (TC) [1]. There have been few reports of TC occurring in patients with pre-existing autoimmune diseases (AID). It has also been hypothesised that the low prevalence of TC in patients with AID might be due to attenuating effect on the inflammatory response to catecholamine excess in TC by immunosuppressive medications used in AID patients [2]. On a population-based level, the prevalence of AID in TC patients and its implications remain unknown. Purpose Using a large national database, we aimed to describe the prevalence of AID in TC patients and its impact on in-hospital outcomes of TC patients. Methods We performed a retrospective analysis using the 2016–2019 National inpatient sample database in the United States, covering over 7 million admissions per year. Using ICD-10 codes, we identified patients with TC and a concomitant diagnosis of any of the AID† depicted in Table 1. We compared TC patients with (AID+) and without AID (AID−) for patient characteristics and in-hospital outcomes. Our primary outcome of interest was mortality. Secondary outcomes are listed in Table 2. Linear regression and multivariate logistic regression analysis were done using STATA 17 to adjust for confounders. Results 158,230 patients were admitted with TC and of those, 2880 (1.8%) had concomitant AID. Systemic lupus erythematosus (n=1515, 54.1%) was the most common AID followed by Sjogren's syndrome (n=645, 23.02%) Systemic sclerosis (n=440, 14%) and Rheumatoid Arthritis (n=200, 7.1%) in TC population. Compared to TC patients without AID, AID+ patients were relatively younger (mean age of 63 vs 67 years, p<0.0001) and more likely to be females (95% vs 83%, p<0.0001*). 200 (7.1%) and 9459 (6.08%) TC patients with and without AID died during hospitalisation,respectively. TC patients with AID had lower odds of developing acute decompensated heart failure [ADHF] (aOR=0.69 95% CI: 0.56–0.85, p=0.001*) and acute stroke (aOR=0.60, 95% CI: 0.43–0.85, p=0.005*) There was no statistical significance in mortality, rates of acute respiratory failure, cardiogenic shock and healthcare utilisation (Table 2). Conclusion Our study notes a substantially higher number of TC patients with pre-existing AID than previously reported in the literature. In addition, these patients have lower odds of developing acute stroke and ADHF, while there was no significant difference for cardiogenic shock and mortality. Further studies are required to decipher the potential link between AID and TC and explore the possible role of immunosuppressants in TC therapy, as suggested in prior studies. *P-value <0.05 was considered statistically significant. aOR = Adjusted Odds Ratio. †AID included in the study are mentioned in Table 1. Funding Acknowledgement Type of funding sources: None.

Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies

Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies

Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors.

Introduction: Physical stressors are common predisposing factors for takotsubo cardiomyopathy (TTC). However, the role of traumatic injuries in TTC has not been well defined. This study describes the characteristics of TTC in the broad spectrum of traumatic injuries using the information available in the National Trauma Data Bank (NTDB).Materials and methods: This retrospective study analyzed trauma patients ≥ 18 years old in the NTDB, from 2007 to 2018, with a diagnosis of TTC.Results: A total of 95 TTC diagnoses were found. The median age was 68 years old (interquartile range: 55-80). Patients were predominantly female (67.4%), white (88.4%), and sustained blunt mechanisms of injury (90.5%). Penetrating trauma was most common in males (16%). Most diagnoses were related to extremity trauma (53.7%), followed by head injury (26.3%). The most common severity scores were Glasgow Coma Scale (GCS) > 13 or < 8, and Injury Severity Score (ISS) < 15 or > 25. Males more commonly presented with GCS < 8 (68%), ISS > 25 (33%), high intensive care unit (ICU) admission rate (77.4%), and mechanical ventilation (51.6%). The median duration of the mechanical ventilation was eight days for both sexes. The ICU length of stay (LOS) was six days with a hospital LOS of nine days and a trend toward a longer LOS in males. The in-hospital mortality rate was 11.7% for both sexes.Conclusions: TTC in traumatic injuries is common at both ends of the severity spectrum and has different sex distribution. TTC patients are predominantly females and have more commonly extremity trauma than head injury. Males are more severely injured and under mechanical ventilation.

Impact of family history of coronary artery disease on clinical outcomes in Takotsubo cardiomyopathy

Family history of coronary artery disease (FHxCAD) is a critical risk factor for CAD, underscoring the contribution of genetic factors to disease pathogenesis and susceptibility. Takotsubo cardiomyopathy (TCM) simulates the...

Association of atrial fibrillation burden with in-hospital outcomes in patients with Takotsubo cardiomyopathy

BackgroundThe effects of atrial fibrillation (AF) and its burden on in-hospital mortality in patients with Takotsubo cardiomyopathy (TCM) are unclear. Here, we examined the effect of AF and paroxysmal AF on in-hospital outcomes in patients with TCM. MethodsWe used ICD-10 codes to retrospectively identify patients with a primary diagnosis of TCM in the National Inpatient Sample database 2016-2018. We compared in-hospital outcomes in TCM patients with and without AF before and after propensity score matching. The effect of AF burden on outcomes was assessed in patients with paroxysmal AF and no AF. ResultsOf the 4,733 patients with a primary diagnosis of TCM, 650 (13.7%) had AF, and 4,083 (86.3%) did not. Of TCM patients with AF, 368 (56.6%) had paroxysmal AF. In-hospital mortality was higher in patients with AF before (3.4% vs 1.2%, P < 0.001) and after propensity matching (3.4% vs 1.7%, P = 0.021) but did not differ between the paroxysmal AF and the no AF groups (P = 0.205). In the matched cohorts, both AF and paroxysmal AF groups were associated with a higher rate of cardiogenic shock (AF, P < 0.001; paroxysmal AF, P < 0.001), ventricular arrhythmia (AF, P = 0.002; paroxysmal AF, P = 0.02), acute kidney injury (AF, P = 0.007; paroxysmal AF, P = 0.008), and acute respiratory failure (AF, P < 0.001; paroxysmal AF, P < 0.001) compared with the no AF group. ConclusionsAlthough AF was associated with increased in-hospital mortality, paroxysmal AF did not affect in-hospital mortality, suggesting a higher AF burden is associated with worse clinical outcome in patients with TCM.

Differences of Hemogram Parameters and Their Ratios among Patients with Takotsubo Syndrome, Acute Coronary Syndrome and Healthy Individuals.

Introduction: Takotsubo cardiomyopathy (TTC) and acute coronary syndrome (ACS) are clinically indistinguishable from each other. Although therapeutically redundant, coronary angiography remains indispensable for differential diagnosis. Methods: In our study, we compared hemogram parameters and their ratios in 103 patients presenting with undiagnosed chest pain. Blood was drawn at baseline in 40 patients with TTC, 63 patients with ACS, and 68 healthy controls ((Ctrl) no coronary artery disease or signs of heart failure). Results: Peripheral lymphocyte counts were significantly depressed in TTC and ACS patients when compared to the Ctrl. Consequently, all three investigated hemogram ratios were significantly elevated in patients with ACS or TTC (NLR: TTC: median 3.20 vs. ACS: median 3.82 vs. Ctrl: median 2.10, p < 0.0001; BLR: median 0.02 vs. ACS: median 0.00 vs. Ctrl: median 0.00, p < 0.0001; MLR: median 0.37 vs. ACS: median 0.44 vs. Ctrl: median 0.28, p < 0.0001). Of note, BLR was only significantly elevated in patients with TTC, and not in patients with ACS (ACS vs. Ctrl p = 0.183). Conclusion: Basophil count and BLR are significantly increased in TTC patients when compared to ACS and may, therefore, be helpful in the distinction of TTC from ACS. Whereas NLR might be useful to differentiate ACS from controls. Elevated basophil counts and BLR in TTC patients are interesting findings and may confirm speculations about the partly unexplained pathophysiology.

Prevalence and Impact of Atrial Fibrillation on Prognosis in Takotsubo Cardiomyopathy Patients.

The purpose of this review is to describe the impact of atrial fibrillation (AF) on the cardiovascular outcomes and prognosis in patients with Takotsubo Cardiomyopathy (TTC). The pathophysiological basis of TTC is set on the release of catecholamines, occurring post an emotional or stressful event. The cardiovascular system of patients with TTC is affected by the high concentrations of catecholamines, creating the ideal background for the development of AF: inflammation, myocardial stress, and excessive sympathetic activity. AF is considered to be the most frequent arrhythmia in TTC patients and is associated with higher rates of cardiovascular and all-cause mortality. AF is also linked with a worse prognosis concerning the hemodynamic status, cardiac fibrosis, lethal arrhythmias, thromboembolic events, and adverse heart failure associated outcomes. The early diagnosis of AF in these patients plays significant role in the prevention of adverse events, the reversibility of left ventricular function, and the restoration of sinus rhythm.

Abstract 14162: Impact of Migraine Headaches on Stress Induced Takotsubo Cardiomyopathy

Introduction: Takotsubo cardiomyopathy (TTC) is an acute process, characterized by ventricular dysfunction, typically due to a neuro-cardiogenic mechanism. Although many stressors have previously been identified and can precipitate TTC, there have been no reports citing the association or effects of migraines attacks. Hypothesis: Migraines predispose a protective effect on TTC patients Methods: We conducted a US-wide analysis of TTC hospitalizations from 2013 to 2017 by querying the National Inpatient Sample database. Patients admitted with a principal diagnosis of TTC with a history of migraines were identified using the ICD-10 codes. TTC patients with migraines were then compared to TTC patients without migraines regarding mortality and acute inpatient complications (intubation, cardiac arrest, heart failure exacerbation, acute kidney injury). A logistic regression model was constructed to account for potential confounders. Results: A total of 172025 TTC patients were identified, of those patients, 3610 were found to have suffered from migraines. After accounting for potential confounders, TTC patients with a diagnosis of migraine were associated with a lower odds for mortality (OR: 0.388; [0.311-0.485]; p &lt;0.001) and acute complications (OR: 0.511 [0.471-0.554]); p &lt;0.001) compared to those without migraines. In terms of mortality, the presence of acute complications had the highest odds for mortality (7.830 [7.439-8.240]; p &lt;0.001), followed by cerebrovascular disease, cancer, and age. Depression, Diabetes, smoking, and obesity were associated with a decreased odds for mortality. Conclusions: TTC patients with migraines were associated with lower mortality and better inpatient outcomes.

Abstract 11513: Impact of Family History of Coronary Artery Disease on Clinical Outcomes in Takotsubo Cardiomyopathy

Introduction: Family history of coronary artery disease (CAD) is a critical risk factor for CAD, underscoring the contribution of genetic factors to disease pathogenesis and susceptibility. Takotsubo cardiomyopathy (TCM) simulates the clinical features of and frequently coexists with CAD. However, the association between family history of CAD (FHxCAD) and TCM is unclear. Aim: We examined the impact of FHxCAD on in-hospital clinical outcomes of TCM patients. Methods: This retrospective cohort study was conducted using the National Inpatient Sample database [2016-2018]. We identified 4,733 patients admitted to hospital with a primary diagnosis of TCM (ICD-10 coding system); 648 (13.7%) had a FHxCAD. We performed propensity score matching at 1:1 ratio (n=646, matched TCM with FHxCAD; n=646, matched TCM without FHxCAD), and we compared in-hospital outcomes and complications between TCM patients with or without a FHxCAD. Results: In the unmatched cohort, the TCM with FHxCAD group had a reduced incidence of cardiogenic shock, acute kidney injury (AKI) and acute respiratory failure (ARF); lower mortality rates; shorter length of stay (LOS); and decreased total charge compared to the TCM without FHxCAD group (p&lt;0.05). After propensity score matching, the TCM with FHxCAD group, when compared with the TCM without FHxCAD group, also had a lower incidence of cardiogenic shock (2.2% vs. 6.3%, p&lt;0.001; odds ratio [OR] 0.33, 95% confidence interval [CI], 0.18-0.61), AKI (5.1% vs. 8.7%, p=0.016; OR 0.57, 95% CI, 0.36-0.88), and ARF (5.7% vs. 12.7%, p&lt;0.001; OR 0.42, 95% CI, 0.28-0.63); decreased in-hospital mortality (&lt;11 vs. 3.1%, p=0.002; OR 0.2, 95% CI, 0.07-0.57); shorter LOS (2.66 ± 1.96 days vs. 3.40 ± 3.05 days, p&lt;0.001); and a reduced total charge (p=0.001), respectively. The incidence of cardiac arrest and ventricular arrhythmias did not differ significantly based on FHxCAD in the unmatched or matched cohorts. Conclusions: Family history of CAD was associated with favorable clinical outcomes in both unmatched and propensity-matched cohorts of in-hospital TCM patients. Further studies are necessary to identify mechanisms contributing to the association between in-hospital TCM outcomes and FHxCAD.

Abstract 11728: Common Primary Medical Conditions Associated With Secondary Takotsubo Cardiomyopathy

Introduction: Secondary Takotsubo cardiomyopathy (TCM) is considered a complication of the patient’s primary medical condition, such as medical, surgical or psychiatric conditions. More than one-third of TCM patients have primary medical conditions and tend to have a worse prognosis. However, there is no comprehensive study on the causes of TCM. Aim: We studied the common primary medical conditions in secondary TCM patients and their prognosis. Methods: We performed a retrospective analysis using the ICD-10-CM codes for a secondary diagnosis of TCM from the National Inpatient Sample database (2016-2018). We identified the primary medical condition represented by the ICD-10-CM diagnosis codes of secondary TCM patients and aggregated similar codes into clinically meaningful categories using the Clinical Classifications Software Refined. We then compared the mortality rate associated with each condition. Results: Of 14,816 patients admitted with secondary TCM, the common primary medical conditions included ‘Sepsis, unspecified organism’ (A419, 13.6%), ‘Chronic obstructive pulmonary disease with (acute) exacerbation’ (J441, 3.6%), ‘Acute respiratory failure with hypoxia’ (J9601, 2.8%), and ‘Pneumonia, unspecified organism’ (J189, 1.8%). After aggregating the individual codes into clinical categories, the common primary medical conditions included septicemia (19.1%), respiratory failure (6.4%), COPD and bronchiectasis (4.6%), hypertension with complications and secondary hypertension (4.2%), and cerebral infarction (3.1%). Primary medical conditions that yielded a higher mortality rate than the overall rate (8.5%) were septicemia (16.5%, P&lt;0.001), respiratory failure (10.7%, P=0.019), cerebral infarction (13.1%, P&lt;0.001), and acute hemorrhagic cerebrovascular disease (26.8%, P&lt;0.001). Conclusions: Sepsis is the most common primary medical condition of secondary TCM in admitted patients. Secondary TCM patients with a primary condition of acute hemorrhagic cerebrovascular disease, sepsis, respiratory failure, or cerebral infarction have higher in-hospital mortality than those with other primary medical conditions.

Analysis of Selected Cardiovascular Biomarkers in Takotsubo Cardiomyopathy and the Most Frequent Cardiomyopathies.

Introduction: Among the causes of de novo diagnosed cardiomyopathy, Takotsubo cardiomyopathy (TTC) plays a minor role, with an occurrence of 50,000–100,000 cases per annum in the United States. In clinical practice, a differentiation of a TTC toward an ischemic cardiomyopathy (ICMP) or a dilatative cardiomyopathy (DCMP) appears to be challenging, especially in a subacute setting or in atypical types of TTC.Methods: To investigate this issue, we analyzed serum levels of sST2, GDF-15, suPAR, HFABP, and clinical parameters including echocardiography in 51 patients with TTC, 52 patients with ischemic cardiomyopathy (ICMP) and 65 patients with dilated cardiomyopathy (DCMP).Results: sST-2 seemed to be the most promising biomarker for prediction of a TTC in differential diagnosis to an ICMP (AUC: 0.879, p = < 0.001, Cut off values: 12,140.5 pg/ml) or to a DCMP (AUC: 0.881, p = < 0.001, cut off value: 14521.9 pg/ml). GDF-15 evidenced a slightly lower AUC for prediction of a TTC in differential diagnosis to an ICMP (AUC: 0.626, p = 0.028) and to a DCMP (AUC: 0.653, p = 0.007). A differential diagnostic value was found for H-FABP in the prediction of a DCMP compared to TTC patients (AUC: 0.686, p = < 0.001). In propensity score matching for left ventricular ejection fraction, sex, and cardiovascular risk factors, differences in the plasma levels of sST2 and H-FABP in the matched cohort of TTC vs. DCMP remained statistically significant. In the matched cohort of TTC vs. ICMP, differences in sST2 also remained statistically significantConclusion: As medical therapy, long term prognosis, interval of follow-ups, rehabilitation program and recommendations differ completely between TTC and ICMP/DCMP, biomarkers for differential diagnosis, or rather for confirmation of diagnosis, are warranted in cases of cardiomyopathies with unsure origin. sST-2, GDF-15 and H-FABP might facilitate the classification.