Abstract 1447: Gender Differences in the Manifestation of Tako- Tsubo- Cardiomyopathy -Results of the German Tako- Tsubo Registry
Background: Tako-tsubo cardiomyopathy (TTC) mimics acute myocardial infarction (AMI). Most studies so far are small and include only females. A German TTC registry has been initiated to further characterize the syndrome. This study assessed if there are gender differences in the manifestation of TTC.
Methods: 314 pts from 37 hospitals were included according to following criteria:
acute chest symptoms,
ischemic ECG changes,
reversible LV akinesia not corresponding to a single coronary artery territory,
absence of coronary artery stenoses.
Results: Of 314 TTC pts, 287 were female (91%), 27 male (9%). Age (68±12 vs 66±13 years, p=ns) and symptoms (angina 213/287 vs 15/27, dyspnea 45/287 vs 5/27, both p=ns) were similar in female and male pts. A triggering event preceding TTC onset was present in 77% of women and 85% of men (p=ns). Physical stress was more frequent in men (29% vs 56%, p=0.003) whereas more women experienced emotional stress (39% vs 22%, p=ns). The time from symptom onset to hospital admission was similar (7.7±6.8 vs 7.4±7.2 hours, p=ns). Creatine kinase was higher in men (median 168 vs 272 U/L, p=0.004) due to physical stress but CK-MB (median 25 vs 26 U/L) and troponin I (3.5 vs 6.6 ng/ml, both p=ns) were not different. Ejection fraction (49±14% vs 46±15%, p=ns) and apical (64% vs 66%) or mid-ventricular involvement (36% vs 34%, p=ns) were comparable. The admission ECG showed no difference in heart rate (87±22 vs 94±32/min), ST-segment elevation (85% vs 93%), T-wave inversion (68% vs 63%) or Q-wave (25% vs 30%, all p=ns). The QTc interval on day 1 was significantly longer in females (467±53 vs 440±52 ms, p=0.014); no difference was seen on day 2 (504±62 vs 488±63 ms) and day 3 (502±66 vs 492±54 ms, both p=ns). Atrial fibrillation (both 16%), ventricular tachycardia (8% vs 11%), pulmonary edema (15% vs 5%), cardiogenic shock (7% vs 5%) and death (2% vs 0%) occurred with similar frequency in both groups.
Conclusion: TTC mainly occurs in elderly females. In this large registry, 9% males are affected with a similar clinical profile. In contrast to AMI, age distribution and symptoms in TTC are not different among both sexes. In males, physical stress as a trigger event is more frequent and CK significantly higher. In females, the QTc interval on admission is longer.