Abstract 15886: Tako-Tsubo Cardiomyopathy is Not a Benign Disease: Results of the German Tako-Tsubo Registry
Aims: Tako-Tsubo cardiomyopathy (TTC) is regarded a benign disease since left ventricular (LV) function returns to normal within a short period of time. However, severe complications have been reported in selected patients. This study evaluated the frequency, severity and outcome of complications occurring in a large TTC registry.
Methods and Results: From 37 hospitals, 324 pts (296 female, age 68±12 years) were included in the registry according to established criteria. Complete data on complications were available in the last 209 pts but information on selected complications was present in a larger patient number. Overall, complications developed in 108/209 pts (52%); 51 of these pts (24%) had >1 and 23 (11%) >2 complications. Complications occurred 1 [IQR 1-3] day after symptom onset; 77% were seen within 3 days but 23% developed later (from day 4 to 56). Pts with complications were older (70±13 vs. 67±10 years, p=0.01), complained less frequently about chest pain (61% vs. 78%, p=0.01), had a higher heart rate on admission (91±26 vs. 83±19, p=0.03), more frequently Q waves (36% vs. 21%, p=0.04), and a lower LV ejection fraction (47±15 vs. 54±14%, p=0.002) than pts without. Arrhythmias were documented in 45/209 patients (22%) including atrial fibrillation in 32 (15%) and ventricular tachycardia in 17 patients (8%). Of 8 patients (4%) resuscitated up to day 4 after admission, 6 survived and 1 received an ICD. Additional complications were right ventricular involvement (18%), pulmonary edema (13%), cardiogenic shock (7%), transient intraventricular pressure gradients (4%), LV thrombi (3%) and stroke (1%). During hospitalisation, 7/324 pts (2.2%) died (multiorgan failure n=2, cardiogenic shock, myocardial rupture, stroke, asystole or sepsis n=1, respectively). In a multivariate regression analysis Q-waves on the admission ECG [OR 2.49 (95% CI 1.23-5.05), p=0.02] and ejection fraction ≤30% [OR 4.03 (95% CI 1.04-15.67), p=0.02] independently predicted a complicated clinical course.
Conclusion: TTC is not a benign disease since it may be associated with severe complications in half of the patients including cardiogenic shock, disabling stroke, and death. The majority of complications occur up to day 3 and monitoring is advisable for this time period.
- © 2011 by American Heart Association, Inc.