Abstract 10031: Prevalence of Migraine, Raynaud’s Phenomenon, and Hormonal Characteristics of Women with Takotsubo Cardiomyopathy (Apical Ballooning Syndrome)

Abstract

Background: Takotsubo cardiomyopathy (TTC) is a unique cardiomyopathy that is often triggered by stress and occurs predominantly in postmenopausal women. The precise etiology is unknown, but coronary vascular dysfunction and the estrogen deficient environment of menopause are thought to be important factors. Our hypotheses were that TTC may be associated with other conditions that are also characterized by female predominance, triggers and vascular dysfunction; and that hormonal characteristics may differ between women with TTC and controls.

Methods: A case control study was conducted by reviewing the entire medical record of 25 consecutive Olmsted County residents presenting with TTC, compared to 2 age- and gender-matched control groups: 25 patients presenting with ST-elevation myocardial infarction, (STEMI controls), matched for index TTC event date and 50 local residents with neither diagnosis, seen at our institution within 5 years of TTC event date (population controls).

Results: All cases were women. Eleven (44%) cases had a migraine history vs. 4 (16%) STEMI controls, OR 4.6 (CI 1.2-20.8, p= 0.03), and 6 (12%) pop. controls, OR 6.5 (CI 2.0-23.6, p=0.003). Four (16%) cases were diagnosed with Raynaud’s phenomenon, vs. none of the STEMI controls, and 1(2%), of the pop. controls, OR 12.2 (CI 1.5-264, p=0.04). There was no difference in the hormonal characteristics, i.e. pregnancies, menopausal status, years of menopause or use of hormonal replacement therapy between the groups.

Conclusions: The premorbid prevalence of migraine and Raynaud’s phenomenon is significantly higher in patients with TTC compared to controls. The coexistence of these 3 entities supports the role for vasomotor dysfunction in the pathogenesis of TTC, and suggests that the impairment in blood flow regulation may be a generalized phenomenon. The absence of a difference in hormonal profile suggests that estrogen deficiency alone is not the major determinant of the pathophysiology.